So here comes the story: You are the anesthesiologist at the surgicenter, at the end of the day the nurse brings you a chart for review. It belongs to a 79 Y/O lady who is coming for sinus surgery in 2 days, she will require GA. Her medical history from what you see in the chart is the following: 1- Ischemic cardiomyopathy with EF of 20 % (echo done last month). 2- History of Mitral valve and aortic valve replacement 2 years ago, on Coumadin that she has stopped 2 days ago and a pt + INR will be done tomorrow. 3- AICD placed after valve replacement and last year it shocked her 15 times for V tach during a 2 days period but no shocks since. Device working fine according to cardiologist. 4- COPD 5- DM type II She has a note from a cardiologist saying she is "cleared" for surgery and that she is moderate risk. EKG shows ventricular pacing. Labs show Elevated AST and ALT in the 200-300 range. Nurse is asking you if the patient is OK for surgery. This is a free standing ASC where you will be the only anesthesiologist with 3 CRNA's. What's the plan??