After having this case handed to me in my lap I did a couple of things
1. I called and spoke with his cardiologist. I know the guy well from all my ICU interactions with him and he always know his patients well. The question i really wanted answered was whether he had any plans for further workup, ie pending date for cath, stress, Cardiac surgical consultation etc. He stated he did not, and he felt the guy was well compensated from his AS and that his most recent echo showed an improvement in the LVOT obstruction, ie better medical management. The wheezing was his COPD, which the family stated was his normal. RA SaO2 was 97% and despite the noise he actually was moving good air
2. I spoke with the surgeon, gave him a little crap for not doing a better job getting a H&P and then having his cardiologist to see him before the surgery and then told him it was Local with a "real" MAC.
(The mass as it turns out was not invading below the dermis)
3. Informed the CRNA who only does outpt anesthesia, she then went and relieved herself
well not really, but she was nervous. To the room, 2 of versed, 50 fent, 30 of propfol with 100mcg of phenylephrine for the injection. The patient was ok with being awake after that.
I posted this case mainly thinking of how complicated his medical history was but how simple this case actually was. As dhb eluded, stop mentally masturbating and do the case already. Regarding the preop "clearance" I only wanted to talk with the cardiologist as a CYA maneuver. If things did go wrong i wanted to know that he wasnt scheduled for an AVR and myomectomy next week.