Elderly patient for iliofemoral endarterectomy for QoL limiting claudication

Background

• COPD – prev on home O2 post CAP, severe emphysema. SpO2 in clinic 89%, reduced to 84% with minor exertion
• PVD – claud 20-50m
• ETOH induced Cirrhosis, Grade 1 varices, bili 20, mildly decreased albumin, Plt 74
• TTE – normal
• Cardiac MIBI -ve

Issues

• Method of anaesthesia – procedure usually under SAB + GA due to need for muscle relaxation around surgical space. 
• Optimisation possible? – severe/critical COPD but recently stable 

Discussion

• Acceptable platelet range in this setting? Proceduralist dependent. Advantages to neuraxial technique. Normal coags and negative bleeding history would provide some reassurance.

Plan

• Check coags, FBC
• Flag to procedural anaesthetist
• Discuss with surgeons – how proximal into illiacs would procedure be? (i.e needing relaxation and therefore GA) given his severe COPD