26yo female, impacted wisdom teeth. Multiple reviews by consultant anaesthetists over 18 month period. Multiple delays secondary to undiagnosed/optimised OSA, asthma, then COVID.

Background

• Brittle asthma – ICU 2021
• OSA now on CPAP
• BMI 63
• Under public guardianship, ASD, appropriate during consultation

Issues

• Suitable to proceed to surgery?
• Level of postoperative care?

Discussion

• BMI unlikely to be optimisable in the short term
• Delays to surgery may lead to a need for emergency procedure due to periodontal infection
• Unlikely to be able to tolerate procedure under LA and may lead to challenge ++ to convert to GA mid-procedure
• Asthma now stable. Unlikely to suffer intraoperative asthma exacerbation
• ICU level 3 seems appropropriate given minor, short procedure with low likelihood of complications, despite poor baseline health

Plan

• Proceed to surgery
• ICU level 3
• GA