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70ym has stable c spine fracture (don’t remember the details but neurosurgery wants in Miami J at all times and to revisit outpatient in a few months kind of thing). Presents with cardiogenic shock from critical Aortic stenosis. On low dose NE, BP 90/60s but not intubated. Let’s say cardiologists wants to do a TAVR, your choice as to general vs MAC.
Would you do general upfront (AFOI) or do MAC? If MAC, how worried would you be to emergently intubate someone with a high risk procedure and possible difficult airway? And related, what are your risk/benefit for MAC sedation cases in patients with known difficult airways? Would you just intubate them ahead of time instead?
For this case I planned towards general given his shock state already.
This is a semi hypothetical case. No right answers. Just wanna see thoughts from everyone.
Would you do general upfront (AFOI) or do MAC? If MAC, how worried would you be to emergently intubate someone with a high risk procedure and possible difficult airway? And related, what are your risk/benefit for MAC sedation cases in patients with known difficult airways? Would you just intubate them ahead of time instead?
For this case I planned towards general given his shock state already.
This is a semi hypothetical case. No right answers. Just wanna see thoughts from everyone.