You will be asked to consider the technique you would use, whether the ECG findings are important and the significance of ischaemic heart disease with respect to the conduct of anaesthesia. Usual day case criteria must be applied – ask about other features in the history (e.g. angina at rest? crescendo pattern? which would make the procedure undesirable). In the absence of any other factors, choose a cautious GA technique – propofol, opioid and volatile with a field block. Watch monitors for adverse events and avoid hypotension. In reality, there will be patients such as this served up every day across the country and basic principles of good anaesthetic practice apply (e.g. preoxygenation). This scenario often leads into a critical arrhythmia on table.

CRITICAL INCIDENT – ARRHYTHMIA

You notice occasional ventricular extra systoles which rapidly progress to 1 in 4 beats.