69 yr old male with known CAD with PTCA done 2yrs back on 2 vessels with 2 D ECHO report EF of 32% and RWMA in LAD territory is on dual anti platelets is being posted for DHS for IT fracture, what is the plan of anaesthesia

Preoperative Considerations:

Patient Factors

1.  old age
2. compromised cardiac status
3. antiplatelet therapy

Surgical Risk Factors

1. Blood Loss
2. Duration of surgery
3. Urgency of surgery

Anaesthetic risk factors

1. Type of anaesthesia GA v RA
2. Reduced reserves in view of age and Reduced EF
3. Blood Loss
4. Pain management

Preoperative management

1. Labs to be sent ...complete blood counts, serum creatinine, Prothrombin time
2. Cardiological  optimisation 
3. Blood products to be kept in hand..PRBC,FFP
4. High Risk Consent to be obtained of any preoperative cardiac event and post op ICU care
5. Emergency of Surgery to be explained 

Intraoperative Management

1. Standard Monitoring and invasive arterial blood pressure monitoring
2. Two broad gauge cannula
3. Good pre oxygenation
4. Slow low dose graded induction 
5. Tracheal intubation and mechanical ventilation
6. All regional and local anaesthesia to be avoided
7. Strict and meticulous fluid replacement more with colloids and blood products if loss is apparent
8. Good Analgesia with multimodal approach

Post Operative Care

1. to continue mechanical ventilation until patient is stabilised
2. intensive monitoring 
3. Good pain control