Elderly High-Risk Patient for Emergency Hernia Repair

You are the anaesthetist for the emergency theatre at a tertiary hospital. The surgeons have booked an 81-year-old male patient for repair of an incarcerated upper abdominal incisional hernia. You review him in the Emergency department. 81-year-old male Examination: On 2L/min oxygen, tachypnoeic Pulse rate 120 bpm BP 105/65 Past medical history: - CABG / MVR (St Jude mechanical valve) 2002 - Chronic obstructive pulmonary disease with bullous disease - home oxygen 18 hours per day - Bowel cancer - laparotomy 2018 Medications: - metoprolol 50 mg daily - digoxin 62.5 microg daily - irbesartan / hydrochlorothiazide (150/12.5mg) daily - warfarin 5mg daily (INR target 2.5-3.5) - tiotropium 2.5microg daily (Spiriva) - fluticasone / salmeterol (250/25microg) 2 puffs twice daily (Seretide) - salbutamol inhaler prn