Emergency Laparotomy in Elderly Smoker

You are the on-call consultant anaesthetist at a small regional hospital. At 09:00 hours on a Saturday morning you receive a call from the surgical registrar regarding a 69-year-old man who presented to the emergency department with a 24-hour history of worsening abdominal pain. An erect chest X-ray demonstrates free gas under the diaphragm. The surgical registrar would like to bring the patient to theatre for a laparotomy. Past medical history Current smoker – 50 pack-years Ischaemic heart disease – non-obstructive, medical management Abdominal aortic aneurysm – 4 cm diameter, currently under surveillance Medications Aspirin 100 mg daily Atenolol 50 mg daily Ibuprofen 400 mg tds PRN Perindopril 5 mg daily Rosuvastatin 20 mg daily Height 175 cm Weight 80 kg BMI 26.1 kg/m2 (ideal body weight 70 kg)