Elderly Dementia Patient for Skin Cancer Excision

You are the anaesthetist in the pre-assessment clinic of a day surgery hospital. You are reviewing an 86-year-old man who has been booked for a wide local excision of a left temple squamous cell carcinoma (SCC) and rotational flap under local anaesthetic and sedation. Medical History Dementia (moderate) – lives in hostel Atrial fibrillation (stable) Hypertension (stable) Medications Dabigatran 110 mg twice daily Diltiazem 180 mg mane He has been brought to the clinic by his son, his enduring guardian, who is very concerned about the possibility for conversion to a general anaesthetic. The patient had a general anaesthetic for removal of an SCC on his leg last year and experienced postoperative delirium requiring a three-day hospital stay. His observations and results of blood tests are included below. Weight 65 kg Body mass index 23 kg/m2 Heart rate 75 beats per minute Blood pressure 140/80 mmHg Respiratory rate 15 breaths per minute SpO2 97% on room air Haemoglobin 120 g/L (115-160) White cell count 7.0 x10^9/L (4.0-11.0) Platelet count 300 x10^9/L (150-400) Sodium 136 mmol/L (135-145) Potassium 3.5 mmol/L (3.5-5.2) Urea 4.0 mmol/L (3.0-8.0) Creatinine 70 µmol/L (45-90)