Acromegaly for Transsphenoidal Pituitary Resection

You are in working in the preadmission clinic, assessing a 40-year-old man who is booked for transsphenoidal resection of pituitary adenoma on your neurosurgical list next week. Medical history: Acromegaly Obstructive sleep apnoea Cardiomyopathy Hypertension Medications: Candesartan 16 mg mane, recently increased from 8 mg mane Frusemide 80 mg bd Metoprolol 47.5 mg bd Octreotide 40 mg monthly by intramuscular injection Cabergoline 1.5 mg weekly There are no known drug allergies. Vital signs: Height 185 cm Weight 125 kg BMI 36.5 kg/m2 HR 80 bpm BP 145/70 mmHg SpO2 96% on room air His only previous anaesthetic was for adenotonsillectomy as a child.