Preoperative Assessment of Mr. Smith, A 45 year old male with a 25 pack-year history of cigarette smoking is scheduled at 7:00 am for a lung resection to remove a malignant tumor under general anesthesia. He is 5’10”, 250 lbs (BMI of 35.9) and leads a sedentary lifestyle. His past medical history includes type 1 diabetes mellitus and chronic renal insufficiency. When he arrives in the preoperative unit two hours in advance, he states that his weight has remained constant over the last five years and that he has been NPO since 10pm last night. Baseline vital signs are assessed and his blood pressure is 148/90 mmHg. The anesthesia professional determines the patient to be ASA class III. The patient is taken to the OR as per the scheduled time.

What is your concern about this patient and why?