Big people on OR table

I showed up today in the hospital looking forward to a fun day. My first patient is a pleasant 64 years old guy with severe shoulder arthritis. He is going for a total shoulder reconstraction. He's got pretty usual array of medical problems: high blood pressure, smoking (although he quit 3 years ago), enlarged prostate, that he had unenetfull surgery for, and last but not least - he is 340lb. And this is his (and now mine)real problem. We have to get him through this pretty extensive surgery. Fat people do present a real problem for anesthesiologists. They may have tons of hidden, underline medical conditions, such as heart disease, high blood pressure, sleep apnea, diabetis, etc. Specifically related to anesthesia, they may have, what we call, a difficult airway, - a situation where putting a breathing tube may be difficult or even impossible and sometimes will require additional instruments and techniques. I thought, my guy would definitly benefit from the nerve block - a technique where i would inject a nubming medicine near a bundle of nerves and his shoulder would be.. well, numb for 12-18 hours. That way, we may avoid General Anesthesia altogether, or at least he will require a significantly less amount of it, plus, after he wakes up, he will not feel any pain for long time and therefore will have no needs for strong pain medicine (narcotics) with serious side effects, especially in overwieght patients.
And that's what I did. The block went great, although took some time because it was difficult to identify the landmarks on his heavy, many times folded neck. And then I did put him to sleep - not a very fast surgeon, sitting position for surgery, i thought it would be easier to take care of his airways (put a breathing tube)while i still had access to him, before the surgery had started rather then struggle under the drapes, if urgent situation developes.
I had to delay the surgery again, since i did not have a full information on his heart status. He had claimed that he did have a stress test done - a test that evaluates heart functional status in patients with high risks factors (being fat, history of smoking), but we didn't get any information on that from his primary doctors office, so we waited for them to fax it to us - could've been avoided through our algorithm - www.surgeytomorrow.com