A 69-year-old, 50 kg woman with pelvic pain is admitted for laparoscopic carbon dioxide laser lysis of pelvic adhesions. Her past history is significant for hypertension and hyperlipidemia. The clinical exam is unremarkable, and although there are no cardiac symptoms, a preoperative ECG shows a left anterior fascicular block. Her medication includes hydrochlorothiazide, triamterene, and gemfibrozil. She is not allergic to any medication. She is sedated with midazolam 2 mg IV and taken to the operating room. Thereafter monitors are placed, and she has a successful induction of general endotracheal anesthesia. She is maintained with desflurane/fentanyl/oxygen/air mixture. Vecuronium is used for muscle relaxation. During the operation the patient receives a total of 2100 ml of crystalloid fluid IV over the 185 min procedure (1000 mL Lactate Ringer’s solution before the procedure started, 1000 mL 0.9% saline during the first 90 min and 100 ml 0.9% saline during the final 95 min). The surgeon infuses a lactated Ringer’s solution through the laparoscope to wash away blood and debris and thereby improve visualization.
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