Case 59: A New Onset of Atrial Fibrillation in the Recovery Room
You have anesthetized a 68-year-old female (62 kg, 5 ft 8 in.) for an inguinal hernia repair. Her past history was significant for a 30-year smoking history, hypertension, noninsulin-dependent diabetes mellitus, and hyperlipidemia. There had been no past history of cardiac arrhythmias. The preoperative EKG was normal. The patient and her daughter were very nervous about the general anesthetic, but the patient refused a monitored anesthetic care plan (IV sedation and the liberal use of local anesthetic by the surgeon). The patient has never had a general anesthetic or surgical procedure before. After placing the IV in her left hand, you sedate her with midazolam up to 4 mg. The general anesthetic with an LMA was uneventful. The operation lasted for 70 min and she was given 2 L of IV crystalloids. Her vital signs remained stable throughout. The urine output was not measured and the blood loss was less than 100 mL.