A 92-year-old man presented with iron-deficiency anemia. Upon evaluation, guaiac-positive stools were found and follow-up colonoscopy revealed an invasive adenocarcinoma of the cecum. He was scheduled for a laparoscopic right hemicolectomy. Preoperative stress echocardiogram revealed no significant cardiac dysfunction. Immediately before surgery, sequential compression devices were placed on his legs to reduce the risk for venous thromboembolic disease. Following his uncomplicated operation, pulse oximetry showed oxygen desaturation requiring supplemental oxygen. The patient developed paroxysmal tachycardia on the third postoperative day. He had no chest pain or mental status alteration. On physical examination, his pulse was 130/min and irregularly irregular, blood pressure was 126/59 mm Hg, and breath sounds were diminished in bibasilar lung fields. The abdomen was soft and laparoscopy port sites were clean and free of erythema, blood, or exudate. A bedside 12-lead electrocardiogram showed atrial fibrillation with rapid ventricular response and no ST-segment elevation. Portable chest x-ray showed pulmonary edema. Laboratory values are shown in the Table.
Wagner JP, Hiatt JR. B-Type Natriuretic Peptide for the Evaluation of Volume Status in Elderly Postoperative Patients. JAMA. 2014;311(19):2017-2018. doi:10.1001/jama.2013.7300