59 year-old, 76 (kg) female in for j-tube revision. Medical history includes, malabsorption syndrome, GERD, chronic pain issues, and HTN. Surgical history, gastric bypass (1993), CTR, bilateral femur fracture (idiopathic osteoporosis), j-tube placement, and exp laparotomy. Labs, electrolytes WNL, Hgb 9.2, Hct 32.

Induction was uneventful but not long after incision it was evident the case would not be straight forward. She had extensive adhesions and difficult anatomy d/t over 250# weight loss. The case lasted 7 hours including, j-tube replacement, extensive LOA, and small bowel resection. In addition, the previous surgery caused him problems but not sure what all issues he incurred as I was more focused on the patient.

Anyway, I thought it would be a good exercise to discuss fluid management for this patient. Large open longitudinal incision, EBL ~300-350 ml, npo for 10 hours. Easy calculation for students and I will provide additional labs and hemodynamic values obtained during the case.

What fluids should be used, why, amount, labs needed, and any other concerns one might have during this case.

Not a terribly interesting case but a "simple" j-tube revision ended up being a significant surgery for the patient along with additional PIV's, A-line, blood transfusion, etc.