A 66 year-old woman is scheduled to undergo an exploratory laparotomy. She is suspected to the suffered a posterior rupture of a duodenal ulcer with resulting pancreatitis.

She has a history of coronary artery disease and is currently orthopneic and dyspneic on exertion

She has received morphine in the past for chest pain, with resulting nausea and vomiting.

case author: Hugh S. Mathewson, M.D., Professor Emeritus, School of Allied Health, Department of Nurse Anesthesia, University of Kansas Medical Center
case editor: Michael Gordon, Ph.D.