LAUSR

A 68-year-old male of the American Society of Anesthesiologists (ASA) physical status I, presented with biopsy-proven moderately differentiated squamous cell carcinoma of the penis and lower urinary tract symptoms. After complete metastatic workup, he was scheduled to undergo total penectomy with bilateral inguinal lymph node dissection and transrectal ultrasound-guided biopsy of the prostate. He was reviewed by an anaesthesia resident the night before surgery and informed consent was taken. In the preoperative holding area, he was found to be slow to react to verbal commands but was conscious and oriented. There were no focal neurological deficits and his haemodynamic status was acceptable, apart from some dehydration. Preoperative investigations were reviewed again and were found to be acceptable. It was decided to go ahead with the surgery under epidural anaesthesia. Two wide bore peripheral lines were inserted for correction of dehydration and standard ASA monitors were attached. A venous blood sample was sent for blood gas analysis that revealed ionised calcium level of 2.1 mmol.l-1 and serum lactate of 2.9 mmol‧l-1. Venous blood samples were sent to the laboratory for investigations like a complete haemogram, serum electrolytes including sodium, potassium, calcium, magnesium and inorganic phosphate, serum albumin and serum urea and creatinine. The total serum calcium was found to be 18.4 mg/dl intraoperatively.