A patient undergoing laparoscopic colon resection is noted to have decreased urine output during the last hour of the case. A bolus is given at the end of the case. One hour later, there is still very poor urine output. The appropriate treatment is:
A. Repeat bolusLow urine output is a normal physiologic response to increased intra-abdominal pressure for up to 1 hour after surgery. Although the effect of the pneumoperitoneum on renal blood flow are immediately reversible, the hormonally mediated changes such as elevated antidiuretic hormone levels decrease urine output for up to 1 hour after the procedure has ended. Intraoperative oliguria is common during laparoscopy, but the urine output is not a reflection of intravascular status; intravenous (IV) fluid administration during an uncomplicated laparoscopic procedure should not be linked to urine output.