Weekly Case 3: Middle age man presents for liver resection for metastatic colon cancer after radiation therapy and chemotherapy. Past medical history includes no other significant cardiopulmonary disease. An epidural and arterial line are placed pre-operatively. Induction of anesthesia was performed uneventfully in the standard manner. The operation progresses uneventfully. Estimated blood loss is 300 cc. However, as the case progresses the patient develops slowly progressive hypotension requiring escalating doses of phenylephrine. By the end of the case, even on lower anesthetic doses, the patient requires greater than 100mcg/min of phenylephrine to maintain mean arterial pressure greater than 60mmHg. The blood pressure is unresponsive to 500cc IV fluid bolus. Hemoglobin is stable on ABG. A Focused Cardiac Ultrasound (FoCUS) exam was performed by the anesthesia team after the drapes were down, prior to emergence.