A 68-year-old businessman was scheduled for laparoscopiccholecystectomy under general anesthesia. He had history of coronaryartery disease and rheumatic heart disease with moderate mitralregurgitation. Preoperative cardiac evaluation showed ejection fractionof 40%. In consideration of anesthnetic care, which one is leastappropriate?
(A) Pre-operative preload augmentation
(B) Nitroglycerin can be chosen to correct the reduction of cardiac outputsecondary to an increase of systemic vascular resistance.
(C) Increased afterload is a major contributor to the altered hemodynamics seenduring pneumoperitoneum
(D) Normalization of hemodynamic is immediate soon after operation wascompleted
(E) Accentuated vagal stimulation should be considered in patient takingβ-blockers.