A 68-year-old female, 231 lb. and 5’1” tall, with a history of hypertension, diabetes mellitus, and large joint chronic arthritis, is scheduled for a laparoscopic cholecystectomy. The patient is noncompliant with her medication: atenolol and glyburide. On the morning of the surgery, the patient’s blood pressure was 145/86 mm Hg, heart rate (HR) 88, respiratory rate (RR) 20, oxygen saturation 97% on room air, and temperature 36.8 °C. Her blood glucose was 186 mg/dL. Physical examination revealed no abnormalities, and the airway was assessed as a Mallampati class II. After a smooth induction of general anesthesia with midazolam, fentanyl, propofol, and rocuronium, a #7.0 endotracheal tube was placed atraumatically. Anesthesia was maintained with mechanical ventilation, isoflurane, oxygen, air, fentanyl boluses, and rocuronium. About 30 minutes after the incision, the patient’s HR increased to 112 beats/min and her blood pressure became 184/99 mm Hg. The anesthesiologist also noticed a depression of the ST segment in the monitored V5 cardiac lead.