Anesthesia for complex spine surgery requires invasive monitoring, large-bore intravenous access, and awareness of the potential for disaster. Anesthesiologists involved in the care of patients undergoing complicated spine surgery should be cognitive of this infrequent but serious complication. This chapter presents a case study of a 75-year-old female who was scheduled for removal of instrumentation at L4-S1 and re-exploration of a previous posterior lumbar inter-body fusion. The intraoperative course was also complicated by significant coagulopathy from massive blood loss and transfusion. The postoperative course was complicated by nonoliguric renal failure, pneumonia, and urinary tract infection. The role of central venous monitoring is always debated in the context of major spine surgery. However, central venous pressure readings in the prone position may not reflect accurate data and large bore intravascular access and invasive blood pressure monitoring are probably more important in the hemodynamic management of these cases.