A 3-day-old infant is comatose 18 hours after surgical correction of transposition of the great vessels. Tracheal suctioning produces only a tachycardic response. Anesthesia included midazolam 0.5 mg/kg, fentanyl 60 mcg/kg, and pancuronium 0.3 mg/kg. Which of the following is the most appropriate first step in evaluation of this infant?
During a right lower lobe resection, SpO2 decreases from 99% to 70% after institution of one-lung ventilation. FiO2 is 1.0. The most appropriate management is to
(A) administer an inhaled bronchodilator
(B) apply continuous positive airway pressure to the right lung
(C) apply positive end-expiratory pressure to the left lung
A 45-kg, 80-year-old woman undergoes pin fixation of the right hip in the lateral decubitus position under spinal anesthesia. One day after the operation, she cannot move her left ankle or foot actively. The most likely cause is
A 62-year-old man with severe emphysema was treated for the sixth time with assisted mechanical ventilation (Fi02 0.6, peak inspiratory pressure 25 mmHg, rate 22/min, insp/exp 0.3). Arterial blood gas values with this therapy are Pa02 73 mmHg, PaC02 48 mmHg, and pH 7.32. During the second day of treatment he suddenly becomes dusky, with increased respiratory rate. Arterial blood gas values are Pa02 42 mmHg, PaC02 67 mmHg, and pH 7.25. Tracheal lavage and suction fail to improve his condition. The therapeutic measure most likely to correct this acute episode is to
(A) administer heparin
(B) increase Fi02
(C) paralyze him with pancuronium
(D) add positive end-expiratory pressure 5 to 10 cmH20
(E) insert a chest tube
E
During induction of general anesthesia in a patient with a supraglottic tumor, both intubation and subsequent ventilation via a face mask are impossible. A cricothyroidotomy is performed with a 16-gauge intravenous catheter. Which of the following statements is true?
(A) Application of pressures greater than 35 cmH2O to the catheter will increase the risk for pulmonary barotrauma
(B) PaC02 can be maintained at a normal level using a standard circle system attached to the catheter
(C) PaO2 greater than 100 mmHg can be maintained indefinitely using transtracheal jet ventilation with pure oxygen through the catheter
(D) Emergency surgical tracheostomy would have improved the likelihood of survival
(E) The presence of this tumor contraindicates jet ventilation via cricothyroidotomy