A previously healthy 26-year-old man sustains massive soft tissue injury in a motor vehicle accident. He appears to be well for 48 hours after initial resuscitation, then develops marked tachypnea. Arterial blood gas analysis would be most likely to show which of the following values? (pH, PaCO2, PaO2, FiO2)
(A) 7.53 60 75 .21
(B) 7.12 25 110 .30
(C) 7.09 60 90 .40
(D) 7.53 25 55 .80
(E) 7.28 40 195 .80
D
A 50-year-old patient is undergoing middle ear exploration with isoflurane, nitrous oxide, and oxygen anesthesia. Ventilation is controlled; PetC02 is 35 mmHg, heart rate is 90 bpm, and blood pressure is 120/70 mmHg. Assistance is needed to minimize bleeding in the surgical field. Which of the following is the most appropriate next step in management?
(A) Addition of 5 cmH20 positive end-expiratory pressure
(B) Changing the anesthetic agent to halothane
(C) Hyperventilation to a PetC02 of 20 mmHg
(D) Placing the patient in reverse Trendelenburg position
(E) Titration of nitroprusside to a mean arterial pressure of 55 mmHg
D
A patient suddenly makes a respiratory effort during craniotomy for clipping of a cerebral aneurysm in a 15-degree head-up position with controlled ventilation. The most likely cause is
A 55-kg, 70-year-old woman with mild chronic renal failure is unresponsive 20 hours after an uneventful coronary artery bypass grafting procedure. Anesthetic drugs included fentanyl 3000 mcg, diazepam 35 mg, and pancuronium 20 mg. Which of the following is the most appropriate next step in management?