In children with preoperative upper respiratory tract infection, which of the following is associated with the greatest risk for postoperative airway obstruction?
A 3.3-kg neonate is brought to the operating room for repair of a left diaphragmatic hernia. A 3-mm endotracheal tube is placed to a depth of 9 cm. Initial arterial blood gas values from a right radial catheter while spontaneously breathing oxygen 50% are PaO2 82 mmHg, PaCO2 41 mmHg, pH 7.33, and base excess -5. After reduction of the hernia (during closure of the abdomen), vigorous attempts to expand the atelectatic lung are unsuccessful. The infant rapidly becomes very dusky, heart rate is 60 bpm, breath sounds are distant and squeaky bilaterally, and pulmonary compliance is decreased. Which of the following should be done first?
(A) Obtain a radiograph of the chest
(B) Place a chest tube on the left side
(C) Place a chest tube on the right side
(D) Withdraw the endotracheal tube 1 cm and suction
A 70-kg 24-year-old man with bilateral pneumonia whose lungs are being mechanically ventilated has the following measured parameters: tidal volume 750 ml; FiO2 0.7; rate 12/min; positive end-expiratory pressure 10 cmH2O; PaO2 75 mmHg; PaCO2 55 mmHg; pH 7.30. Which of the following alterations should be made in the ventilatory settings?
Following the administration of 4 MAC hours of enflurane, peak serum concentrations of inorganic fluoride are highest in patients who
(A) are physically dependent on barbiturates
(B) are taking isoniazid chronically to suppress tuberculosis
(C) are epileptics taking phenytoin chronically
(D) are obese
(E) consume alcohol regularly
B
Following induction of general anesthesia, mask ventilation and the initial attempt at intubation is unsuccessful. Which of the following procedures is most appropriate?