![]() ![]() When the operation concluded, she remained intubated and mechanically ventilated and was transferred to the surgical intensive care unit. Desaturation was initially attributed to an unobserved aspiration. An arterial blood gas in the operating room later revealed p H of 7.25, carbon dioxide partial pressure of 55, oxygen partial pressure of 83, and HCO 3of 25 on 1.0 fraction of inspired oxygen, and positive end-expiratory pressure of 10 cm H 2O. She also was noted to have high peak airway pressures (> 40 cm H 2O), a low end-tidal carbon dioxide level (approximately 22 mmHg), and Sp O 2around 95%. Prompt intubation, ventilation with oxygen at a fraction of inspired oxygen of 1.0 atm, and confirmation of tube placement, both by auscultation as well as by positive end-tidal carbon dioxide, did not succeed in restoring her Sp O 2to the preanesthesia level. Her systolic blood pressure also decreased to 90 mmHg from a preanesthesia value of 130/70 mmHg. ![]() After injection of induction agents but before insertion of an endotracheal tube, the pulse oximeter reported a near instantaneous decrease from 100% to approximately 75% (despite the administration of 100% oxygen). The medications included thiopental and succinylcholine. General anesthesia was induced using a rapid-sequence technique. The sequential device was turned on just before the induction of anesthesia with inflation pressures around 45 mmHg. A sequential compression device with long sleeves (Sequel model 6325 Kendall Company, Mansfield, MA) was applied to both legs as part of routine practice for any surgery lasting over 3 h. After fluid resuscitation and administration of antibiotics, the patient was taken to the operating room, where her initial vital signs and oxygen saturation (Sp O 2) were within normal limits. ![]()
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