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 patient with no acute bleeding has a preoperative platelet count of 40,000/mm3. Following preoperative transfusion of platelets 10 units, the predicted platelet count would be
Following maternal epidural injection, fetal exposure to chloroprocaine is lower than fetal exposure to bupivacaine for which of the following reasons?
(A) Chloroprocaine is metabolized by plasma cholinesterase
(B) Chloroprocaine is more protein bound
(C) Chloroprocaine is not readily absorbed from the epidural space
(D) The ionized fraction of chloroprocaine in the fetal circulation is smaller
(E) The pKa of chloroprocaine is less than that of bupivacaine