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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