Operation:
- The patient was transported to the
operating room and after monitors were placed,
the patient experienced a smooth intravenous
induction of sleep with fentanyl and thiopental.
- Placement of a left-sided doubled lumen
endotracheal tube was facilitated with the use of
succinylcholine. The patient was positioned and
the doubled lumen endotracheal tube placement was
documented with bronchoscopy.
- Anesthesia was maintained with
isoflurane, 50% oxygen and nitrous oxide.
- Neuromuscular paralysis was maintained
with vecuronium
- Skin incision was made and thoracotomy
was achieved.
- The operative lung was deflated without
difficulty
- Anesthesia was maintained with 1-1.5%
isoflurane and a varied oxygen and nitrous oxide
to maintain arterial oxygen saturations > 92%.
- Forty-five minutes into the procedure the
patient's anesthetic requirements began to
increase, BP 155/90 and heart rate 85 bpm,
requiring 2% isoflurane. It was suspected that
the initial epidural dose was receding. An
epidural infusion of 0.125% bupivacaine with 3 mg
of morphine per 60 ml was begun after an initial
3 ml bolus. Within twenty minutes of the
bupivacaine bolus, the blood pressure had fallen
to 120/60 and heart rate decrease to 65 bpm
without a significant change in surgical
stimulus.
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