Patient Male, 55 yr old and diagnosed with RHD: MS, MR, AS, AR was to undergo DVR. The history presented no coexisting disorder to increase anesthetic risk. He came into the OR at 8 a.m. with the following ABG:
pH - 7.40
pCO2 - 37 mm Hg
pO2 - 55 mm Hg
Na - 135 mmol/l
K - 4.4 mmol/l
Ca - 1.12 mmol/l
Glu - 6 mmol/l
Lac - 0.8 mmol/l
Hct - 46%
SpO2 - 80%
The SpO2 was increased to 92% by Bag-mask ventilation. Then general anesthesia was induced with fentanyl, vecuronium, midazolam. After intubation, the SpO2 increased to 100%. Maintenance was done with propofol and sevoflurane (inhaled). At 9:10 a.m. the CVP was recorded as 24 mmHg (i.e. markedly increased). What happened? |