A 27-Year-Old Man Is Brought to the Emergency Department with an Anterior

question 108

Multiple Choice

A 27-year-old man is brought to the emergency department with an anterior abdominal stab injury sustained in a street fight.  He has a history of alcohol and polysubstance abuse.  Imaging reveals free air under the diaphragm.  The patient undergoes urgent exploratory laparotomy.  General anesthesia is achieved with an inhalation anesthetic agent, muscle relaxant, and opioid, and ventilation is mechanically controlled.  Intraoperatively, he also receives intravenous fluids and packed red blood cell transfusion.  Anesthesia is terminated after successful repair of the liver and small intestinal lacerations.  Prior to the transfer to the recovery unit, the patient is breathing spontaneously.  Blood pressure is 160/90 mm Hg, pulse is 130/min, and respirations are 9/min.  An hour later, blood pressure is 110/60 mm Hg, pulse is 70/min, and respirations are 7/min.  Arterial blood gas analysis shows pH 7.30, pCO₂ 50 mm Hg, and pO₂ 70 mm Hg.  Which of the following best explains this patient's postoperative findings?

• A)Acute cardiogenic pulmonary edema
• B)Anesthesia-induced hypermetabolic state
• C)Delayed emergence from anesthesia
• D)Ongoing intraabdominal hemorrhage
• E)Postextubation laryngeal edema

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