Aborted takeoff

Any landing you walk away from is a good one. – anonymous pilot wisdom The case A 12-year-old white female with idiopathic scoliosis, but an 85° curve, comes to the operating room (OR) for anterior-posterior (AP) spinal fusion. She is obese, weighing 100 kg at 5 feet 1 inch, but was thought to be otherwise healthy. She had limited exercise ability due to back pain but was reportedly able to swim six laps without difficulty. She had donated three autologous units and came to the OR with a hematocrit of 34%. Her other preoperative laboratory values were normal. The electrocardiogram (ECG) showed inverted T-waves in leads III and AVF. Preoperative vital signs were as follows: blood pressure 138/74, P 118, R20, and SaO₂98% on room air. She reported being nil per os (NPO) since 10 o'clock the night before surgery. The airway exam was consistent with a Mallampati I classification, the lungs were clear, and the heart sounds were normal. A peripheral IV was started and monitors were placed. Induction of anesthesia was achieved with midazolam 5 mg, fentanyl 250 mcg, lidocaine 40 mg, and propofol 100 mg, and after mask ventilation was assured, pancuronium 6 mg was given. Isoflurane of approximately 1% was administered while neuromuscular blockade was established. The patient was nasally intubated with a full, grade I view of the vocal cords. No end-tidal CO₂was returned and ventilation was difficult, so the patient was extubated and reintubated with the same results.