Question

A 2-month-old, 4-kg infant with a nonrestrictive ventricular septal defect is brought to the OR for repair. Which of the following perioperative inter.ventions will most likely precipitate hypotension?

A. Pulmonary artery banding
B. Hypoventilation to an ETCO2 of 45
C. Decreasing the FiO2 to 21%
D. Inhalation induction with 8% sevofl urane
E. 50 mcg/kg of fentanyl prior to incision

Answer 1

The perioperative intervention that is most likely to precipitate hypotension in a 2-month-old, 4-kg infant with a nonrestrictive ventricular septal defect is inhalation induction with 8% sevofl urane.

Step-by-step explanation:

The perioperative intervention that is most likely to precipitate hypotension in a 2-month-old, 4-kg infant with a nonrestrictive ventricular septal defect is option D. Inhalation induction with 8% sevofl urane.

Sevoflurane is a volatile anesthetic that can cause vasodilation and decrease systemic vascular resistance, leading to hypotension. In an infant with a ventricular septal defect, there is already a shunting of blood from the right ventricle to the left ventricle, which can further decrease systemic vascular resistance and exacerbate hypotension.

Therefore, the use of sevoflurane in this patient population should be approached cautiously to prevent precipitating hypotension.