As the patient stabilizes and the hemodynamics improve, other anesthetic agents can be carefully titrated to prevent hypotension, as follows:

• Sedatives or amnestics should be added to the anesthetic as soon as tolerated. Start with small doses and check the response between doses.

• Opioids should be titrated to control the hemodynamic response to surgery.

• Nitrous oxide is best avoided since it can accumulate in closed airspaces and expand an occult pneumothorax which is very likely in this patient.

• Inhalational anesthetics can be used in low concentrations if the patient's hemodynamics are not compromised.