Clinical Quiz

Thought I would add an experience that happened to me recently; after reading the "ventilate-or-not induction sequence" thread a few pages back. I enjoy reading other's experiences, and hope this one may offer some insight for future practice:

Did a machine check before my first case; thought the absorber was a bit dusky, so asked a technician to change it as I went to go see my patient. I returned a bit later to the room, saw the absorber was changed, did a pressure check on my circuit to ensure there were no leaks, and a few minutes later wheeled my patient into the room. Patient was 1 ppd X 40 years smoker; used bronchodilators prn but not for the past year or so. Big history GERD; RSI. Induction time, sux in, well ventilated, sat never drops below 100. Uncomplicated intubation with open cords. Cuff up......can't ventilate. No breath sounds. ET CO2 immediately 30 plus or so, and stayed there or higher. Trying to ventilate....making a little headway, bag is tight, airway pressures in the 50's and 60's trying to get a breath in. Thinking about the smoking....patient must be bronchospastic. Bronchodilators, Zantac, Benadryl, and epi....(patient concurrently showing signs of anaphylactoid reaction....marked rash, mild response to epi; was vasodilated). Slightly better ventilation, according to MD; CRNA notices the same improvement (now with ambu) on way to PACU, where patient is extubated after a while....lungs clear bilaterally on arrival in PACU, clean emergence and extubation. Sat never dropped below 100; ETCO2 in 30's. Anyone want to hazard a guess at the cause of the problem? I'll tell y'all in a little bit....:)