A 35-year-old man has acute onset of low back pain, lower extremity weakness, and bladder dysfunction. He had a lumbar laminectomy two years ago. A myelogram shows disk herniation at L4-5. The most appropriate management is
(A) bed rest
(B) administration of a nonsteroidal anti-inflammatory agent
Which of the following statements concerning the choice of nitroprusside or nitroglycerin to induce deliberate hypotension is true?
(A) Nitroglycerin is more potent
(B) Nitroglycerin produces hypotension by acting on both arterial and venous capacitance vessels
(C) Nitroprusside produces less rebound hypertension on discontinuation
(D) The toxic effects of nitroprusside are independent of dose
(E) The therapeutic effects of nitroprusside may persist on discontinuation
B
A 62-year-old patient undergoes resection of a descending thoracic aneurysm under anesthesia with morphine, nitrous oxide, oxygen, and pancuronium. In spite of normal somatosensory evoked potentials (SSEP) during the procedure, the patient has paraplegia postoperatively. The factor most likely responsible for failure to note the deficit intraoperatively is
(A) the effect of nitrous oxide on SSEP
(B) the effect of morphine on SSEP
(C) failure to test motor pathways
(D) hyperventilation to a PaC02 of 30 mmHg
(E) unintentional hypothermia to 34°C
C
A 57-year-old man has back pain, a heart rate of 90 bpm, decreased pulse in the left arm, and blood pressure of 200/110 mmHg. During infusion of nitroprusside, heart rate increases to 115 bpm and blood pressure decreases to 140/80 mmHg. The most appropriate management at this time is administration of