During laser microsurgery of the larynx, a rubber endotracheal tube wrapped with aluminum-foil tape starts to smolder and give off smoke. The first step is to
(A) suction the endotracheal tube
(B) add helium to the inspired gas mixture
(C) remove the endotracheal tube
(D) turn off the fresh gas flow
(E) pack a saline-soaked gauze sponge into the hypopharynx
C
A 65-year-old man undergoes prostatectomy in the lithotomy position under spinal anesthesia using bupivacaine 12 mg. Ten hours later, he reports that his left foot is numb. Examination shows decreased pinprick sensation over the lateral dorsal aspect of the left foot; dorsiflexion is limited. Which of the following is the most likely cause?
A 50-year-old patient is undergoing middle ear exploration with isoflurane, nitrous oxide, and oxygen anesthesia. Ventilation is controlled; PetC02 is 35 mmHg, heart rate is 90 bpm, and blood pressure is 120/70 mmHg. Assistance is needed to minimize bleeding in the surgical field. Which of the following is the most appropriate next step in management?
(A) Addition of 5 cmH20 positive end-expiratory pressure
(B) Changing the anesthetic agent to halothane
(C) Hyperventilation to a PetC02 of 20 mmHg
(D) Placing the patient in reverse Trendelenburg position
(E) Titration of nitroprusside to a mean arterial pressure of 55 mmHg
Compared with fentanyl, alfentanil is characterized by
(A) greater volume of distribution
(B) greater lipid solubility
(C) less protein binding
(D) faster redistribution
(E) longer terminal elimination phase
D
A 70-year-old patient is shivering and has chest pain in the PACU following a cholecystectomy. Heart rate is 120 bpm, and blood pressure is 220/120 mmHg. SpO2 is 97% at an FiO2 of 0.4. An ECG shows ST-T wave changes, which are not affected by intravenous administration of nitroglycerin. Which of the following is the most appropriate next step?