A 70-kg, 20-year-old athlete receives nitrous oxide and oxygen, thiopental, and fentanyl 1.25 mg (25 ml) during a knee reconstruction procedure lasting three hours. Postoperatively, he does not awaken or resume spontaneous breathing for three hours. The most likely explanation for the prolonged effect of fentanyl is
(A) dose-dependent elimination half-life
(B) genetically slow biotransformation
(C) large volume of distribution
(D) presence of an active metabolite in high concentration
A patient being mechanically ventilated in the ICU requires wound debridement twice daily. Each of the following agents would be appropriate for induction of brief general anesthesia EXCEPT
You are asked to evaluate a 2000-g male infant three hours after vaginal delivery because of a respiratory rate of 50/min, pulse rate of 115 bpm, and the following arterial blood gas values while breathing room air: PaO2 64 mmHg, PaCO2 43 mmHg, and pH 7.33. His mother received meperidine 75 mg two hours before delivery. Appropriate management includes
(A) administration of naloxone 50 mcg intramuscularly
(B) increasing the FiO2 to 0.4
(C) intubation and mechanical ventilation at an FiO2 of 0.5
(D) administration of oxygen 50% with 5 cm H2O continuous positive airway pressure
A 19-year-old woman has severe nausea and vomiting following laparoscopy. After intramuscular administration of prochlorperazine 10 mg, she has muscle spasms in the face, neck, and tongue. Which of the following is the most appropriate management?