A 27-year-old man with chronic renal failure is to undergo revision of an arteriovenous graft. He insists on general anesthesia. Hemodialysis was completed two hours ago, and serum potassium concentration is now 5 mEq/L. Which of the following statements concerning anesthetic management of this patient is true?
(A) Enflurane is contraindicated
(B) Succinylcholine is contraindicated
(C) Neostigmine will be required in larger than usual dosage
(D) The duration of action of atracurium will be prolonged
(E) The duration of action of propofol will be unchanged
E
Each of the following statements concerning the activated clotting time (ACT) is true EXCEPT:
(A) The ACT is more sensitive than the activated partial thromboplastin time (APTT) to blood heparin concentration
(B) The ACT is prolonged if the specimen is not warmed during the assay
(C) The ACT should be greater than 300 sec before initiating cardiopulmonary bypass
(D) Hypofibrinogenemia may prolong the ACT after cardiopulmonary bypass
(E) Whole blood is used for measurement of the ACT
A 66-year-old patient with aortic stenosis is scheduled for aortic valve replacement. Examination shows blood pressure of 110/60 mmHg and sinus rhythm at a rate of 75 bpm. Pulmonary artery occlusion pressure (PAOP) is 20 mmHg with a prominent a-wave on the tracing. Which of the following is the most appropriate management?
(A) Increasing myocardial contractility
(B) Maintaining PAOP below 20 mmHg
(C) Maintaining sinus rhythm
(D) Promoting mild tachycardia
(E) Decreasing peripheral resistance
C
Which of the following is the most likely cause of the increased incidence of right ventricular failure in patients with morbid obesity?
A newly developed inhalational anesthetic has a blood-gas partition coefficient of 0.2. Which of the following statements best describes this drug compared with isoflurane?
(A) MAC is lower
(B) The difference between Fa and Fl during maintenance of anesthesia is greater
(C) Time to emergence is shorter
(D) Rapid induction requires greater overpressure
(E) Equilibrium in a circle system with the same flow of fresh gas is slower
A patient with jaundice who has a minimally elevated SGOT (AST), markedly elevated alkaline phosphatase, and normal prothrombin time is to receive a muscle relaxant. Which of the following is most likely in this patient?