The shorter duration of action of alfentanil relative to fentanyl is due to its
(A) greater lipid solubility
(B) increased clearance
(C) increased rate of hepatic metabolism
(D) lesser protein binding
(E) smaller volume of distribution
E
Each of the following increases cardiac output EXCEPT
(A) an arteriovenous fistula
(B) fever
(C) normovolemic anemia
(D) shivering
(E) carotid sinus stimulation
E
A 65-kg, 57-year-old man has an initial activated clotting time (ACT) of 122 seconds prior to elective cardiopulmonary bypass. Five minutes after administration of heparin 200 mg, ACT increases to 154 seconds. After two additional doses of 200 mg each from different lots, ACT increases to 240 seconds. The most appropriate next step is to
Which of the following should be included in the preoperative management of a 12-year-old patient with Duchenne's muscular dystrophy who is unable to ambulate?
(A) Determination of serum creatine kinase concentration
(B) Determination of serum potassium concentration
A 35-year-old woman receiving isoflurane anesthesia suddenly develops tachycardia, hypertension, and multifocal ventricular ectopy during dissection of a pheochromocytoma. Each of the following would be appropriate treatment EXCEPT
(A) administration of an alpha-adrenergic blocker
(B) administration of a beta-adrenergic blocker
(C) administration of lidocaine
(D) administration of nitroprusside
(E) switching from isoflurane to enflurane
E
A 6-year-old child with severe cerebral palsy is scheduled for general anesthesia. He is at increased risk for each of the following EXCEPT
(A) gastroesophageal reflux
(B) hypersensitivity to central nervous system depressants
A 38-year-old woman with B-positive blood requires immediate blood transfusion during abdominal hysterectomy. No B-positive blood is available; O-negative blood is used. Three minutes after starting transfusion of packed red blood cells, the patient develops tachycardia, bronchospasm, and hypotension. Which of the following is the most likely cause?
(A) Anaphylactic reaction to donor IgA
(B) Bacterial contamination of transfused blood
(C) Hemolysis resulting from ABO incompatibility
(D) Hypocalcemia
(E) IgG-mediated reaction to Rh antigens
A
Which of the following must be considered during perioperative management of a patient on long-term lithium therapy?
(A) Intravenous fluids should include sodium
(B) Therapy should be discontinued for 14 days prior to anesthesia
(C) The requirement for succinylcholine is increased
(D) The requirement for volatile anesthetics is increased
(E) Urine output should be maintained with furosemide