An 86-kg, 67-year-old man is undergoing a second coronary artery bypass operation. Five minutes after administration of protamine, blood pressure is 69/40 mmHg, pulmonary artery pressure is 65/42 mmHg, and the cardiac output measured by thermodilution is 2.3 L/min. Which of the following is the most likely cause of these findings?
(A) Allergy to fish
(B) Increased plasma thromboxane concentration
(C) Increased plasma histamine concentration
(D) Insulin-dependent diabetes mellitus
(E) IgE antibodies to protamine
B
The muscular action most likely to remain intact following an axillary brachial plexus block is
After brachial plexus block via an axillary approach, a patient has sensation on the dorsum of the second and third digits and is able to extend the distal phalanx of the thumb. To block the unaffected nerve, anesthetic should be injected at which of the following sites?
(A) 2 Cm lateral to the biceps tendon at the level of the elbow
(B) At the radial border of the palmaris longus tendon
(C) Between the medial epicondyle and the olecranon
(D) Between the radial artery and the styloid process
(E) Just medial to the brachial artery at the elbow
A
A 6-year-old child with asthma begins wheezing during anesthesia with halothane and nitrous oxide in oxygen. A loading dose of aminophylline is administered followed by continuous infusion. Premature ventricular contractions appear on the ECG. The most appropriate management is to
(A) administer fentanyl
(B) discontinue aminophylline
(C) increase exhalation time
(D) increase the inspired concentration of halothane
A 62-year-old man, who had a myocardial infarction three years ago, complicated by congestive heart failure and renal failure, is undergoing a colectomy. A pulmonary artery catheter demonstrates a cardiac output higher than measurements recorded during a cardiac catheterization two months after the infarction. Which of the following most likely contributes to the increased cardiac output?
(A) Creation of an arteriovenous fistula
(B) Increased hemoglobin concentration from 10 to 12 g/dL
(C) Stimulation of carotid body receptors
(D) Transcutaneous nitroglycerin
(E) Use of a beta-adrenergic blocker to prevent myocardial reinfarction
A
The use of glycine as irrigating solution during transurethral resection of the prostate could be associated with each of the following EXCEPT