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
A 78-year-old man who is scheduled for an inguinal hernia repair has a preoperative ECG showing left bundle branch block. He has had no symptoms of cardiovascular disease. This ECG finding most likely indicates
(A) cardiac disease
(B) the need for spinal anesthesia
(C) an electrolyte disturbance
(D) the need for insertion of a temporary pacemaker
A 65-year-old patient with compensated congestive heart failure undergoes resection of a large tumor of the temporal lobe. During the procedure, the brain is noted to protrude through the surgical incision. After increasing minute ventila- tion, which of the following is the most appropriate next step in management?
(A) Administration of dexamethasone
(B) Administration of furosemide
(C) Administration of mannitol
(D) Induction of barbiturate coma
(E) Induction of deliberate hypotension
B
The central anticholinergic syndrome is LEAST likely to occur after administration of
(A) atropine
(B) chlorpromazine
(C) diphenhydramine
(D) glycopyrrolate
(E) scopolamine
D
During enflurane anesthesia for colectomy in a 75-year-old man with sepsis, urine output decreases to 10 ml/hr. Heart rate is 120 bpm, blood pressure is 100/50 mmHg, central venous pressure is 10 mmHg, and pulmonary artery occlusion pressure is 15 mmHg. The most appropriate management at this time is to
Compared with the response of a normal patient, administration of a bolus dose of pancuronium (0.15 mg/kg) to a patient with cirrhosis and ascites would be associated with