A 58-year-old man with a history of angina is undergoing resection of an abdominal aortic aneurysm under morphine, nitrous oxide, d-tubocurarine anesthesia. Just before removal of the aortic cross-clamp, heart rate is 74 bpm, blood pressure is 115/70 mmHg, and pulmonary artery occlusion pressure is 7 mmHg. Immediately after removal of the cross-clamp, heart rate increases to 120 bpm, blood pressure decreases to 80/55 mmHg, and pulmonary artery occlusion pressure decreases to 3 mmHg. The V5 lead on the EKG demonstrates sudden ST-segment depression and T-wave inversion. Initial therapy should be
(A) reapplication of the aortic cross-clamp
(B) intravenous administration of sodium bicarbonate
(C) initiation of a phenylephrine infusion
(D) rapid expansion of blood volume by transfusion
A 23-year-old man who is receiving his first anesthetic has not resumed spontaneous ventilation two hours after receiving succinylcholine. The train-of-four monitor shows no twitch response. Which of the following is the most likely cholinesterase genotype in this patient?
An infant is delivered by forceps following labor in which variable decelerations were noted. Amniotic fluid was clear. Initial evaluation shows a cyanotic, limp infant with a heart rate of 80 bpm, poor respiratory efforts, and grimacing in response to suctioning. The most appropriate method of resuscitation for this newborn is
(A) vigorous tactile stimulation
(B) bag and mask ventilation with oxygen
(C) immediate endotracheal intubation
(D) administration of sodium bicarbonate 1 mEq/kg
(E) volume expansion with normal saline solution 10 mL/kg
Compared with healthy persons, patients with myasthenic (Eaton-Lambert) syndrome have increased
(A) resistance to vecuronium
(B) response to neostigmine during reversal of muscle paralysis
(C) sensitivity to succinylcholine
(D) susceptibility to development of malignant hyperthermia
(E) weakness with repetitive activity
C
In an infant, spinal anesthesia to a sensory level of T8 is achieved with tetracaine administered at the L2-3 interspace. Compared with spinal anesthesia to the same sensory level in an adult, this anesthetic is associated with a
In a patient receiving an epidural analgesic infusion postoperatively, clear fluid is noted to drip back freely from the epidural catheter. Each of the following findings correctly identifies the associated fluid EXCEPT
(A) precipitation when mixed with an equal volume of thiopental — local anesthetic
A healthy 60-kg 52-year-old woman undergoing reduction mammoplasty is anesthetized with isoflurane and oxygen, and deliberate hypotension to 80/40 mmHg is induced with nitroprusside. Urine output through an indwelling urethral catheter has been 10 mL during the past hour. You should now
(A) administer furosemide 40 mg intravenously
(B) infuse normal saline solution until urine output reaches 35 mL/hr
(C) administer dopamine at 3 mcg/kg/min
(D) expect normal urine flow with restoration of normal blood pressure
A 56-year-old woman with pulmonary fibrosis is scheduled for pneumonectomy. Which of the following parameters best predicts potential postoperative functional impairment?