A 16-year-old girl is receiving isoflurane, nitrous oxide, oxygen, and pancuronium for insertion of a Harrington rod. In order to perform a "wake-up test" the muscle relaxant was antagonized with neostigmine 2.5 mg and atropine 1 mg. The patient abruptly moved all extremities and was given thiopental 100 mg and succinylcholine 100 mg rapidly. Forty-five minutes later no twitch could be elicited with a nerve stimulator. The most likely explanation is
(A) a dibucaine number of 20
(B) incomplete antagonism of pancuronium
(C) prolongation of the action of succinylcholine by neostigmine
(D) spinal cord damage caused by the abrupt arousal
(E) synergism between succinylcholine and pancuronium
A 52-year-old man develops oliguria 24 hours after left hemicolectomy. Urinalysis shows a specific gravity of 1.028, an osmolality of 650 mOsm/L, and a sodium concentration of 10 mEq/L. Which of the following is the most likely diagnosis?
(A) Acute tubular necrosis
(B) Hypoaldosteronism
(C) Hypovolemia
(D) Interstitial renal disease
(E) Obstructive uropathy
C
When antagonizing neuromuscular block produced by pancuronium, the combination of simultaneously administered anticholinergic and anticholinesterase drugs that is most likely to produce bradycardia is
A 55-year-old patient with hypertrophic cardiomyopathy (IHSS) is undergoing bladder suspension with enflurane 1%, nitrous oxide 50%, and oxygen 50%. Junctional tachycardia and hypotension develop suddenly immediately after skin incision. The most appropriate management is to
(A) decrease enflurane concentration
(B) administer an intravenous fluid bolus
(C) administer intravenous esmolol
(D) administer intravenous phenylephrine
(E) begin nitroglycerin infusion
C
Inhibition of labor by terbutaline causes each of the following maternal side effects EXCEPT
A 5-year-old child undergoes strabismus correction during spontaneous ventilation with halothane 1.5%, nitrous oxide and oxygen 50%. Intravenous atropine 0.2 mg is administered after inhalation induction. Ten minutes after incision, heart rate decreases from 110 bpm to 40 bpm. Which of the following is the most likely cause?
(A) Administration of phenylephrine eyedrops
(B) Inadvertent external pressure on the carotid sinus
(C) Paradoxical response to a small dose of atropine