A multigravid woman is receiving oxytocin by infusion for augmentation of labor. Fetal heart rate is 190 bpm with beat-to-beat variability of 6 to 8 bpm. The most appropriate immediate action would be to
(A) continue observation
(B) sample fetal scalp blood
(C) discontinue oxytocics
(D) administer a beta-adrenergic blocker to the mother
A 60-year-old woman who is taking propranolol for hypertension and is allergic to penicillin is anesthetized with thiopental and halothane for resection of an abdominal aortic aneurysm. Shortly after intubation she is given vancomycin 500 mg intravenously, after which her blood pressure decreases from 140/80 to 70/50 mmHg while her heart rate remains steady at 64 bpm. The most likely explanation for the decrease in blood pressure is
(A) cross-sensitivity of penicillin and vancomycin
(B) interaction of vancomycin and propranolol
(C) vancomycin-induced anaphylactoid reaction
(D) interaction of halothane and propranolol
(E) interaction of halothane and vancomycin
C
A 54-year-old man receives 25 ml of a 50% alcohol and 0.25% bupivacaine solution for celiac plexus block. During the next 20 minutes, blood pressure decreases from 130/75 mmHg to 85/55 mmHg. Which of the following is the most likely cause?
A 76-year-old patient is restless and hallucinating in the preoperative holding area. He received morphine 5 mg and scopolamine 0.4 mg intramuscularly as premedication and is now breathing oxygen 2 L/min through nasal prongs. SpO2 is 98%. Which of the following is the most appropriate next step?
(A) Administration of naloxone
(B) Administration of physostigmine
(C) Induction of general anesthesia
(D) Determination of serum electrolyte concentrations
A patient with lumbar disk disease requires lumbar epidural injection of a corticosteroid for control of low back pain. Which of the following statements concerning this treatment is true?
(A) Maximum effect occurs one hour after injection
(B) Maximum effect occurs when drug concentration peaks in cerebrospinal fluid
(C) Maximum effect occurs during the acute phase of the disease
(D) The beneficial effect results primarily from sympathetic neurolysis
(E) It is contraindicated if the patient has had prior surgical procedures on the lumbar disks