After inflation of both the tracheal and endobronchial cuffs of a left-sided double-lumen tube, the following are noted on auscultation of the chest: Left lumen clamped --> Breath sounds absent bilaterally; Right lumen clamped --> Breath sounds present on left only; Both lumens open --> Breath sounds present on left only. The most appropriate action is to
(A) decrease the endobronchial cuff volume
(B) decrease the tracheal cuff volume
(C) reinsert the tube, rotating it 180 degrees to the right
(D) suction both lumens
(E) withdraw the tube slightly and repeat the auscultory maneuvers
Ten minutes after induction of anesthesia with thiopental and isoflurane but before incision, a patient's nasopharyngeal temperature has decreased to 35.4°C. Which of the following contributed most to this decrease in temperature?
(A) Anesthesia-induced block of nonshivering thermogenesis
A 55-year-old man requires intravenous lidocaine for multifocal premature ventricular contractions occurring in the first hour after a below-knee amputation. He has alcoholic cirrhosis, portal hypertension, and ascites. Which of the following correctly describes the appropriate modification of the usual loading bolus and maintenance infusion of lidocaine?
(A) Larger bolus, faster infusion
(B) Larger bolus, slower infusion
(C) Smaller bolus, faster infusion
(D) Smaller bolus, slower infusion
(E) No change necessary
B
A 26-year-old woman has headache, nausea, and photophobia 36 hours after cesarean delivery for chorioamnionitis using subarachnoid block. Temperature is 38.8°C and leukocyte count is 14,200/mm3. Which of the following is the most appropriate next step in management?
You are asked to evaluate a 2000-g male infant three hours after vaginal delivery because of a respiratory rate of 50/min, pulse rate of 115 bpm, and the following arterial blood gas values while breathing room air: PaO2 64 mmHg, PaCO2 43 mmHg, and pH 7.33. His mother received meperidine 75 mg two hours before delivery. Appropriate management includes
(A) administration of naloxone 50 mcg intramuscularly
(B) increasing the FiO2 to 0.4
(C) intubation and mechanical ventilation at an FiO2 of 0.5
(D) administration of oxygen 50% with 5 cm H2O continuous positive airway pressure
A woman with chronic obstructive pulmonary disease is extubated and minimally responsive after isoflurane anesthesia. She is receiving oxygen 6 L/min through a face mask. Respirations are 10/min, PaO2 is 68 mmHg, PaCO2 is 54 mmHg, and pH is 7.28. The most likely cause of the respiratory acidemia is
(A) blunted sensitivity to low pH in the medullary respiratory center
(B) chronic carbon dioxide retention
(C) decreased lung volume from supine positioning
(D) depression of carotid body chemoreceptors by halothane
(E) suppression of hypoxic ventilatory drive by supplemental oxygen