A 32-year-old man who is addicted to opioids complains of pain in the PACU one hour after fixation of a mandibular fracture. He has received intravenous morphine 30 mg during the past hour. The most appropriate management is
(A) continued intravenous administration of morphine until the pain resolves
(B) intravenous administration of nalbuphine in 5-mg increments until the pain resolves
(C) intramuscular administration of hydroxyzine 75 mg
(D) evaluation for entrapment of the mandibular nerve
A 62-year-old man is in the intensive care unit after successful craniotomy for excision of a meningioma. Blood volume is normal; laboratory studies show serum sodium concentration of 120 mEq/L, serum osmolality of 260 mOsm/L, urine sodium concentration of 50 mEq/L, and urine osmolality of 820 mOsm/L. Which of the following is the most likely explanation?
(A) Fluid overload with 5% dextrose in water
(B) Inappropriate secretion of antidiuretic hormone
A 31-year-old man received an uneventful epidural anesthetic for arthroscopy of the knee and meniscectomy. Twenty-four hours later he still has painless flaccid paralysis in both legs. This clinical presentation is most consistent with
Following maternal epidural injection, fetal exposure to chloroprocaine is lower than fetal exposure to bupivacaine for which of the following reasons?
(A) Chloroprocaine is metabolized by plasma cholinesterase
(B) Chloroprocaine is more protein bound
(C) Chloroprocaine is not readily absorbed from the epidural space
(D) The ionized fraction of chloroprocaine in the fetal circulation is smaller
(E) The pKa of chloroprocaine is less than that of bupivacaine
Each of the following can produce adequate analgesia for the first stage of labor EXCEPT
(A) subarachnoid morphine
(B) epidural bupivacaine
(C) pudendal block with lidocaine
(D) paracervical block with lidocaine
(E) lumbar sympathetic block with lidocaine
C
A 70-year-old patient is shivering and has chest pain in the PACU following a cholecystectomy. Heart rate is 120 bpm, and blood pressure is 220/120 mmHg. SpO2 is 97% at an FiO2 of 0.4. An ECG shows ST-T wave changes, which are not affected by intravenous administration of nitroglycerin. Which of the following is the most appropriate next step?