A 68-year-old patient is undergoing total hip replacement during general anesthesia using positive pressure ventilation and neuromuscular blockade. Intraoperative monitoring shows a gradual decrease in end-tidal CO2, an increase in exhaled tidal volume, and an increase in measured FiO2. Which of the following is the most likely cause of these changes?
(A) Air entrainment around a deflated endotracheal tube cuff
(B) Channeling of the exhaled air through the carbon dioxide canister
(C) Fat embolism
(D) Inadequate muscle relaxation with spontaneous patient ventilation
A tourniquet with dual bladders is being used for intravenous regional anesthesia of the upper extremity. At what point in the procedure should the distal tourniquet be inflated?
(A) During injection of the local anesthetic
(B) After the patient complains of tourniquet pain
(C) Coincident with inflation of the proximal tourniquet
If the low-pressure alarm of an anesthesia circuit is broken, which of the following monitors will provide the earliest indication of a disconnected ventilator hose?
An anesthetized, paralyzed patient is placed in the lateral position and mechanically ventilated. End-tidal PCO2 is 34 mmHg and PaCO2 is 43 mmHg. This gradient
(A) increases during spontaneous breathing
(B) indicates increased dead space ventilation
(C) is caused by increased intrapulmonary shunt
(D) reflects inhibition of hypoxic pulmonary vasoconstriction
A patient with hypokalemic familial periodic paralysis develops weakness of skeletal muscles at the end of an emergency appendectomy under spinal anesthesia. If the weakness is a result of the familial periodic paralysis, which of the following statements is true?
(A) Bicarbonate therapy is indicated
(B) Cardiac dysrhythmias are unlikely
(C) Initial treatment is intravenous edrophonium
(D) Potassium infusion is contraindicated
(E) The paralysis spares the diaphragm
E
During general anesthesia, a patient has the acute onset of atrial fibrillation with rapid ventricular response and hypotension to 50 mmHg systolic. The most appropriate treatment is
During attempted awake intubation, the patient gags when the laryngoscope presses on the base of the tongue. Which of the following cranial nerves is responsible for the afferent limb of this reflex?
During laser microsurgery of the larynx, a rubber endotracheal tube wrapped with aluminum-foil tape starts to smolder and give off smoke. The first step is to
(A) suction the endotracheal tube
(B) add helium to the inspired gas mixture
(C) remove the endotracheal tube
(D) turn off the fresh gas flow
(E) pack a saline-soaked gauze sponge into the hypopharynx
C
A 27-year-old man with a one-month history of quadriplegia at a C6 level is given general anesthesia for cystoscopy. During the cystoscopy, blood pressure suddenly increases to 220/120 mmHg. Further evaluation is most likely to show