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 15-kg, 3-year-old child is anesthetized for an inguinal hernia repair with halothane and nitrous oxide. The trachea is intubated after administration of succinylcholine 30 mg. At the conclusion of the 45-minute procedure, the child is not breathing; a peripheral nerve twitch monitor indicates no response to a train-of-four stimulus. Further investigation is most likely to show
(A) abnormal response to nondepolarizing muscle relaxants
(B) a low dibucaine number
(C) a low plasma cholinesterase concentration
(D) an underlying myopathy
(E) a positive halothane-caffeine contracture test
A 35-year-old woman with a grade III subarachnoid hemorrhage is undergoing clipping of a middle cerebral artery aneurysm 48 hours after initial hemorrhage. Which of the following drugs used to induce hypotension is LEAST likely to affect intracranial pressure?
A 55-kg, 70-year-old woman with mild chronic renal failure is unresponsive 20 hours after an uneventful coronary artery bypass grafting procedure. Anesthetic drugs included fentanyl 3000 mcg, diazepam 35 mg, and pancuronium 20 mg. Which of the following is the most appropriate next step in management?
After termination of cardiopulmonary bypass, a patient who is chronically digitalized receives digoxin 0.5 mg in error. An ECG shows sinus bradycardia with intermittent sinus arrest; blood pressure is 90/60 mmHg. Which of the following drugs is contraiindicated in this patient?
The following hemodynamic values are obtained two hours after coronary artery bypass surgery: Cardiac index 1.7 L/min/m2; Pulm Art. Occ. Pressure 22 mmHg; MAP 60 mmHg; Urine volume 0.2 ml/kg/hr. The most appropriate management is
A 23-year-old man who is receiving his first anesthetic has not resumed spontaneous ventilation two hours after receiving succinylcholine. The train-of-four monitor shows no twitch response. Which of the following is the most likely cholinesterase genotype in this patient?
A 64-year-old man with diabetes mellitus well controlled with NPH insulin undergoes lower extremity revascularization. Following administration of protamine 10 mg, the patient has facial flushing and blood pressure of 60/30 mmHg. The most appropriate initial step in management is administration of which of the following drugs?
A patient receiving monoamine oxidase inhibitor therapy for depression undergoes an emergency cholecystectomy. Which of the following is the best means of providing postoperative analgesia in this patient?
(A) Epidural analgesia using 0.25% bupivacaine
(B) Intravenous meperidine
(C) Epidural analgesia using meperidine
(D) Epidural analgesia using 1% lidocaine with epinephrine
(E) Intercostal analgesia using 1% lidocaine with epinephrine
A 70-year-old man who has just undergone an abdominal aortic aneurysm repair under halothane anesthesia develops hypertension, dyspnea, and cyanosis shortly after awakening in the recovery room. Administration of furosemide 20 mg intravenously improves the cyanosis within 10 minutes. This immediate effect of furosemide is best explained by
A previously healthy 28-year-old woman scheduled for laparoscopic tubal ligation becomes, agitated and refuses to undergo the procedure after being brought to the operating room. This behavior most likely resulted from preoperative administration of
Anesthesia is induced with halothane in a 3-year-old girl. Sixty seconds after administration of succinylcholine 1 mg/kg intravenously, heart rate decreases rapidly from 120 to 60 bpm. The most likely cause is
(A) acute hyperkalemia
(B) failure to pretreat with a nondepolarizing relaxant
One week after sustaining third-degree burns over 40% of his body surface area, a patient requires general anesthesia for debridement and skin grafting. Which of the following responses to neuromuscular blockers is most likely?
(A) Clinically insignificant increases in serum potassium concentration after administration of succinylcholine 1 mg/kg
(B) Increased risk of hyperkalemia after administration of succinylcholine 1 mg/kg
(C) Increased sensitivity to vecuronium
(D) Laudanosine toxicity after administration of atracurium 0.4 mg/kg
(E) Normal serum potassium concentration if administration of succinylcholine is preceded by d-tubocurarine 3 mg
In a patient who is receiving nitroglycerin intravenously after a coronary artery operation, peripheral oxygen saturation is 85% and PaO2 is 200 mmHg. The most appropriate management is administration of
A patient has tonic movements of the head and neck, nystagmus, and slurred speech after receiving metoclopramide for nausea after nitrous oxide-opioid anesthesia. The most appropriate pharmacologic treatment is
In the diagram, point "X" represents a patient with severe left ventricular dysfunction. The points labeled 1, 2, and 3 each represent the results of a different therapeutic intervention. Which of the following represents the most likely intervention at each point?
A 64-year-old, 70-kg woman treated with lithium for manic-depressive psychosis is given methohexital 90 mg and succinylcholine 35 mg intravenously for electroconvulsive therapy. Ten minutes later she remains sedated and the peripheral nerve stimulator shows a decreased twitch response. The most likely explanation is