A 4-year-old child with myelomeningocele and a ventriculoperitoneal shunt is scheduled for bladder augmentation. One year ago, hypotension and bronchospasm occurred during laparotomy for placement of a feeding gastrostomy and responded to fluids and epinephrine. At that time, anesthesia was induced with thiopental, the trachea was intubated with a polyvinyl tracheal tube following administration of succinylcholine, and anesthesia was maintained with halothane and nitrous oxide. No diagnostic tests were performed after that incident. Which of the following should be avoided during the bladder augmentation?
A 62-year-old woman with polycythemia vera is scheduled to undergo total knee arthroplasty using a tourniquet. Preoperative hematocrit is 60%. Which of the following is the most appropriate action?
(A) Perform total knee arthroplasty without use of a tourniquet
(B) Preoperative reduction of the hematocrit to 45% to 50%
(C) Prophylactic administration of aprotonin during surgery
(D) Prophylactic administration of epsilon-aminocaproic acid during surgery
(E) Prophylactic administration of low-dose heparin during surgery
B
Which of the following statements concerning the use of epidural opioids during labor is true?
(A) Fentanyl decreases the concentration of epidural bupivacaine required for satisfactory analgesia
(B) Fentanyl is an effective analgesic for the second stage of labor
(C) Sufentanil is an unsatisfactory analgesic for labor
(D) The addition of epinephrine to morphine prolongs the duration of analgesia
(E) The duration of analgesia with fentanyl is six to ten hours
The shorter duration of action of alfentanil relative to fentanyl is due to its
(A) greater lipid solubility
(B) increased clearance
(C) increased rate of hepatic metabolism
(D) lesser protein binding
(E) smaller volume of distribution
E
A patient with jaundice who has a minimally elevated SGOT (AST), markedly elevated alkaline phosphatase, and normal prothrombin time is to receive a muscle relaxant. Which of the following is most likely in this patient?
Three hours prior to induction of anesthesia for elective laparotomy, a 40-kg 8-year-old boy is anxious and clings to his parents. Which of the following preanesthetic medications is most appropriate?
A 72-year-old man has ST-segment depression of 2 mm in ECG lead II immediately after suprarenal aortic clamping. Which of the following is the most likely cause?
(A) Decreased left ventricular stroke volume
(B) Decreased venous return
(C) Increased left ventricular wall tension
(D) Reflex tachycardia
(E) Release of epinephrine from hypoperfused adrenal medulla