A 70-kg, 46-year-old man is undergoing clipping of a cerebral aneurysm with nitrous oxide, opioid, relaxant anesthesia. He is otherwise healthy. As the surgeons are about to enter the dura, the brain is noted to be tense and bulging. Heart rate is 100 bpm and mean arterial pressure is 90 mmHg. PaO2 is 120 mmHg, PaCO2 is 23 mmHg, and pH is 7.50. Which of the following should be done immediately?
(A) Hyperventilation to a PaCO2 of 15 to 20 mmHg
(B) Administration of furosemide 20 mg intravenously
(C) Administration of mannitol 0.5 g/kg
(D) Administration of thiopental 250 mg in increments
A 57-year-old man has back pain, a heart rate of 90 bpm, decreased pulse in the left arm, and blood pressure of 200/110 mmHg. During infusion of nitroprusside, heart rate increases to 115 bpm and blood pressure decreases to 140/80 mmHg. The most appropriate management at this time is administration of
Which of the following statements concerning the ventilatory effects of inhalational anesthesia is true?
(A) Assisted ventilation is not an effective technique to achieve normocarbia
(B) Surgical stimulation does not affect ventilation
(C) Combined doses of nitrous oxide and isoflurane depress ventilation the same as an equipotent dose of isoflurane alone
(D) The ventilatory response to increasing carbon dioxide concentration is normal
(E) The ventilatory response to hypoxemia is preserved
A
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 woman is undergoing a repeat cesarean delivery at term following a normal pregnancy. Anesthesia consists of thiopental 250 mg, succinylcholine infusion (180 mg in 20 minutes), nitrous oxide and oxygen (7:3 L/min) until delivery. Twenty minutes after the incision a floppy newborn with a 1-minute Apgar score of 5 is delivered. The most likely explanation for the infant's condition is