A 45-year-old woman undergoes aortic valve replacement for aortic stenosis. Two minutes after removal of the venous cannulae, air is noted in the arterial inflow cannula. Heart rate is 80 bpm, blood pressure is 95/60 mmHg, and cardiac index is 1.5 L/min/m2. ST-segment elevation is noted in EKG leads II, III, and aVF. The most appropriate next step is to
(A) administer thiopental
(B) decrease left ventricular afterload
(C) increase arterial blood pressure
(D) replace the left ventricular vent
(E) resume cardiopulmonary bypass
C
A 30-year-old woman is undergoing laparoscopic tubal ligation. Thirty minutes after induction of general anesthesia, arterial oxygen saturation has decreased to 89%. Arterial blood gases at an FiO2 of 1.0 are PaO2 63 mmHg and PaCO2 40 mmHg; PetCO2 is 32 mmHg. Which of the following is the most likely cause?
(A) Carbon dioxide embolus
(B) Endobronchial intubation
(C) Hypoventilation
(D) Inadvertent application of high levels of positive end-expiratory pressure
A 46-year-old man is scheduled for repair of an inguinal hernia. Six years ago, he had an episode of malignant hyperthermia during cholecystectomy. Which of the following is the most appropriate perioperative management?
(A) Administration of a regional anesthetic
(B) Administration of dantrolene orally for two days prior to surgery
(C) Avoidance of all inhalational anesthetics except isoflurane
(D) Avoidance of ester local anesthetics
(E) Flushing the anesthesia machine with oxygen 10 L/min for a minimum of 12 hours
A patient with a fasting blood glucose concentration of 100 mg/dL undergoes a four-hour operation under general anesthesia without intraoperative administration of glucose. On emergence the most likely finding will be
An 86-kg, 67-year-old man is undergoing a second coronary artery bypass operation. Five minutes after administration of protamine, blood pressure is 69/40 mmHg, pulmonary artery pressure is 65/42 mmHg, and the cardiac output measured by thermodilution is 2.3 L/min. Which of the following is the most likely cause of these findings?
(A) Allergy to fish
(B) Increased plasma thromboxane concentration
(C) Increased plasma histamine concentration
(D) Insulin-dependent diabetes mellitus
(E) IgE antibodies to protamine
B
Neurolytic block is most appropriate for
(A) abdominal pain secondary to hepatic carcinoma
(B) abdominal pain secondary to chronic pancreatitis
(C) persistent chest wall pain secondary to intercostal neuralgia following a thoracotomy for trauma
(D) reflex sympathetic dystrophy of the upper extremity with an excellent but transient response to a series of stellate ganglion blocks with local anesthetic
(E) a diabetic patient scheduled for surgical sympathectomy to relieve unilateral lower extremity pain secondary