Twelve hours after an uneventful hysterectomy with lidocaine epidural anesthesia, a 70-year-old woman has partial paralysis of the lower extremities. She is receiving morphine 0.5 mg/hr through an epidural catheter and is pain free. On examination, definite motor loss is noted in the lower extremities, but no other deficits are apparent. The most appropriate action at this time is to
(A) administer naloxone
(B) substitute fentanyl for morphine infusion
(C) remove the epidural catheter
(D) obtain an MRI of the lumbar spine
(E) reassure the patient
D
Following completion of an ankle block, the patient reports intact sensation on the tips of the toes. Which of the following nerves was blocked inadequately?
Which of the following EEG findings is expected during maintenance anesthesia with high-dose fentanyl (50 ju-g/kg), nitrous oxide, and oxygen?
(A) Low-frequency high-voltage activity
(B) Nondominant hemispheric slowing
(C) Predominant alpha activity
(D) Prominent beta activity
(E) Spindle-shaped bursts
A
A 40-year-old man is undergoing open reduction and internal fixation of a fractured femur. During anesthesia with fentanyl, sevoflurane, and oxygen, heart rate decreases to 20 bpm and 6 premature ventricular contractions per minute are noted. No pulse is detected. The most appropriate next step is to
A 75-kg, 45-year-old patient with quadriplegia at the level of C6 is scheduled for elective cholecystectomy. Pulmonary function tests show an FVC of 2.4 L and an FEV, of 1.2 L. Which of the following is the most appropriate conclusion based on these findings?
(A) Intercostal muscle function is normal
(B) SpO, will be 80% or less while breathing room air
(C) Total lung capacity is normal
(D) The patient has chronic obstructive pulmonary disease
A 40-year-old man requires brief surgical relaxation after administration of neostigmine and glycopyrrolate for reversal of vecuronium-induced neuromuscular blockade. Succinylcholine 1 mg/kg is administered intravenously. Compared with a patient who has not had prior reversal of neuromuscular blockade, which of the following characterizes the succinylcholine blockade in this patient?
(A) Greater antagonism with calcium chloride
(B) Slower onset
(C) Less profound
(D) Less likelihood of phase II neuromuscular blockade
In an infant, spinal anesthesia to a sensory level of T8 is achieved with tetracaine administered at the L2-3 interspace. Compared with spinal anesthesia to the same sensory level in an adult, this anesthetic is associated with a