Which of the following findings on the left is most likely to be associated with an increased risk of complications with cannulation of the left internal jugular vein compared with cannulation of the right internal jugular vein?
(A) Longer recurrent laryngeal nerve
(B) Lower location of the cupola of the pleura
(C) More acute angle between the internal jugular and innominate veins
An obese, 35-year-old man had an episode of coughing followed by vomiting during induction of anesthesia for arthroscopy of the left knee. Intense wheezing developed bilaterally over five minutes. PaO2 is 60 mmHg, PaCO2 is 42 mmHg, and pH is 7.35. Optimal management following intubation of the trachea includes
(A) mechanical ventilation with positive end-expiratory pressure (PEEP), cancellation of surgery, and transfer to the intensive care unit
(B) saline lavage and continuation of surgery using halothane anesthesia
(C) cancellation of surgery and administration of corticosteroids and antibiotics
(D) thorough suctioning and proceeding with halothane anesthesia
(E) cancellation of surgery, vigorous mechanical ventilation, thorough suctioning, and administration of aminophylline
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
(B) decreased affinity of maternal hemoglobin for oxygen
(C) decreased maternal and fetal cardiac output
(D) increased placental transfer of oxygen
(E) increased fetal cerebral blood flow
C
Which of the following statements concerning the pharmacokinetics of nondepolarizing muscle relaxants is true?
(A) Drugs with a longer duration of action depend on the liver for excretion
(B) Drugs with a shorter duration of action depend primarily on redistribution for recovery
(C) Onset of action is independent of dose
(D) Recovery rate parallels the decrease in plasma relaxant concentration
(E) The shorter the duration of action, the faster the onset
D
A child undergoing general anesthesia is breathing spontaneously using the Jackson-Rees modification of the Ayres T-piece. Respiratory rate is 20/min and tidal volume is 75 ml. What is the minimum fresh gas flow required to prevent rebreathing?
Which of the following statements concerning use of temperature-corrected blood gas measurement (pH-stat) during hypothermic cardiopulmonary bypass is true?
(A) Blood gas analysis is performed at the patient's temperature
(B) Carbon dioxide should not be added to the bypass circuit
(C) The carbon dioxide content of the patient's blood is greater than it would be without temperature correction
(D) The incidence of postoperative neurologic deficits is increased compared with the alpha-stat method
(E) The patient's temperature should be maintained above 25°C