A 26-year-old man who sustained multiple trauma undergoes open reduction and internal fixation of bilateral tibial-fibular fractures during anesthesia with isoflurane. nitrous oxide, and oxygen with positive pressure ventilation. During the procedure, the patient has sudden onset of hypotension, jugular venous distention, deviation of the trachea to the right, and decreased ventilatory compliance. Isoflurane is discontinued and 100% oxygen is administered. Which of the following is the most appropriate next step in management?
During surgery of the forearm under axillary block, a patient has pain in the lateral aspect of the forearm and responds by flexing the elbow. The most likely cause is inadequate block of which of the following nerves?
A 76-year-old patient is restless and hallucinating in the preoperative holding area. He received morphine 5 mg and scopolamine 0.4 mg intramuscularly as premedication and is now breathing oxygen 2 L/min through nasal prongs. SpO2 is 98%. Which of the following is the most appropriate next step?
(A) Administration of naloxone
(B) Administration of physostigmine
(C) Induction of general anesthesia
(D) Determination of serum electrolyte concentrations
A moderately obese 38-year-old woman is using patient-controlled morphine analgesia one day after open cholecystectomy. While breathing room air, oxygen saturation is 85%, Pa02 is 48 mmHg, PaC02 is 42 mmHg, and pH is 7.36. In addition to administration of oxygen, the most effective management is to
(A) decrease the dosage of opioids
(B) change to epidural morphine
(C) administer an inhaled bronchodilator
(D) initiate 4 cm of nasal continuous positive airway pressure
(E) initiate incentive spirometry therapy
E
Failure of contrast material to enter the duodenum following intraoperative cholangiography is most likely related to administration of
(A) butorphanol
(B) fentanyl
(C) halothane
(D) nalbuphine
(E) naloxone
B
Which of the following is most likely to occur during deliberate hypotension with trimethaphan?
(A) Bronchoconstriction
(B) Cerebral vasodilation
(C) Increased heart rate
(D) Potentiation of pancuronium
(E) Pupillary constriction
C
Which of the following is the most reliable indicator of antagonism of nondepolarizing neuromuscular block sufficient for airway protection?
(A) Clinically assessed ulnar nerve train-of-four ratio of 0.75
(B) Peak negative pressure of 25 cmH2O
(C) End-tidal PC02 of 40 mmHg during spontaneous ventilation