A 70-kg, 50-year-old man is scheduled for muscle flap closure of a decubitus ulcer over the sacrum. He has been quadriplegic at the level of C6-7 for six years. Which of the following is most likely to result from subarachnoid anesthesia with tetracaine 10 mg for this procedure?
During insertion of a Harrington rod with deliberate hypotension for correction of spinal scoliosis, accurate interpretation of somatosensory evoked potentials requires
(A) core temperature greater than 35∞C
(B) hematocrit of at least 25%
(C) mean arterial pressure greater than 70 mmHg
(D) P02 of at least 80 mmHg
(E) reversal of neuromuscular block
A
A 60-year-old woman who is taking propranolol for hypertension and is allergic to penicillin is anesthetized with thiopental and halothane for resection of an abdominal aortic aneurysm. Shortly after intubation she is given vancomycin 500 mg intravenously, after which her blood pressure decreases from 140/80 to 70/50 mmHg while her heart rate remains steady at 64 bpm. The most likely explanation for the decrease in blood pressure is
(A) cross-sensitivity of penicillin and vancomycin
(B) interaction of vancomycin and propranolol
(C) vancomycin-induced anaphylactoid reaction
(D) interaction of halothane and propranolol
(E) interaction of halothane and vancomycin
C
A 67-kg, 52-year-old man is undergoing heart transplantation. After implantation of the donor heart and discontinuation of cardiopulmonary bypass, isoproterenol is administered intravenously to maintain heart rate greater than 100 bpm. During the next 10 minutes, blood pressure decreases from 105/55 mmHg to 75/40 mmHg. Heart rate is 102 bpm and cardiac output is 5.8 L/min. The most appropriate management is administration of
A 62-year-old woman with polycythemia vera is scheduled to undergo total knee arthroplasty using a tourniquet. Preoperative hematocrit is 60%. Which of the following is the most appropriate action?
(A) Perform total knee arthroplasty without use of a tourniquet
(B) Preoperative reduction of the hematocrit to 45% to 50%
(C) Prophylactic administration of aprotonin during surgery
(D) Prophylactic administration of epsilon-aminocaproic acid during surgery
(E) Prophylactic administration of low-dose heparin during surgery
B
Which of the following will occur if the top of the oxygen flowmeter is cracked and leaking during anesthesia with nitrous oxide and oxygen?
(A) The back-pressure check valve will protect against a hypoxic gas mixture
(B) The fail-safe mechanism will protect against a hypoxic gas mixture
(C) The inspired oxygen concentration will be less than that set by the flowmeters
(D) The leak will be detected if the circle is pressurized prior to use
(E) The rotameter will accurately reflect the fresh gas flow to the patient
A 70-year-old man sustains injuries to both carotid bodies during bilateral carotid endarterectomies performed four days apart. Two hours after the second procedure, the patient is breathing room air in the PACU. Which of the following sets (pH, pCO2, pO2) of arterial blood gas values is LEAST likely?