A 72-year-old man has massive venous hemorrhage during a radical prostatectomy. Blood pressure decreases from 110/60 to 75/30 mmHg and central venous pressure decreases from 12 to 4 mmHg. PetC02 decreases from 34 to 24 mmHg during constant minute ventilation. The most appropriate next step should be to
(A) apply positive end-expiratory pressure to the breathing circuit
(B) attempt to aspirate air from the central venous catheter
(C) expand intravascular volume
(D) place the patient in the Trendelenburg position
(E) turn the patient to the left lateral decubitus position
A 50-year-old woman has episodes of electric-shock-like pain of one minute in duration affecting the right side of the face. In between episodes of this pain, she is relatively pain free. Which of the following is the most appropriate management?
(A) Beta-adrenergic blockers
(B) Carbamazepine
(C) Infrared heat therapy
(D) Nonsteroidal anti-inflammatory drugs
(E) Stellate ganglion block
B
Optimal ventilation of a newborn with congenital diaphragmatic hernia should consist of
Which of the following is characteristic of the pharmacokinetics of alfentanil?
(A) Clearance is greater than that of fentanyl
(B) Elimination half-life is normal in patients with hepatic insufficiency
(C) Protein binding is minimal
(D) The majority of alfentanil in plasma is ionized
(E) Volume of distribution is smaller than that of fentanyl
E
A 65-year-old patient with compensated congestive heart failure undergoes resection of a large tumor of the temporal lobe. During the procedure, the brain is noted to protrude through the surgical incision. After increasing minute ventila- tion, which of the following is the most appropriate next step in management?
(A) Administration of dexamethasone
(B) Administration of furosemide
(C) Administration of mannitol
(D) Induction of barbiturate coma
(E) Induction of deliberate hypotension
B
A 45-year-old patient with chronic alcoholism develops jaundice four days after a cholecystectomy under halothane/morphine general anesthesia. Bilirubin and alkaline phosphatase are elevated, but ALT is only slightly above normal. All values were within normal limits preoperatively. The most likely cause of jaundice is
(A) opioid-induced spasm of the sphincter of Oddi
(B) hepatic dysfunction secondary to halothane exposure
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