During right upper lobectomy and one-lung ventilation with a double-lumen endotracheal tube, the PaO2 decreases to 40 mmHg. The PaCO2 is 39 mmHg. Which of the following is most appropriate?
(A) Confirm position of the tube with bronchoscopy
(B) Apply 5 cmH20 continuous positive airway pressure to the nondependent lung
(C) Apply 5 cmH20 positive end-expiratory pressure to the dependent lung
(D) Resume two-lung ventilation
(E) Clamp the pulmonary artery of the nondependent lung
The severity of chronic bronchitis is best assessed by measuring
(A) tidal volume
(B) carbon dioxide diffusion capacity
(C) sputum production over 24 hours
(D) forced vital capacity
(E) arterial blood gases
E
During an aortic aneurysm repair, end-tidal carbon dioxide tension decreases from 35 to 20 mmHg in three breaths. The most likely cause is
(A) acute arteriovenous fistula
(B) bronchospasm
(C) decreased cardiac output
(D) increased tidal volume
(E) venous air embolism
C
A 30-year-old, 70-kg woman with mitral stenosis is scheduled for elective laparoscopic sterilization. Preoperatively she is taking digoxin and an unknown medication for chronic mental depression. The EKG demonstrates atrial fibrillation. Heart rate is 68 bpm. Anesthesia is induced with thiopental followed by nitrous oxide 50%, halothane 0.75%, and a continuous succinylcholine infusion. The ventilator is set to deliver a minute volume of 5 liters through an endotracheal tube. As the carbon dioxide is being insufflated into the abdomen, the blood pressure is noted to be elevated (150/100 mmHg) and ventricular bigeminy is present. The most appropriate therapy is to
(A) increase the halothane concentration to 1.25%
(B) discontinue the succinylcholine infusion
(C) increase minute ventilation to 7.5 L/min
(D) administer potassium 5 mEq intravenously over one minute followed by propranolol 0.25 mg
(E) measure arterial blood gas and serum electrolyte values
Upon removal of the epidural catheter after uneventful labor and delivery in a 25-year-old primiparous woman, approximately 1.2 cm of the Teflon catheter is left behind in the epidural space. The patient is informed of the complication. The most appropriate management is
(A) immediate surgical removal
(B) prophylactic antibiotics
(C) lumbar myelogram
(D) monthly neurologic examinations
(E) no intervention
E
A patient is undergoing cholecystectomy with enflurane, nitrous oxide, fentanyl, and oxygen. He takes theophylline and cromolyn sodium for bronchial asthma. During skin incision he has bilateral wheezing; peak inspiratory pressure is 50 cmHzO, and the ECG shows occasional premature ventricular contractions. The most appropriate management is to
(A) switch from enflurane to isoflurane
(B) administer lidocaine intravenously
(C) administer methylprednisolone intravenously
(D) administer nebulized cromolyn sodium
(E) administer nebulized metaproterenol
E
A 19-year-old woman has severe nausea and vomiting following laparoscopy. After intramuscular administration of prochlorperazine 10 mg, she has muscle spasms in the face, neck, and tongue. Which of the following is the most appropriate management?