A 15-year-old previously healthy boy is scheduled for a celiotomy to relieve an acute intestinal obstruction. A rapid sequence induction is used. Anesthesia is maintained with a balanced technique including nitrous oxide and oxygen (5L:2L), meperidine, and pancuronium. Because of abdominal distention and the high pressure required for inflation of the lungs, a nasogastric tube is inserted. The abdomen remains distended, but compliance improves dramatically. At this time the patient is cyanotic, PaO2 is 48 mmHg, PaCO2 is 52 mmHg, and pH is 7.29. Nitrous oxide is discontinued. The most important therapeutic measure is to
(A) remove the nasogastric tube
(B) insert a chest tube on the right side
(C) withdraw the endotracheal tube 1 cm
(D) deflate the cuff on the endotracheal tube
(E) replace the endotracheal tube with one of larger internal diameter
Recognized side effects of magnesium sulfate used for the treatment of preeclampsia that would be of anesthetic concern include each of the following EXCEPT
(A) maternal pulmonary edema
(B) neonatal hypotonia
(C) increased maternal sensitivity to succinylcholine
A 70-kg, 46-year-old man is undergoing clipping of a cerebral aneurysm with nitrous oxide, opioid, relaxant anesthesia. He is otherwise healthy. As the surgeons are about to enter the dura, the brain is noted to be tense and bulging. Heart rate is 100 bpm and mean arterial pressure is 90 mmHg. PaO2 is 120 mmHg, PaCO2 is 23 mmHg, and pH is 7.50. Which of the following should be done immediately?
(A) Hyperventilation to a PaCO2 of 15 to 20 mmHg
(B) Administration of furosemide 20 mg intravenously
(C) Administration of mannitol 0.5 g/kg
(D) Administration of thiopental 250 mg in increments