(B) abdominal pain secondary to chronic pancreatitis
(C) persistent chest wall pain secondary to intercostal neuralgia following a thoracotomy for trauma
(D) reflex sympathetic dystrophy of the upper extremity with an excellent but transient response to a series of stellate ganglion blocks with local anesthetic
(E) a diabetic patient scheduled for surgical sympathectomy to relieve unilateral lower extremity pain secondary to severe peripheral vascular disease
A 65-year-old man is disoriented and has a headache and nausea in the recovery room 30 minutes after transurethral resection of the prostate with glycine irrigation performed under spinal anesthesia. Heart rate is 50 bpm and blood pressure is 180/110 mmHg. Which of the following is LEAST likely?
A 30-year-old woman undergoes thyroidectomy under general endotracheal anesthesia. Immediately after extubation while breathing spontaneously, she has laryngospasm that resolves after 60 seconds of continuous positive airway pressure applied by face mask. In the PACU, she develops shortness of breath, tachypnea, hypoxemia, and rales. Which of the following is the most likely diagnosis?
Postoperatively, a patient is being mechanically ventilated by a constant-flow, pressure-cycled ventilator with the following initial settings: inspiratory/expiratory (I/E) ratio of 1:2, peak inspiratory pressure (PIP) of 25 cmH2O, and rate of 10/min. One hour later, the I/E ratio is 1:4. Which of the following would ensure that the minute ventilation is the same as that initially set?
(A) Inflate the endotracheal tube cuff to prevent leakage
(B) Double the respiratory rate
(C) Decrease the expiratory pause until the I/E ratio is 1.0
An endobronchial Robertshaw tube is inserted for resection of a midesophageal tumor under isoflurane, oxygen, pancuronium anesthesia. Forty minutes into a planned two-hour resection, arterial blood gas values are reported as PO2 45 mmHg, PCO2 45 mmHg, and pH 7.33. Ten minutes earlier, the values were PO2 210 mmHg, PCO2, 41 mmHg, and pH 7.39. The first action should be to
(A) reposition the Robertshaw tube
(B) apply positive end-expiratory pressure to the ventilated lung
(C) reinflate and ventilate the non ventilated lung
A 50-year-old man who takes aspirin and nifedipine is scheduled for thoracotomy with one-lung ventilation. Which of the following is associated with the greatest risk for intraoperative hypoxemia?
(A) Preoperative withdrawal of nifedipine therapy
(B) Intraoperative mild respiratory acidosis
(C) Intraoperative administration of isoflurane
(D) Intraoperative administration of nitroglycerin
During use of the ventilator on an anesthesia machine, positive pressure is noted on the airway pressure gauge during exhalation. Positive end-expiratory pressure has not been purposefully added to the breathing circuit. Which of the following is the most likely cause?
(A) Closure of the pop-off valve in the circle system
(B) Excessive tidal volume settings on the ventilator
(C) Obstruction of the pressure relief valve on the scavenging system
(D) Overinflation of the endotracheal tube balloon
A neurologically intact 48-year-old woman is scheduled for removal of a parietal lobe arteriovenous malformation. The relative risk for complete resection is to be determined by a test occlusion of the feeding artery. Which of the following intraoperative monitoring techniques is most appropriate for this test?
(A) Brain stem auditory evoked potentials
(B) Cerebral blood flow using radioactive xenon
(C) EEG
(D) Evoked potentials elicited by stimulating the posterior tibial nerve