A healthy 60-kg 52-year-old woman undergoing reduction mammoplasty is anesthetized with isoflurane and oxygen, and deliberate hypotension to 80/40 mmHg is induced with nitroprusside. Urine output through an indwelling urethral catheter has been 10 mL during the past hour. You should now
(A) administer furosemide 40 mg intravenously
(B) infuse normal saline solution until urine output reaches 35 mL/hr
(C) administer dopamine at 3 mcg/kg/min
(D) expect normal urine flow with restoration of normal blood pressure
A comatose 40-year-old man is to undergo evacuation of an acute subdural hematoma. His left pupil is dilated and blood is present behind the left tympanic membrane. Each of the following is an acceptable intervention EXCEPT
(A) application of 5 cm H20 positive end-expiratory pressure
(B) blind nasotracheal intubation
(C) use of isoflurane
(D) use of nitrous oxide
(E) use of succinylcholine
B
Which of the following statements concerning the pharmacokinetics of local anesthetics is true?
(A) Decreased molecular weight is associated with decreased incidence of allergic reactions
(B) Decreased protein binding is associated with decreased systemic toxicity
(C) Increased ionization is associated with increased placental transfer
(D) Increased lipid solubility is associated with faster onset
(E) Presence of an ester linkage is associated with increased duration of action
A 70-kg, 47-year-old man is undergoing a repeat coronary artery bypass graft. Following sternotomy, administration of heparin 300 units/kg for anticoagulation increases the activated coagulation time from a baseline of 135 sec to 210 sec. This finding is compatible with
A 72-year-old woman is somnolent one day after left carotid endarterectomy. She has smoked 2 packs of cigarettes daily for 50 years. Six weeks ago, she underwent right carotid endarterectomy. At this time, arterial blood gases while breathing room air are PO2, 45 mmHg, PCO2, 60 mmHg, and pH 7.30. Which of the following is the most likely cause of the increased PCO2?
A 50-year-old patient undergoes subtotal thyroidectomy for Graves' disease. In the immediate postoperative period, he has marked hoarseness but no stridor. The most likely cause of the hoarseness is trauma to the
(A) external branch of the superior laryngeal nerve
(B) internal branch of the superior laryngeal nerve
A 35-year-old patient with asymmetric septal hypertrophy (IHSS) is undergoing bladder suspension with sevoflurane 1%, nitrous oxide 50%, and oxygen 50%. Immediately after skin incision, blood pressure decreases to 90/60 mmHg and junctional tachycardia of 150 bpm is noted on the ECG. Which of the following is the most appropriate management?