Ten days after sustaining burns over 40% of his body surface area, a patient requires greater than expected doses of vecuronium for adequate relaxation of skeletal muscle. The primary cause is increased
A 65-year-old patient with hypertrophic cardiomyopathy has chest pain prior to induction of anesthesia. Pulse is 80 bpm and blood pressure is 130/80 mmHg. The ECG (V5) shows sinus rhythm and new ST-segment depression. The most appropriate management is administration of
Twelve hours after an uneventful hysterectomy with lidocaine epidural anesthesia, a 70-year-old woman has partial paralysis of the lower extremities. She is receiving morphine 0.5 mg/hr through an epidural catheter and is pain free. On examination, definite motor loss is noted in the lower extremities, but no other deficits are apparent. The most appropriate action at this time is to
(A) administer naloxone
(B) substitute fentanyl for morphine infusion
(C) remove the epidural catheter
(D) obtain an MRI of the lumbar spine
(E) reassure the patient
D
In children with preoperative upper respiratory tract infection, which of the following is associated with the greatest risk for postoperative airway obstruction?
A 22-year-old woman with severe preeclampsia vaginally delivers a 3-kg infant after 12 hours of treatment with magnesium sulfate and continuous epidural infusion of bupivacaine 0.0625% and fentanyl 1 mcg/ml at 10 ml/hr. The infant is pink and hypotonic; heart rate is 110 bpm and blood pressure is 35/25 mmHg. Which of the following is the most appropriate initial management of the infant?
A 70-kg patient experiences pain on incision of a thigh abscess. The area around the abscess had been infiltrated with 30 ml of 1% lidocaine in 1:200,000 epinephrine. The local anesthetic was most likely ineffective because of
(A) acidosis at the site of the injection
(B) epinephrine-induced limitation of drug diffusion