A healthy 30-year-old woman is undergoing laparoscopy with carbon dioxide insufflation under nitrous oxide 50% in oxygen, isoflurane 0.5%, fentanyl 150 u.g, and controlled ventilation. During the first 15 minutes of the procedure, blood pressure decreases 30%. The most likely cause is
(A) anesthetic overdose
(B) compression of the vena cava
(C) gas embolization
(D) hypercarbia
(E) hypoxemia
B
Each of the following changes is expected with deliberate hypothermia EXCEPT
(A) decreased unloading of oxygen from hemoglobin
(B) a 5% decrease in MAC for each 1°C decrease in temperature
(C) increased arterial oxygen and carbon dioxide contents
(D) a 50% decrease in cerebral metabolic rate at 28°C
(E) spike and dome EEG activity at temperatures below 30°C
During induction of general anesthesia in a patient with a supraglottic tumor, both intubation and subsequent ventilation via a face mask are impossible. A cricothyroidotomy is performed with a 16-gauge intravenous catheter. Which of the following statements is true?
(A) Application of pressures greater than 35 cmH2O to the catheter will increase the risk for pulmonary barotrauma
(B) PaC02 can be maintained at a normal level using a standard circle system attached to the catheter
(C) PaO2 greater than 100 mmHg can be maintained indefinitely using transtracheal jet ventilation with pure oxygen through the catheter
(D) Emergency surgical tracheostomy would have improved the likelihood of survival
(E) The presence of this tumor contraindicates jet ventilation via cricothyroidotomy
A patient with a fasting blood glucose concentration of 100 mg/dL undergoes a four-hour operation under general anesthesia without intraoperative administration of glucose. On emergence the most likely finding will be
A 75-year-old man with a left bundle branch block is undergoing placement of a pulmonary artery catheter through the right internal jugular vein. He becomes pale and his heart rate decreases to 40 bpm when the catheter tip enters the right ventricle. The most likely cause is
A 45-year-old woman with mitral stenosis is scheduled for elective mitral valve replacement. Two minutes after tracheal intubation, she develops atrial fibrillation with a ventricular response rate of 150 bpm and a decrease in blood pressure to 75/45 mmHg. Which of the following is the most appropriate first step in management?
(A) Increasing the concentration of enflurane
(B) Increasing the infusion rate of lactated Ringer's solution
(C) Intravenous administration of digoxin
(D) Intravenous administration of propranolol
(E) Electrical cardioversion
E
A 27-year-old man with type I von Willebrand's disease requires internal fixation of an open fracture of the femur. Prothrombin time, partial thromboplastin time, and platelet count are normal. During surgery, there is significant oozing from the wound and the surgeon notes poor clot quality. The most appropriate therapy at this time is administration of
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