A 25-year-old woman undergoes a difficult open cholecystectomy during anesthesia with isoflurane, nitrous oxide, fentanyl, and vecuronium. Five units of blood are administered intraoperatively. Two days later, the patient has mildly increased serum transaminase concentrations and markedly increased alkaline phosphatase and direct bilirubin concentrations. Which of the following is the most likely cause?
A 62-year-old patient undergoes resection of a descending thoracic aneurysm under anesthesia with morphine, nitrous oxide, oxygen, and pancuronium. In spite of normal somatosensory evoked potentials (SSEP) during the procedure, the patient has paraplegia postoperatively. The factor most likely responsible for failure to note the deficit intraoperatively is
(A) the effect of nitrous oxide on SSEP
(B) the effect of morphine on SSEP
(C) failure to test motor pathways
(D) hyperventilation to a PaC02 of 30 mmHg
(E) unintentional hypothermia to 34°C
C
A 25-year-old man requires exploratory laparotomy following a motor vehicle accident. He is acutely intoxicated with alcohol. Which of the following is the most likely result of the alcohol ingestion?
(A) Hyperdynamic circulation
(B) Hyperglycemia
(C) Hyperthermia
(D) Increased respiratory depression from opioids
(E) Increased sensitivity to neuromuscular blocking drugs
A 58-year-old man undergoes repeat coronary artery bypass grafting. Which of the following is LEAST likely to decrease the need for exogenous blood transfusion?
(A) Cell saver blood collection before and after cardiopulmonary bypass
(B) Epsilon-aminocaproic acid administered during cardiopulmonary bypass
(C) High-dose aprotinin administered during cardiopulmonary bypass
(D) Tranexamic acid infusion during cardiopulmonary bypass
(E) Desmospressin administered after cardiopulmonary bypass
E
Compared with healthy nonhypertensive patients, in patients with untreated hypertension undergoing anesthesia and operation,
(A) cerebral ischemia may occur at higher blood pressures
(B) intravenous fluid should be restricted before induction
(C) left ventricular hypertrophy enhances compensation for intraoperative fluid loss
(D) responses to sympathetic stimulation are decreased
(E) the incidence of intraoperative hypotension is lower