In a 35-year-old patient, which of the following is associated with an increased duration of clinical narcosis following infusion of a total dose of 10 mg/kg thiopental over three hours?
Four days after subarachnoid hemorrhage and surgical clipping of a cerebral aneurysm, a patient develops cerebral artery vasospasm. Appropriate treatment includes each of the following EXCEPT
(A) administration of nimodipine
(B) controlled hypertension
(C) hemodilution to hematocrit of 33%
(D) hyperventilation to PaC02 of 25 to 30 mmHg
(E) increasing preload
D
Two days after myocardial infarction involving the left anterior descending coronary artery, a patient's blood pressure decreases acutely from 125/80 to 70/40 mmHg, heart rate increases from 75 to 90 bpm, pulmonary artery pressure increases to 50/30 mmHg, and urine output decreases from 60 to 10 ml/hr. Thermodilution cardiac output has increased from 4 to 7 L/min. The most appropriate action is to
(A) compare mixed venous oxygen saturation in the right atrium and pulmonary artery
(B) draw blood for culture and start antibiotic therapy
(C) start dopamine infusion in low dose
(D) administer a fluid challenge
(E) monitor peripheral capillary oxygenation by transcutaneous oximetry
A 48-year-old woman with von Willebrand's disease is scheduled for a hysterectomy. The most appropriate initial preoperative therapy to decrease bleeding is administration of
Which of the following statements concerning metoclopramide is true?
(A) It is antagonized by concomitant administration of atropine
(B) It decreases gastrointestinal motility
(C) It decreases gastric secretion
(D) It lacks antiemetic properties
(E) It stimulates dopamine receptors
A
A 20-kg, 5-year-old boy under treatment for five days for a cerebral contusion not requiring an operation is still unconscious. After three days of mechanical ventilation, humidified oxygen 40% via T-tube is started. Arterial blood gas analysis shows PaO2 120 mmHg, PaCO2 44 mmHg, pH 7.48, and base excess +6. A nasogastric tube is in place and draining to gravity. Daily fluid therapy has been 5% dextrose in 0.5 normal saline solution 500 ml and 5% dextrose in lactated Ringer's solution 500 ml. Serum electrolyte concentrations are sodium 140, potassium 3.2, and chloride 91 mEq/L. Serum osmolality is 300 mOsm/L. Urine output averages 15 ml/hour. Dexamethasone 8 mg/day has been the only drug therapy. This patient most likely requires
Following induction of general anesthesia, mask ventilation and the initial attempt at intubation is unsuccessful. Which of the following procedures is most appropriate?