During insufflation of the peritoneal cavity with carbon dioxide at the start of laparoscopy, heart rate increases to 140 bpm, blood pressure decreases to 70/40 mmHg, and a loud murmur is heard through the esophageal stethoscope. The most appropriate immediate step is to
A combined epidural and general anesthetic is used for aortofemoral bypass surgery. Just prior to extubation, the patient received morphine 5 mg through the epidural catheter. Eleven hours later, he is unresponsive while breathing 40% oxygen from a face mask. Respiratory rate is 6/min and SpO2 is 92%. Arterial blood gas analysis shows PaO2 80 mmHg, PaCO2 84 mmHg, and pH 7.16. Which of the following statements concerning this patient is true?
(A) Hypercarbia is contributing to the decreased level of consciousness
(B) Naloxone is ineffective for reversing the respiratory depression
(C) The oxygen saturation is higher than expected because of the pH
(D) The risk for respiratory depression would have been lower with subarachnoid administration of 0.5 mg morphine
(E) Residual local anesthetic is contributing to the respiratory depression
An unvaccinated health care worker is stuck by a needle contaminated with blood from an HBsAg-positive patient. Which of the following statements concerning this situation is true?
(A) The risk for development of HIV infection is greater than the risk for development of hepatitis
(B) Hepatitis immune globulin is indicated if the health care worker is HBcAg positive
(C) Hepatitis B vaccine should be administered
(D) Hepatitis immune globulin will protect equally against hepatitis B and hepatitis C (non-A, non-B)
(E) Hepatitis B vaccine carries a risk for transmission of HIV
Pulmonary artery occlusion pressure is NOT a reliable estimate of left ventricular end-diastolic pressure when
(A) junctional cardiac rhythm is present
(B) mitral insufficiency is present
(C) pulmonary compliance is decreased
(D) pulmonary hypertension is present
(E) the catheter tip is in zone 1 of the lung
E
A 33-year-old woman is scheduled for emergency appendectomy under general anesthesia. She has hypertrophic cardiomyopathy and has had two episodes of syncope in the past year. Which of the following statements concerning anesthetic management is true?
(A) Spinal anesthesia is preferred to general anesthesia
(B) Deep levels of isoflurane anesthesia are appropriate
(C) Fluid administration should be restricted
(D) Phenylephrine is preferred to ephedrine to treat hypotension
(E) Positive end-expiratory pressure will decrease left ventricular outflow obstruction
A Fluotec vaporizer is set to administer halothane 4% using a fresh gas flow of 4 L/min. If the diluent gas flow is increased to 8 L/min, and at the same time the room temperature increases from 20 to 25°C, the approximate concentration of halothane delivered to the patient would be
Which of the following drugs is contraindicated in patients with Parkinson's disease?
(A) Atropine
(B) Dopamine
(C) Droperidol
(D) Fentanyl
(E) Isoflurane
C
A 62-year-old man, who had a myocardial infarction three years ago, complicated by congestive heart failure and renal failure, is undergoing a colectomy. A pulmonary artery catheter demonstrates a cardiac output higher than measurements recorded during a cardiac catheterization two months after the infarction. Which of the following most likely contributes to the increased cardiac output?
(A) Creation of an arteriovenous fistula
(B) Increased hemoglobin concentration from 10 to 12 g/dL
(C) Stimulation of carotid body receptors
(D) Transcutaneous nitroglycerin
(E) Use of a beta-adrenergic blocker to prevent myocardial reinfarction