Which of the following attenuates the most common cardiovascular side effect of protamine administration?
(A) Pretreatment with a diuretic
(B) Pretreatment with a prostaglandin inhibitor
(C) Pretreatment with a pulmonary vasodilator
(D) Injection via the distal lumen of the pulmonary artery catheter
(E) Slow peripheral intravenous injection
E
A patient has seizure activity 30 seconds after injection of 0.25% bupivacaine 2 ml with epinephrine 1:200,000 for stellate ganglion block. The most likely cause is
(A) reaction to epinephrine in the anesthetic solution
A 70-kg, 22-year-old man who is unconscious after a closed head injury is to undergo emergency splenectomy. He is anesthetized with thiopental, given pancuronium for paralysis, and started on nitrous oxide and oxygen 50% each with controlled ventilation (tidal volume 700 ml, rate 10/min). Pulse is 70 bpm, blood pressure is 160/100 mmHg, PaO2 is 65 mmHg, PaC02 is 45 mmHg, and pH is 7.30. In adjusting the ventilator at this time, which of the following is most appropriate?
A comatose 40-year-old man is to undergo evacuation of an acute subdural hematoma. His left pupil is dilated and blood is present behind the left tympanic membrane. Each of the following is an acceptable intervention EXCEPT
(A) application of 5 cm H20 positive end-expiratory pressure
(B) blind nasotracheal intubation
(C) use of isoflurane
(D) use of nitrous oxide
(E) use of succinylcholine
B
In a 65-year-old man, which of the following findings on preoperative pulmonary function testing is associated with the highest risk for respiratory insufficiency following pneumonectomy?
(A) Maximum voluntary ventilation at 65% of predicted
(B) Mean pulmonary artery pressure of 28 mmHg
(C) Predicted postoperative forced expiratory volume in one second (FEV1) of 800 ml
(D) Residual volume to total lung capacity (RV/TLC) ratio of 0.35
One hour after induction of anesthesia for a posterior fossa craniotomy using opioid, relaxant, and nitrous oxide, the brain begins to protrude through the dura. The most effective measure to decrease intracranial pressure is to
The two E oxygen cylinders on an anesthesia machine have pressure readings of 1100 psi each. At an oxygen flow of 3 L/min, there will be sufficient oxygen for approximately