A 27-year-old man with chronic renal failure is to undergo revision of an arteriovenous graft. He insists on general anesthesia. Hemodialysis was completed two hours ago, and serum potassium concentration is now 5 mEq/L. Which of the following statements concerning anesthetic management of this patient is true?
(A) Enflurane is contraindicated
(B) Succinylcholine is contraindicated
(C) Neostigmine will be required in larger than usual dosage
(D) The duration of action of atracurium will be prolonged
(E) The duration of action of propofol will be unchanged
E
An obese, 35-year-old man had an episode of coughing followed by vomiting during induction of anesthesia for arthroscopy of the left knee. Intense wheezing developed bilaterally over five minutes. PaO2 is 60 mmHg, PaCO2 is 42 mmHg, and pH is 7.35. Optimal management following intubation of the trachea includes
(A) mechanical ventilation with positive end-expiratory pressure (PEEP), cancellation of surgery, and transfer to the intensive care unit
(B) saline lavage and continuation of surgery using halothane anesthesia
(C) cancellation of surgery and administration of corticosteroids and antibiotics
(D) thorough suctioning and proceeding with halothane anesthesia
(E) cancellation of surgery, vigorous mechanical ventilation, thorough suctioning, and administration of aminophylline
A 55-year-old man has quadriplegia after undergoing suboccipital craniotomy in the sitting position for treatment of acoustic neuroma. Which of the following is the most likely cause?
(A) Air embolism with the presence of a probe-patent foramen ovale
(B) Compression of the cervical cord related to neck flexion
(C) Jugular venous obstruction
(D) Postoperative tension pneumocephalus
(E) Sustained elevation of cerebral perfusion pressure
A 3-day-old infant is comatose 18 hours after surgical correction of transposition of the great vessels. Tracheal suctioning produces only a tachycardic response. Anesthesia included midazolam 0.5 mg/kg, fentanyl 60 mcg/kg, and pancuronium 0.3 mg/kg. Which of the following is the most appropriate first step in evaluation of this infant?
A 30-year-old woman develops urticaria immediately after administration of 2% 2-chloroprocaine for removal of a nevus on the chest wall. This reaction resolves with administration of diphenhydramine and the surgery is rescheduled. During the second procedure, a field block is performed using 10 ml of 1% lidocaine from a multidose vial. Within 10 minutes the patient develops urticaria and wheezing and has difficulty breathing. These symptoms resolve with administration of epinephrine. Which of the following substances is the most likely cause of these reactions?