A 62-Year-Old Woman Undergoes Hip Replacement Surgery

A 62-year-old woman undergoes hip replacement surgery.  The patient has a history of advanced hip osteoarthritis that limits her daily activities.  She has no other medical conditions and no known drug allergies.  After appropriate preoperative evaluation, total hip arthroplasty is performed under general anesthesia.  The intraoperative course is uncomplicated, and after recovery from anesthesia, patient-controlled intravenous morphine is started for pain control.  Several minutes later, the patient reports generalized itching.  Physical examination reveals hypotension, tachycardia, and mild bilateral wheezing but no rashes.  Which of the following drug effects is most likely responsible for this patient's current condition?

A) Decreased myocardial contractility
B) Decreased sympathetic output
C) Direct mast cell degranulation
D) Formation of drug-IgE complexes
E) Increased 5-lipoxygenase activity

Correct Answer:

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