| NEEDS STATEMENT
Tracheoesophageal fistula (TEF) and associated esophageal
atresia (EA) in the neonate present during the first week of life.
These congenital defects can be complicated by aspiration,
respiratory distress, and other congenital anomalies. The
knowledge and ability of the anesthesiologist to anticipate
challenges in managing neonates requiring repair play an important
role in the treatment and survival of patients. Also, it is not
uncommon for anesthesiologists to care for patients later in life
following repair of TEF. A familiarity with immediate
complications and long-term outcomes and sequelae after TEF repair
is important. The management of neonatal anesthesia has been
identified by committee as required information for
anesthesiologists.
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| CASE HISTORY An
11-year-old girl presented with shortness of breath,
related to physical activity, that had been occurring for
2 months. For the previous 2 days she had also been
experiencing dyspnea at rest. Her medical and surgical
history was complicated, including repair of TEF,
ventricular septal defect, and patent ductus arteriosus
during infancy, and anterior cricoid split and
medialization thyroplasty at the age of 9 years. An
examination with flexible fiber optics revealed
laryngotracheal stenosis, immobility of the left true
vocal cord, and apparent granulation tissue or a foreign
body causing an almost complete obstruction of the larynx.
The patient was scheduled for direct laryngoscopy,
bronchoscopy, and possible tracheostomy under general
anesthesia.
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LEARNING OBJECTIVES
At the end of this activity, the participant should be able
to:
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Summarize the special anesthetic
problems associated with managing the neonate with EA and TEF.
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Describe the generally accepted
classification systems of EA and TEF.
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List associated anomalies.
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Describe the embryologic
development of EA and TEF.
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Identify the main
pathophysiologic entities associated with EA and TEF.
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Describe the clinical features
of TEF.
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Develop an anesthetic plan.
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List potential perioperative
complications.
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Discuss the prognosis after TEF
repair.
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Describe the long-term sequelae
of TEF repair.
TARGET AUDIENCE: Anesthesiologists
INSTRUCTIONS FOR COMPLETING THIS COURSE
The estimated time to complete this activity is 2 hours. There
are two options for completing this CME activity.
Option 1: Exam Only. This option can only be
exercised by subscribers to Anesthesiology News who possess
a material copy of the course. Participants who select this
option must read the article in the journal, reflect on the information
presented, and then register to complete the exam and course evaluation
online before the availability date listed above. (CME credit is not valid past this
date.)
To register for the exam only, click on the Register For Exam link
located at the bottom of this page. DO NOT select this option if you
do not possess a material copy of the CME course material.
There are ten questions in the examination and you must achieve
a score of 70% or better to earn CME credit. Following successful
completion, your certificate will be immediately available online.
In addition, a historical record of completed CME courses is
maintained online in an individualized profile. This includes
copies of course certificates which can be printed at any time.
Option 2: Course Material and Exam. All participants
are eligible for this option.
You must first register for this course by clicking the "Register
for Course" link located at the bottom of this page. Course
material is presented in small digestible sections followed by exam
questions pertaining to the information in the segment covered.
As you read through the material on the course pages, you will occasionally
be prompted to answer exam questions.
There are several short pages of information and 10 multiple choice
questions presented in this course. You must achieve a minimum
grade of 70% (7 correct answers) to receive CME credit. The exam and
course evaluation must be completed before the availability date
listed above. (CME
credit is not valid past this date.)
The course software does not permit you to page back from the exam
questions. You must be sure that you understand the material
presented on each page before proceeding.
When you have answered the last exam question, the Course Results
page will display. This page will contain your final grade and allow
you to immediately view/print your Certificate if you have achieved
the minimum passing score of 70%.
Upon successful completion, your Certificate will be available
at all times from your Student Control Panel. In addition,
a historical record of completed CME courses is maintained online
in an individualized profile. This includes copies of course
certificates which can be printed at any time.
The course does not need to be completed in a single online session.
You can log off at any point and return to the course at your convenience.
If you wish to obtain more information regarding the features of this
site, you may visit the Orientation page.
Click here to view Orientation.
REGISTRATION
The registration fee for this course is $15.00
Physicians are provided with two opportunities to complete the
course presented here.
Accreditation Statement
Mount Sinai School of Medicine is accredited by the Accreditation
Council for Continuing Medical Education (ACCME) to provide continuing
medical education for physicians.
Credit Designation: The Mount Sinai School of Medicine designates
each educational activity for a maximum of 2 AMA PRA Category 1 CreditsTM.
Physicians should only claim credit commensurate with the extent of
their participation in the activity.
It is the policy of Mount Sinai School of Medicine to ensure objectivity,
balance, independence, and scientific rigor in all CME-sponsored educational
activities. All faculty participating in the planning or implementation
of a sponsored activity are expected to disclose to the audience any
relevant financial relationships and to assist in resolving any conflict
of interest that may arise from the relationship. Presenters must
also make a meaningful disclosure to the audience of their discussions
of unlabeled or unapproved drugs or devices.
Disclosures
Dr. Kaye has disclosed that he is a member of the speakers’
bureau of Baxter. The authors and editor have no relationships
with pharmaceutical companies or manufacturers of products to
disclose. This educational activity may contain discussion of
published and/or investigational uses of agents for the treatment
of disease. Some uses of these agents have not been approved by
the FDA. Please refer to the official prescribing information for
each product for approved indications, contraindications, and
warnings.
CONTACT INFORMATION
Questions regarding course content may be directed to Dr. Elizabeth
Frost: ElzFrost@aol.com.
If you require technical assistance with completing this
course, please contact Continuing Education Online Customer Service
at 718-648-8080 or send e-mail to
CEO.support6@proceo.com.
All other requests for administrative assistance should be directed
to Josephine Greene in the CME office at the Mount Sinai School of
Medicine : 212-241-4441 or send email to
Josephine.Greene@msnyuhealth.org
CALL FOR WRITERS
If you would like to write a CME lesson in Anesthesiology News,
please send an e-mail to Elizabeth A.M. Frost, MD, at
ElzFrost@aol.com
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This option is for the examination
ONLY. No course material is provided. This option
is available for subscribers of Anesthesiology News who
possess a material copy of the course material. DO NOT select
this option if you do not have the course material. |
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This option is available for all participants. This option
includes a full online text version of the course material and
exam. |
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