Lesson 291: PreAnesthetic Assessment of the Patient With Systemic Lupus Erythematosus

Authored By:

Sharon Carrillo, Medical student, Louisiana State University School of Medicine, New Orleans, Louisiana. Dr. Carrillo is now a resident in anesthesiology with Ochsner Clinic Foundation, in New Orleans; and Alan D. Kaye, MD, PhD, Professor and chairman, Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana

Registration Fee: $15.00
2.0 AMA PRA Category 1 CreditsTM
available until April 30, 2012

Reviewed By:

Elizabeth A.M. Frost, MD, Clinical professor, Department of Anesthesia, Mount Sinai Medical Center, New York, New York

Review Date: March, 2011
REGISTRATION INFORMATION:

Participants who do not possess a copy of Anesthesiology News can download and print the course material in an easy to read convenient  format.  Participants must 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).  

Click on the link below to download and print the course material and post-test exam.  Register for the exam to enter your responses to receive CME credit.  There are ten questions in the examination and you must achieve a score of 80% 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.

The registration fee for this course is $15.00

Physicians are provided with two opportunities to successfully complete the exam presented here. 

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CLICK HERE TO VIEW / PRINT COURSE MATERIAL

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NEEDS STATEMENT

Systemic lupus erythematosus (SLE) is an autoimmune, connective tissue disorder with multiple manifestations that complicate the functionality of key target organs. Persistent autoantibodies cause pathologic processes in systems that affect anesthetic practice. Anesthesiologists should be able to appropriately manage patients with SLE perioperatively. Drugs used in treating SLE and associated organ dysfunctions—particularly cardiac, neuromuscular, pulmonary, renal, hepatic, and hematologic—influence management of anesthesia.

CASE HISTORY

A 32-year-old woman with long-standing SLE presented to the preoperative area with new-onset kidney failure. She was scheduled for surgery to create an arteriovenous shunt and place a temporary dialysis catheter. Electrolyte analyses were normal. Hemoglobin and hematocrit levels were 13 g/dL and 39.1%, respectively. Blood urea nitrogen and creatinine levels were 54 and 3.8 mg/dL, respectively. Vital signs were within normal limits and oxygen saturation by pulse oximetry (SpO2) on room air was 99%. The patient had received glucocorticoid therapy in the past. Recently, she had been taking 200 mg of celecoxib once daily for joint pain. She had never before undergone surgery.

LEARNING OBJECTIVES

At the end of this activity, the participant should be able to:

    1. Define SLE.
    2. Review the pathophysiology and anesthetic implications of SLE.
    3. Describe the mucocutaneous and systemic manifestations seen in patients with SLE.
    4. Explain the pathogenesis of SLE.
    5. Apply appropriate preoperative testing and evaluation of patients.
    6. Evaluate laboratory findings.
    7. Present an anesthetic and analgesic plan.
    8. Outline treatment options.
    9. Cite the incidence and prevalence of SLE.
    10. Anticipate, recognize, and manage likely perioperative complications.

TARGET AUDIENCE:  Anesthesiologists

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

The author, the reviewer, and the editor have no relation-ships 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.contact7@proceo.com.

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