Lesson 283: PreAnesthetic Assessment of the Patient With von Hippel-Lindau Syndrome

Registration Fee: $15.00
2.0 AMA PRA Category 1 Credits^TM
available until December 31, 2010

Review Date: May, 2009 

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. 

Software Requirements: Adobe Acrobat Reader and any standard Internet Browser.

Anesthesiologists are trained to appreciate and respond appropriately to the considerable consequences of pheochromocytomas. It is, however, less appreciated that the tumors also may be associated with other syndromes that pose significant risk for patients undergoing anesthesia.

CASE HISTORY

A 23-year-old man whose medical history was significant for vHLS presented for a laparoscopic right partial nephrectomy. The patient was diagnosed with renal cell carcinoma, found incidentally on a computed tomography (CT) scan to assess for rib fractures after a motor vehicle accident. The patient’s surgical history was significant for a craniotomy with tumor resection (9 years earlier) secondary to hemangiomas related to vHLS, and a right total adrenalectomy and left partial adrenalectomy (8 years earlier) to remove pheochromocytomas. Other than the renal cell carcinoma, no other lesions secondary to vHLS had recurred. The patient—183 cm tall, weighing 100 kg, with blood pressure of 125/78 mm Hg, and heart rate of 80 beats per minute—was taking medication that included a muscle relaxant for the treatment of back spasms after the accident. He was otherwise asymptomatic.

LEARNING OBJECTIVES

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

1. Cite the perioperative mortality rate for diagnosed pheochromocytoma.
2. Describe the pathophysiology of pheochromocytoma.
3. Discuss the association between pheochromocytoma and other syndromes.
4. Identify the “rule of 10s.”
5. Present an anesthetic plan for patients with von Hippel-Lindau syndrome (vHLS).
6. List the 3 familial syndromes of multiple endocrine neoplasia (MEN).
7. Describe the characteristics of vHLS.
8. Identify appropriate laboratory studies to diagnose pheochromocytoma.
9. Estimate the age-related prevalence of adrenal incidentalomas.
10. Manage the postanesthetic care of a patient with vHLS.

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 Credits^TM. 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, reviewer, 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.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