| NEEDS STATEMENT
Central anticholinergic syndrome can be caused by various
chemical compounds, including over-the-counter medications. The
clinical presentation is highly variable. Physicians—especially
anesthesiologists—should be aware of patients at risk. Medications
recently ingested by the patient and medications required during
general anesthesia must be accurately reported and the potential
for anticholinergic blockade established, so that prompt and
efficacious therapy may be applied.
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| CASE HISTORY A
19-year-old man stationed as a soldier in central Europe,
who was 5 ft 7 in tall, weighed 72 kg, and was otherwise
healthy, was transferred to a hospital emergency room for
repair of a severe leg wound sustained in an accident. The
man had attended a local religious ritual (of the German
revival religion Odinism) and consumed a large amount of
mandrake (genus Mandragora), a plant of the nightshade
family. He had assumed it was a species of tomato, and
after ingesting enough to become anxious, hallucinated,
and confused, he had fallen on a sharp gardening blade. A
review of his signs and symptoms revealed blurred vision,
ataxia, mydriasis, tachycardia at 114 beats per minute,
and a dry throat. The patient was scheduled to undergo
incision, exploration, and either repair or possible
amputation of his left leg.
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LEARNING OBJECTIVES
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Cite plants and pharmaceuticals
that are common causes of anticholinergic syndrome.
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Summarize the clinical symptoms
and signs of anticholinergic syndrome.
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Describe the treatment for
anticholinergic syndrome.
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Provide details of the
pathophysiology of the disorder.
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Review a differential diagnosis of
affected patients.
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Present an appropriate anesthetic
plan for patients.
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List common anesthetics associated
with anticholinergic syndrome.
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Describe how the use of
antimuscarinics can induce anticholinergic syndrome.
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Identify the role of physostigmine
in the treatment of patients with anticholinergic syndrome.
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Discuss the role of insecticides
and other classes of biocides (including potential agents for
bioterrorism) in inducing anticholinergic syndrome.
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 other authors, 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.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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