NEW!! Supplemental Online Lessons!!

Lesson S01: PreAnesthetic Assessment of the Patient for Major Back Surgery

Registration Fee: $15.00
2.0 AMA PRA Category 1 Credits^TM

Release Date: July 1st, 2008
 Termination Date: July 31st, 2009

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.

In a survey of 801 anesthesiologists conducted by the Anesthesia Patient Safety Foundation, blindness due to anesthetic technique was viewed as “high priority” by 49% of the respondents and was ranked 11th highest among the total of 53 patient safety issues. Because the incidence of this complication appeared to be increasing, the American Society of Anesthesiologists established a registry in July 1999 to collect data in an attempt to identify risk factors. Although a single cause has not been specifically identified, much useful information has been gathered and the practicing anesthesiologist should be knowledgeable as to possible mechanisms, outcome statistics and preventive measures.

A 57 year old bus driver presented to the pain clinic with severe back pain. He had undergone multilevel laminectomies in the past with short lived relief. Results of epidural steroid injections and many analgesic drug and herbal therapies had also been disappointing. Repeat MRI at this time indicated severe spinal stenosis and osteophytes. Consultation with a neurosurgeon and an orthopedist resulted in a recommendation for repeat surgery with wide dissection and instrumentation. He gave a past history of heavy smoking although recently he had tried to decrease his intake. He was known to be hypertensive and was maintained on monopril, hydrochlorothiazide and diltiazem. Previous surgeries were without anesthetic complications. Laboratory tests were within normal limits except for a blood sugar level of 157mg/dl. He weighed 125kg, height 5’10”. BP was recorded at 160/95. He required glasses for reading. He donated 2 units of autologous blood 10 and 3 days before surgery. Immediately before surgery, his Hb was 14.1g. At the preanesthetic assessment visit the patient asked the anesthesiologist what, if any, risks are there to him undergoing this procedure.

LEARNING OBJECTIVES

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

1. Cite the incidence of postoperative visual problems.

2. Identify risk factors for postoperative visual problems.

3. Be familiar with the ASA Postoperative Visual Loss Registry.

4. Understand the difference between anterior and posterior ischemic optic neuropathy.

5. Realize the several procedures in which visual difficulties may occur.

6. Present an anesthetic plan for the patient who must undergo extensive back surgery.

7. Define central retinal artery occlusion.

8. Describe appropriate blood replacement after major loss.

9. Be aware of the responsibility of the anesthesiologist as to positioning and pressure point protection during surgery.

10. Describe appropriate postoperative consultation and care for the patient with visual loss.

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