Supplemental Online Lesson

Lesson S13: PreAnesthetic Assessment of the Patient With a History of Intraoperative Awareness

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

Release Date:July 1st, 2010
 Termination Date: July 31st, 2011

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.

Intraoperative awareness during anesthesia has been the subject of popular films receiving a good amount of publicity over the past few years.  Questions about the true incidence have arisen because of variable study results. A thorough understanding of all aspects of this phenomenon is considered to be required knowledge for practicing anesthesiologists.

A 36-year-old woman with a history of gastric reflux, depression and anxiety was scheduled for robotic myomectomy. Operating time was expected to be 3.5 hours. She reported that while anesthetized for an upper endoscopy 6 months prior, she heard the anesthesiologist and endoscopist arguing. She sensed that she was choking and was acutely aware of a tube being pushed down her throat.  She panicked and believed that she was going to die but was unable to move or signal her distress.  Since that procedure, she has experienced nightmares and symptoms of post-traumatic stress syndrome. Her medications included omeprazole, zolpidem and sertraline.  The patient’s weight was 275 lbs and her height measured 65 inches.  She reported that her internist recommended a sleep study to address her snoring but it had not been completed.

LEARNING OBJECTIVES

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

1. Define intraoperative awareness.

2. Describe diagnostic instruments used for recognition of awareness.

3. Cite risk factors for awareness.

4. Discuss the psychological impact of awareness.

5. Outline a management plan for the patient who reports intraoperative awareness.

6. List preoperative considerations for the patient who has experienced intraoperative awareness.

7. Discuss the prevention of awareness.

8. Recognize the limitation of brain function monitors.

9. State the incidence of postoperative awareness.

10. List the types of surgery most likely to result in awareness.

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