Supplemental Online Lesson

Lesson S05: PreAnesthetic Assessment of the Patient for Deep Brain Stimulation

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

Release Date: March 1st, 2009
 Termination Date:  March 31st, 2010

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.

With an expanding society of persons living to advanced age, movement disorders such as Parkinson’s disease remain consistently prevalent. Deep brain stimulation is a recognized approach to management of uncontrollable movement. This technique has advanced significantly over the past 4 decades and the role of the anesthesiologist is vital to achieving a positive outcome. To provide optimal care, the anesthesiologist should possess a clear understanding of the procedure, the specific needs of patient, and the requirements of the surgical team.

A 76 year old male with Parkinson’s disease was scheduled for insertion of electrodes for deep brain stimulation. The patient was alert and oriented. A marked tremor interfered with his quality of life. Current medications included levodopa (Sinemet®), bromocriptine (Parlodel®), selegiline (Eldepryl®), pramipexole (Mirapex®) and amantadine (Symmetrel®). This regimen afforded only fair movement control. He was clinically depressed and sertraline hydrochloride (Zoloft®) had been prescribed. He had a history of hypertension which was treated with hydrochlorothiazide and diltiazem; diabetes, controlled with diet and glyburide; and gastroesophageal reflux disease.

LEARNING OBJECTIVES

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

1. List indications for deep brain stimulation.

2. Describe the salient features of Parkinson’s disease.

3. Outline preanesthetic assessment of the patient with Parkinson’s disease.

4. Identify the target for deep brain stimulation for Parkinson’s disease.

5. List complications of the procedure.

6. Outline an anesthetic plan for each stage.

7. Describe the signs, symptoms and treatment of air embolism.

8. List the effects of dexmedetomidine.

9. Explain what is required of the patient during deep brain stimulation.

10. List the anesthetic concerns for a patient with Parkinson’s disease.

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