Supplemental Online Lesson

Lesson S17: PreAnesthetic Assessment of the Patient for Lumbar Spinal Surgery - Part 2

Registration Fee: $15.00
2.0 AMA PRA Category 1 Credits^TM
available until March 31, 2012

Review Date: March, 2011

REGISTRATION INFORMATION FOR SUPPLEMENTAL LESSONS:

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.

Surgical interventions to alleviate back pain are the most common procedures performed by neurosurgeons and orthopedists. Patients frequently possess multiple comorbidities that impact anesthetic care.  The use of regional anesthesia has been suggested as a means to improve outcome.

This is the second segment of two part activity.   Part 1 addressed the surgical approach with a discussion of the performance of general patient history and physical examination including a detailed description of appropriate cardiac evaluation.  Part 2 expands on co-morbid conditions that are commonly seen in the older patent presenting for complex lumbar surgery and describes pulmonary evaluation, the problems of obstructive sleep apnea, obesity, renal insufficiency, diabetes, hematological considerations and drug interactions.

CASE HISTORY

A 67 year old gentleman with a height of 68 inches and weight of 295lbs was scheduled for T8-L4 laminectomies and instrumentation for intractable back pain. He had undergone 2 lumbar surgeries within the past 12 years and had been attending a pain clinic for 9 months with little improvement in his symptoms. Other medical history includes hypertension, treated with beta and calcium channel blockers for 20 years, hypercholesterolemia and a smoking history, 1 pack per day for 50 years. Recently Captopril®, an angiotensin converting enzyme inhibitor, was added to his medication regimen. Physical examination reveals a BP 155/95, HR 53, Hb 14.6, serum glucose 174. He wears eye glasses.

On examination of the infant in the preoperative holding area, he appeared to be vigorous; he weighed 5 kg, his heart rate was 137 beats per minute, oxygen saturation on room air was 96%, and respiratory rate was 40 breaths per minute. Breath sounds were clear on auscultation. No laboratory tests were ordered preoperatively. Hematocrit level was 29% at the time of discharge from the hospital 4 weeks previously. The decision was made to proceed with a spinal anesthetic, and parental consent was obtained.

LEARNING OBJECTIVES

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

1. State time for return of normal lung function after cessation of smoking.
2. Describe the ASA risk scoring system for OSAS.
3. Compare the ASA risk scoring with the STOP questionnaire.
4. Differentiate between creatinine and creatinine clearance.
5. Identify the relationship between carboxyhemoglobin and oxygen availability.
6. List anesthetic concerns in the obese patient.
7. Describe the signs and symptoms of pulmonary hypertension.
8. Understand why polycythemia and thrombocytosis should be identified and treated.
9. Advise a patient as to which drugs should be discontinued prior to surgery.
10. Present an anesthetic plan. .

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, the reviewer, and the editor have no relation-ships 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