Supplemental Online Lesson

Lesson S06: PreAnesthetic Assessment of the Child with A Cold or Asthma

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

Release Date: May 1st, 2009
 Termination Date:  May 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.

Pediatricians, surgeons and anesthesiologists sometimes differ in opinion as to the best course of action for a child with asthma or respiratory infection who requires either scheduled or emergent surgery. The pediatrician may favor postponing the case until the patient is asymptomatic while a surgeon, with constraints in time and schedule, may wish to proceed. Administration of anesthesia is often cited as the most dangerous part of the procedure, although few studies confirm this supposition. The practitioner should be aware of available data to make a reasoned decision and appropriately advise all concerned.

A 4 year old boy was brought to the ambulatory unit by his parents on the morning of surgery. He was scheduled for repeat laser ablation surgery of a port wine stain of his leg.

Past medical history was remarkable for several “colds” for which he was treated with a nebulizer and antibiotics. He was not on any regular medications. His mother reported that he had a slight cold over the past two days and had complained of an earache. She administered baby aspirin on several occasions. A clear nasal discharge had resolved. He was reported to be a mouth breather with occasional asthma type symptoms when exposed to dog and cat hair. He had been sneezing recently but had only coughed on one or two occasions. Although his mother reported that he was slightly febrile at one point, his temperature was found to be normal. The patient and two siblings attended a school where two cases of chickenpox were reported in the last month but not among their close contacts. None of the children had developed a rash.

Physical examination showed an appropriate 4 year old. There was some crusting around his nose and slight throat redness. Inspection of the eardrums was normal. Auscultation of the chest revealed clear breath sounds with no wheezing. Pulse was 110 beats/min; blood pressure was recorded at 95/60; temperature was 98.9 degrees F; white cell count by finger stick was 9.9 th/cu.mm.

LEARNING OBJECTIVES

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

1. Define rhinitis and provide a differential diagnosis.

2. Describe the signs and symptoms of an upper respiratory infection.

3. Identify situations in which surgery for a child with a cold should be postponed.

4. Discuss circumstances in which surgery may proceed despite the presence of a runny nose.

5. List means to decrease postoperative critical incidents.

6. Describe the appropriate preoperative assessment of asthma in a child.

7. Discuss the possible complications of an upper respiratory infection.

8. Note the criteria that should be met prior to discharge from hospital of a child with a cold.

9. Discuss the use of a laryngeal mask airway.

10. Outline important viral effects on the airway.

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