Supplemental Online Lesson

Lesson S18: PreAnesthetic Assessment of the Pregnant Patient with Pulmonary Artery Hypertension

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

Review Date: April, 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.

The presence of pulmonary hypertension in pregnant patients complicates anesthetic management and it is essential for anesthesiologists to be knowledgeable of current information regarding management of such patients. This topic is frequently reviewed in medical journals throughout the world and understanding recent trends in addressing this complication will be useful to the anesthesiologist’s clinical practice.

CASE HISTORY

A 39 year old pregnant woman, primigravida at 21 weeks, presents to the emergency room complaining of excessive tiredness, dyspnea, syncope and ankle swelling. She reports no prior history of surgery and no prenatal care, and states that she was told of a heart murmur. She reports taking several multivitamin preparations and some herbal treatments. Physical examination reveals a weight of 235 lbs and height of 64 inches. Her lips are slightly cyanotic and there is marked swelling of the feet and ankles. On auscultation, split S2 and loud P2 sounds are heard. Her BP is 155/95; heart rate 101 with frequent PVC’s; spO2 92 on room air; hct 29%; serum glucose 189 mg/dl. A diagnosis of pulmonary artery hypertension is made and she is tentatively scheduled for termination of pregnancy.

LEARNING OBJECTIVES

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

1. Cite the incidence of pulmonary hypertension and pregnancy
2. List the physiologic changes of pregnancy as they relate to the cardiorespiratory system
3. Classify pulmonary hypertension
4. Diagnose and evaluate pulmonary hypertension
5. Identify the effects of pulmonary hypertension on pregnancy
6. List options for treatment of pulmonary hypertension
7. Quantify mortality rates
8. Describe the management of pulmonary hypertension during pregnancy
9. Prepare an anesthetic plan for late pregnancy termination
10. Present alternatives to termination

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