Supplemental Online Lesson

Lesson S09: PreAnesthetic Assessment of the Geriatric Patient for Cataract Extraction

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

Release Date: November 1st, 2009
 Termination Date:  November 30th, 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.

Preoperative testing is a routine part of clinical practice throughout the world regardless of the patient’s age or circumstances. Multinational and multi-institutional studies performed over more than two decades have demonstrated that preoperative testing is extremely costly, offers little or no useful information, may be harmful to the patient, rarely influences perioperative management and should be largely abandoned in otherwise healthy individuals. Nevertheless, many groups of physicians believe that such testing is necessary to protect against potential malpractice lawsuits should the patient suffer an adverse outcome. Cataract extraction is a common procedure in geriatric patients. It is very important for clinicians to understand the facts surrounding appropriate preoperative evaluation of geriatric patients undergoing this procedure.

An 86 year old man was scheduled for cataract extraction. He reported increased difficulty seeing over the last few years, especially when driving at night when he drove. He received annual checkups, ceased smoking for the last 2 years, and drank wine daily. His personal doctor informed him that his blood pressure was slightly elevated but did not prescribe treatment with medication. Previous surgery consisted of a hernia repair and appendectomy, both many years ago. The nurse at the ophthalmologist’s office advised the patient that several tests were required before the cataract extraction. The patient reported that he felt healthy and did not want the tests. In addition, he lived a long distance from the hospital and the preoperative testing was a major inconvenience. The nurse informed the patient that the anesthesiologist would have to determine the necessity of preoperative testing prior to the procedure.

LEARNING OBJECTIVES

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

1. Outline a preoperative evaluation plan for a healthy geriatric patient.

2. Advise hospital administrators regarding preparation of a policy manual for preoperative testing.

3. Identify preoperative tests for patients with hypertension.

4. Appreciate the lack of association between test abnormalities and perioperative morbidity.

5. Realize the economic impact of routine testing.

6. Appreciate the lack of association between abnormal preoperative results and risk factors.

7. Discuss the appropriateness of ordering EKGs and chest X-rays preoperatively.

8. Educate other colleagues in identifying essential, patient specific, tests.

9. Identify appropriate testing for common disease states.

10. Quote the average incidence of abnormal test results obtained preoperatively.

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