Lesson 294: PreAnesthetic Assessment of the Patient With Hereditary Angioedema

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

Review Date: September, 2011

Participants who do not possess a copy of Anesthesiology News can download and print the course material in an easy to read convenient  format.  Participants must reflect on the information presented, and then register to complete the exam and course evaluation online before the availability date listed above.  (CME credit is not valid past this date).  

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.

Hereditary angioedema (HAE) is a condition with important anesthetic consequences; surgery and airway manipulation are recognized triggers, and attacks involving laryngeal edema may lead to a compromised airway that is life-threatening. Recent drug developments have expanded the modalities available for acute treatment and long-term management of these patients. Clinical experience with these agents has been de-scribed in journals not generally read by anesthesiologists.

CASE HISTORY

A 13-year-old girl was brought to the emergency department by her parents after developing progressive swelling of the face, lips, and tongue. Her parents explained that over the course of the afternoon, the child’s voice had become increasingly hoarse, and she began to complain of difficulty in swallowing. Earlier that day, she had been to the dentist for routine dental cleaning. She had been well at the time, and the visit itself was uneventful. On physical examination, there was marked edema of the perioral region. Her tongue was severely enlarged such that she had difficulty keeping her mouth closed and controlling her saliva. She resisted lying down, preferring to sit in a forward-leaning position. No other constitutional symptoms, including rash or urticaria, were apparent. Vital signs included blood pressure, 100/60 mm Hg; heart rate, 88 beats per minute; oxygen saturation, 96%; and temperature, 97.2°F.

LEARNING OBJECTIVES

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

1. Summarize the epidemiology and pathophysiology of HAE.
2. Recognize signs and symptoms that support the diagnosis of HAE.
3. List laboratory tests that can be used to confirm the diagnosis of HAE.
4. Manage the symptoms in patients presenting with acute HAE attacks.
5. Tabulate common triggers for HAE attacks and indications for short-term prophylaxis.
6. Identify medications used for short-term prophylaxis against HAE attacks and explain their respective mechanisms of action.
7. Review the side effects and contraindications associated with commonly used HAE prophylactic therapies.
8. Discuss options available for long-term management of patients with HAE.
9. Describe how to monitor patients with HAE who are receiving long-term prophylactic drug therapy.
10. Name new drugs currently available for HAE acute therapy and prophylaxis.

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