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Defining an Intraoperative Hypotension Threshold in Association with Stroke in Cardiac Surgery
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Intraoperative use of neuromuscular blocking (NMB) drugs and postoperative residual weakness have been identified as key risk factors in anesthetic-related morbidity and mortality, as well as increased overall costs. Residual neuromuscular block in the postoperative phase is increasingly recognized as a complication of the use of non-depolarizing NMB drugs.
That said, complex surgical procedures are increasingly performed in an outpatient setting. In the US, it is estimated that over 60% of surgical and non-surgical procedures are now performed as day-cases, with approximately 40% of these occurring in free-standing ambulatory surgery centers. For anesthesiologists and their care teams, the challenge of ambulatory surgery lies in balancing anesthesia with a safe and rapid recovery to a level of minimal or no residual cognitive and psychomotor impairment.
In this course, you will learn how to recognize the risk factors associated with preoperative, intraoperative, and postoperative neuromuscular blockade and implement safe and effective monitoring of residual postoperative neuromuscular blockade and recovery.
This FREE program is supported by an educational grant from Merck.
This is a 3 module education activity with up to 2.5 credits available for completion of Module 1 and up to 7.5 additional credits available after completion of Modules 2 and 3 for a total of 10 credits.
Didactic. Module 1 provides a series of presentations and quizzes to help you learn concepts relevant to the safety and efficacy of the reversal of NMB in outpatient surgery. Up to 2.5 credits are available upon completion.
The optional Performance Improvement part starts with Module 2. Through a series of guided questions and utilizing concepts learned, you will create a Performance Improvement Action Plan. Subscribe to the discussion board to post comments or questions. See directions on how to subscribe.
After plan submission, spend a minimum of 14 days for implementation. On day 15 you will have access to Module 3 to reflect and report on outcomes. Up to 7.5 credits are available upon completion.
Activity Release Date: 12/20/2017
Activity Expiration Date: 12/19/2019
Activity Release Date:12/20/2017
Activity Expiration Date:12/19/2019
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Learning Objectives: Upon completion of this course, you will be able to recognize the risk factors associated with preoperative, intraoperative, and postoperative neuromuscular blockade and implement safe and effective monitoring of residual postoperative neuromuscular blockade and recovery.
In the preoperative phase, you will be able to do the following:• Determine whether outpatient surgery is right for the patient.• Recognize planning considerations for the appropriate use of muscle relaxants.• List muscle relaxants that can serve as alternatives to succinylcholine.• Explain how neuromuscular blocking agents affect patients with obstructive sleep apnea.• Recognize what patient medications and other conditions, such as muscular disorders, must be considered.In the intraoperative phase, you will be able to do the following:• Identify muscle relaxant options and their related considerations.• List important monitoring considerations when using neuromuscular blockade.• Explain how to effectively reverse neuromuscular block.In the postoperative phase, you will be able to do the following:• State the incidence of residual neuromuscular blockade (RNMB).• Recognize the presentation of a patient who may have RNMB.• Discuss the importance of neuromuscular assessment in the immediate postoperative phase to facilitate the diagnosis and treatment of RNMB.• Apply strategies to better assess reversal of neuromuscular blockade in the post-anesthesia care unit to optimize discharge.Target Audience: This activity is intended for Physician Anesthesiologists, Anesthesiologist Assistants, CRNAs, Post-Operative Recovery Room Nurses/Critical Care Nurses/Others, Ambulatory and OR Care Team Members, Perioperative pharmacists and the Anesthesia Care Team.
Scott B. Groudine, M.D. has indicated that he has received consulting fees and honoraria from Merck.M. Anthony Cometa, M.D., Uday Jain, M.D., and Jason Anderson, CRNA, MSNA have indicated no relevant financial relationships with commercial interests.ASA Staff
Gerry Higgins, Kenneth King, and Ann Woo have reported no relevant financial relationships with commercial interests.
The American Society of Anesthesiologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Physicians: ASA designates this enduring activity for a maximum of 10 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Maintenance of Certification in Anesthesiology Program® and MOCA® are registered certification marks of The American Board of Anesthesiology®
This activity contributes to the patient safety CME requirement for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology’s (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0™. Please consult the ABA website, www.theABA.org, for a list of all MOCA 2.0 requirements.
This activity contributes to the Part IV: Improvement in Medical Practice requirement of the American Board of Anesthesiology’s (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®) known as MOCA 2.0™. Part IV points are 7.5 and they can be achieved by completing modules 2 and 3. Please consult the ABA website, for a list of all MOCA 2.0 Part IV requirements and their associated point values.
Module One: This continuing nursing education activity was approved by Montana Nurses Association, an accredited approver with distinction by the American Nurses Credentialing Center’s Commission on Accreditation.
Criteria for successful completion of this program includes completing the pre-test, participating in the learning module, scoring 80% or higher on the post-test and completing the program evaluation.
This program has been prior approved by the American Association of Nurse Anesthetists for 2.50 Class A CE credits; Code Number 1035954; Expiration Date 12/20/2019.
AANA designates this program as meeting the criteria for up to 2.50 CE Credits in pharmacology/therapeutics.
This continuing nursing education activity was approved by Montana Nurses Association, an accredited approver with distinction by the American Nurses Credentialing Center’s Commission on Accreditation.
The American Society of Anesthesiologists remains strongly committed to providing the best available evidence-based clinical information to participants of this educational activity and requires an open disclosure of any potential conflict of interest identified by our faculty members. It is not the intent of the American Society of Anesthesiologists to eliminate all situations of potential conflict of interest, but rather to enable those who are working with the American Society of Anesthesiologists to recognize situations that may be subject to question by others. All disclosed conflicts of interest are reviewed by the educational activity course director/chair to ensure that such situations are properly evaluated and, if necessary, resolved. The American Society of Anesthesiologists educational standards pertaining to conflict of interest are intended to maintain the professional autonomy of the clinical experts inherent in promoting a balanced presentation of science. Through our review process, all American Society of Anesthesiologists education activities are ensured of independent, objective, scientifically balanced presentations of information. Disclosure of any or no relationships will be made available for all educational activities.
The information provided at this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
Required Hardware/Software: Internet connection, web browser version must have been released within the last three years.
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