Anesthesiology’s journal-based CME program is open to all readers. Members of the American Society of Anesthesiologists participate at a preferred rate, but you need not be an ASA member or a journal subscriber to take part in this CME activity. Please complete the following steps:
Read the article by Snapir et al. entitled “Effects of low and high plasma concentrations of dexmedetomidine on myocardial perfusion and cardiac function in healthy male subjects” on page 902 of this issue.
Review the questions and other required information for CME program completion (published in both the print and online journal).
When ready, go to the CME Web site: http://www.asahq.org/journal-cme. Submit your answers, form of payment, and other required information by December 31 of the year following the year of publication.
The American Society of Anesthesiologists is approved by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education programs for physicians.
The American Society of Anesthesiologists designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Purpose: The focus of the journal-based CME program, and the articles chosen for the program, is to educate readers on current developments in the science and clinical practice of the specialty of Anesthesiology.
Target Audience: Physicians and other medical professionals whose medical specialty is the practice of anesthesia.
Learning Objectives: After reading this article, participants should have a better understanding of the pharmacology and cardiovascular effects of dexmedetomidine.
Authors –Amir Snapir, M.D., Ph.D., Jussi Posti, B.M., Erkki Kentala, M.D., Ph.D., Juha Koskenvuo, M.D., Ph.D., Jan Sundell, M.D., Ph.D., Helena Tuunanen, M.D., Kristo Hakala, M.Sc., Harry Scheinin, M.D., Ph.D., Juhani Knuuti, M.D., Ph.D., and Mika Scheinin, M.D., Ph.D.
Grants or research support: Supported by grants from Turku University Hospital, Turku, Finland, the Academy of Finland, the Juselius Foundation, and the Finnish Heart Foundation, Helsinki, Finland. The laboratory of Dr. Scheinin has contract research relationships with Orion Corporation, Espoo, Finland. Hospira, Lake Forest, Illinois, has a license agreement with Orion Corporation regarding Precedex.
Consultantships or honoraria: None
Question Writer –Peter L. Bailey, M.D. Dr. Bailey has no grants, research support, or consultant positions, nor does he receive any honoraria from outside sources, which may create conflicts of interest concerning this CME program.
Based on the article by Snapir et al. entitled “Effects of low and high plasma concentrations of dexmedetomidine on myocardial perfusion and cardiac function in healthy male subjects”http://content.wkhealth.com/linkback/openurl/trusted?issn=0003-3022&volume=105&issue=5&spage=902&part=fulltextin the November issue of Anesthesiology, choose the one correct answer for each question:
1. Which of the following statements concerning the pharmacology of α2-adrenoreceptor agonists is most likely true?
A. They produce sympatholysis at low doses and sympathetic activation at high doses.
B. They produce vasoconstriction through peripheral actions only.
C. They produce sympatholysis through central actions only.
D. They produce hypotension during initial intravenous loading.
2. Which of the following effects is most likely when dexmedetomidine is infused to produce low therapeutic plasma drug concentrations in healthy humans?
A. Increased heart rate
B. Increased blood pressure
C. Decreased coronary vascular resistance
D. Decreased myocardial blood flow
3. Which of the following effects is most likely when dexmedetomidine is infused to produce high therapeutic plasma drug concentrations in healthy humans?
A. Increased heart rate
B. Increased mixed venous oxygen saturation
C. Decreased cardiac output
D. Decreased pulmonary artery blood pressure
4. Which of the following statements concerning the cardiac effects of dexmedetomidine in healthy humans is most likely true?
A. Coronary vascular resistance decreases at high plasma drug concentrations.
B. Echocardiographic signs of myocardial ischemia are found in association with high plasma drug concentrations.
C. Systolic myocardial function is slightly depressed.
D. Diastolic function is significantly depressed.
5. Which of the following statements concerning the effects of dexmedetomidine in humans is most likely true?
A. In healthy subjects, myocardial blood flow remains matched to myocardial work only at low doses of the drug.
B. In healthy subjects, α2-adrenoceptor activation by dexmedetomidine induces coronary vasodilatation.
C. In humans with impaired endothelial function, dexmedetomidine may produce significant coronary vasoconstriction.
D. The cardiac effects of dexmedetomidine are opposite those produced by β-adrenergic blockers.