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 Myles et al. entitled “Avoidance of nitrous oxide for patients undergoing major surgery: A randomized controlled trial” on page 221 and the accompanying editorial by Hopf entitled “Is it time to retire high-concentration nitrous oxide?” on page 200 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 risks associated with the use of nitrous oxide in patients undergoing general anesthesia for major operations.
Authors – Paul S. Myles, M.B., B.S., M.P.H., M.D., F.C.A.R.C.S.I., F.A.N.Z.C.A., Kate Leslie, M.B., B.S., M.D., M.Epi., F.A.N.Z.C.A., Matthew T. V. Chan, M.B., B.S., F.A.N.Z.C.A., Andrew Forbes, M.Sc., Ph.D., Michael J. Paech, M.B., B.S., D.M., D.R.C.O.G., F.R.C.A., F.A.N.Z.C.A., F.F.P., M.A.N.Z.C.A., Philip Peyton, M.B., B.S., M.D., F.A.N.Z.C.A., Brendan S. Silbert, M.B., B.S., F.A.N.Z.C.A., Elaine Pascoe, B.Sc., and the ENIGMA Trial Group
Grants or research support: Supported by grants from the Australian National Health and Medical Research Council (project 236956), Canberra, Australian Capital Territory, Australia; the Australian and New Zealand College of Anaesthetists, Melbourne, Victoria, Australia; and the Health and Health Services Research Fund (project 02030051), Hong Kong, People’s Republic of China. Dr. Myles is supported by an Australian National Health and Medical Research Council Practitioner’s Fellowship. Drs. Myles and Forbes are supported by the National Health and Medical Research Council Centre for Clinical Research Excellence in Therapeutics (project 219284), Monash University, Melbourne, Australia.
Consultantships or honoraria: None
Authors – Harriet W. Hopf, M.D.
Grants or research support: None
Consultantships or honoraria: None. The article authored by Dr. Hopf was supported solely from institutional and/or departmental sources.
Question Writers – Peter L. Bailey, M.D., and Leslie C. Jameson, M.D. Drs. Bailey and Jameson have no grants, research support, or consultant positions, nor do they receive any honoraria from outside sources, which may create conflicts of interest concerning this CME program.
Based on the article by Myles et al. entitled “Avoidance of nitrous oxide for patients undergoing major surgery: A randomized controlled trial”http://content.wkhealth.com/linkback/openurl?issn=0003-3022&volume=107&issue=2&spage=221&part=fulltextand its accompanying editorial by Hopf entitled “Is it time to retire high-concentration nitrous oxide?”http://content.wkhealth.com/linkback/openurl?issn=0003-3022&volume=107&issue=2&spage=200&part=fulltextin the August issue of Anesthesiology, choose the one correct answer for each question:
1. Which of the following statements concerning nitrous oxide and vitamin B12is most likely true?
A. Preoperative vitamin B12supplements increase adverse outcomes associated with nitrous oxide administration.
B. Nitrous oxide increases methionine synthase activity.
C. Nitrous oxide increases availability of vitamin B12.
D. Megaloblastic anemia may result from the inhibition of vitamin B12by nitrous oxide.
2. Which of the following statements concerning the use of nitrous oxide, compared with a nitrous oxide–free anesthetic, in patients undergoing major operations is most likely true?
A. It shortens the time to readiness for postanesthesia care unit discharge.
B. It shortens hospital length of stay.
C. It is associated with higher incidence of postoperative fever.
D. It increases postoperative intensive care unit length of stay.
3. Which of the following statements concerning patients who receive a nitrous oxide–free anesthetic, compared with an anesthetic with nitrous oxide, for major operations is most likely true?
A. They have the same overall incidence of postoperative complications.
B. They have a lower incidence of wound infection.
C. They have a higher incidence of pneumonia.
D. They have the same quality of recovery.
4. Which of the following statements comparing anesthesia with or without nitrous oxide is most likely true?
A. The use of nitrous oxide is associated with less atelectasis.
B. The use of nitrous oxide is associated with a lower incidence of postoperative myocardial infarction.
C. The use of nitrous oxide is associated with a higher incidence of pulmonary complications.
D. The avoidance of nitrous oxide increases the risk of awareness.