Summary of Discussion Boards

This list offers a summary of the questions asked for each Discussion Board. You may click to go to the Discussion Board of your choice or to that CME Module. Modules are listed starting with the most recently added module.

Module 12: Aseptic Technique and Septic Complications of Regional Anesthesia

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Go to Discussion Board for Module 12
Go to CME Module 12

Module 11: Obstructive Sleep Apnea and the Anesthesia Patient

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Go to Discission Board for Module 11
Go to CME Module 11

Module 10: Recent Developments in Supraglottic Airway Devices

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Go to Discussion Board for Module 10
Go to CME Module 10


Module 9 : Peri-Operative Cardiac Risk Reduction

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Module 8 : Management of Post Partum Hemorrhage

The major “take home” points from the questions are that the degree of hypovolemia in young, previously healthy patients can often be misleading and therefore one has to be particularly aggressive in using frequent laboratory tests to guide fluid resuscitation. As well, it is important for all clinicians to be aware of the various alternative therapies used in the treatment of PPH and that management requires a multidisciplinary approach.

Go to Discussion Board for Module 8
Go to CME Module 8


Module 7 : Accidental Subdural Injections

The questions generally reflect whether or not there is a way of decreasing the incidence of subdurals. For example, would the LOR to saline minimize the risk of an accidental subdural? The answer to this issue is not known and cannot be studied, as one could not ethically try to purposefully subject patients to subdural injections. Therefore, the only way we can ever see if subdurals are less with one technique or the other is to collect case reports where subdurals were suspected and confirmed radiologically and then retrospectively calculate the incidence. This is unlikely to be done. The main lesson here is that accidental subdurals are one of the risks of epidural insertion, can present later than unintentional spinal injections and are, for the most part, a clinical diagnosis. The clinical symptoms vary amongst patients and clinicians must be aware of the potential for this complication.

Go to Discussion Board for Module 7
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Module 6 : Patient-Controlled Epidural Analgesia for Labour

Technical issues were the main discussion point. For the most part the pumps available today are quite reliable and any reoccurring issues should be referred to the manufacturer or the biomedical department of the hospital.

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Go to CME Module 6


Module 5 : CSE and Mobile Analgesia for Labour

Most of the questions centered on technical difficulties with CSE which we all know can occur. The use of the smallest needle available (26 -27 gauge) is probably wise in order to limit the incidence of PDPH and performing the procedure in the sitting to maximize CSF return. Clinicians should also be reminded that with the low dose medications that we are presently using, some patients will not receive adequate analgesia, particularly during the second stage of labour and therefore one must not be reticent to administer higher concentrations of medication to these women.

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Module 4 : Blood Transfusions and the Jehovah's Witnesses Patient

The issue of consent for blood transfusion for minors was the major discussion point. At the present time, the laws in Canada and the United States allow for the administration of blood to JW children by making them wards of the court. What constitutes a “mature minor” continues to be a grey area.

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Go to CME Module 4


Module 3 : Confidential Enquiry into Maternal Deaths

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Module 2 : Amniotic Fluid Embolus

The main message here is that AF emboli can present in many different ways and in varying severity. We must always keep the possibility of this entity in our minds while at the same time remember that it is a diagnosis of exclusion. Thus, we must be certain to rule out the other possibilities for the presenting symptoms.

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Module 1 : Laryngeal Mask Anesthesia

The discussion serves as a reminder that although the LMA is widely used it is not without its complications. Also, it is important to be aware that it has a much wider range of application in the European medical world. However, as Dr. Doyle points out, some of the uses are controversial in North America and one must be careful regarding “standard of care” issues.

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