CPD Modules

CAS and the Canadian Journal of Anesthesia plan and develop several CPD Self-Assessment modules every year, designed as reviews on a topic of interest, as revealed by the needs assessment process.

Modules are published in the CJA as Continuing Professional Development (CPD) articles and uploaded to our learning management system, Knowledge Direct.   

To complete a CPD module, participants must read the review and the 2-3 authoritative articles clearly indicated in the reference list, and then answer questions pertaining to a clinical case outlined in the article.

CAS members can access the modules for free.

To access the learning management system, go to:
Knowledge Direct learning management system

Login details:
Your username is the email address you have in our member directory
Your password is your CAS ID

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Access the Canadian Journal of Anesthesia

Please note that the CJA article is included in the learning management system, so this step is optional.

If you have difficulties signing in to either system, please contact: anesthesia@cas.ca.

Once you are on the CPD site:

  • Read the module article and accompanying reference articles.
  • Answer the multiple-choice questions on the case presented.
  • When you have entered all your answers, you will have access to experts’ explanations for all the possible choices.
  • After module completion, you can download and save your certificate of attendance.

Generally, participants may claim up to 4 h of CPD, for a total of 12 credits under Section 3 of the CPD program of the Royal College of Physicians and Surgeons of Canada. Still, each module description contains the corresponding number of hours.

Modules are accredited for three years and are available in the system for two additional years. You will get a notice if the module you are trying to access is not accredited.

Currently available ACCREDITED CPD modules, and reference in Canadian Journal of Anesthesia

 

Synopsis of the point-of-care ultrasound assessment for perioperative emergencies

Vol. 66 | Number 4/ April 2019 | Pgs: 448-460

This module introduces the concept of a point-of-care ultrasound (POCUS) examination for perioperative clinicians. A focused cardiac examination of ventricular filling and function is presented. An examination of the inferior vena cava is also reviewed as a tool to assess volume status. Finally, a brief examination of the lung and pleura is explored to aid the clinician in situations of patient hypoxia and difficult ventilation. Limited ultrasound cardiorespiratory examinations can be performed by non-cardiologists and non-radiologists. Information drawn from POCUS may aid in diagnosis and early rescue in perioperative care.

Point-of-care ultrasound is likely to become standard of care for anesthesiologists in the same way that stethoscopy is presently.

Updated guide for the management of malignant hyperthermia

Vol. 65 | Number 6/June 2018 | Pgs: 709-721

This continuing professional development module aims to prepare anesthesiologists for the timely recognition and management of a malignant hyperthermia (MH) reaction, which is crucial for averting its life-threatening complications and ultimately for the patient’s survival.

Malignant hyperthermia is a genetic disorder of skeletal muscle cells affecting myoplasmic calcium homeostasis. It can present with nonspecific signs of a hypermetabolic reaction, which can be fatal if treatment, including administration of dantrolene sodium, is not implemented promptly. Rapid evaluation and rejection of alternative diagnoses can lead to a prompt diagnosis and treatment and therefore will significantly reduce the complications, including renal failure, cardiac dysfunction, disseminated intravascular coagulation, and death. After the reaction, patients should be observed for a minimum of 24 hr because of the possibility of recrudescence. As it is a genetic condition, survivors and their family members should be referred to a specialized MH centre for further testing and counselling.

Anesthetic implications of recreational drug use

Vol. 64 | Number 12/ December 2017 | Pgs: 1236–1264

As the use of recreational drugs increases, the likelihood of an anesthesiologist perioperatively encountering patients using or addicted to these drugs will also increase.

Addicted patients may present for anesthetic care in a variety of circumstances in everyday elective surgeries or in acute or life-saving situations, such as emergency Cesarean delivery or trauma surgery. Therefore, it is important for anesthesiologists to know about the most common illicit drugs being used, their clinical presentation and side effects, and the anesthetic options that are beneficial or detrimental to these patients. The most frequently used illicit substances, apart from alcohol and tobacco, are cannabis, cocaine, heroin, prescription opioids, methamphetamine, and hallucinogens. When planning anesthetic care, it is important for anesthesiologists to understand the effects of these agents, including various drug interactions, to predict tolerance to some anesthetic agents, to recognize drug withdrawal signs and symptoms, and to be prepared to manage all these factors in the perioperative period.

For optimal patient care through the perioperative period, it is critical to obtain information about patient drug use and other associated treatment in order to construct an appropriate anesthetic plan, including specific considerations during surgery, emergence, and in the post anesthesia care unit.

Massive hemorrhage and transfusion in the operating room

Vol. 64 | Number 9 / September 2017 | Pgs: 962–978

In this Continuing Professional Development module, we review the pathophysiology and clinical manifestations associated with massive hemorrhage as well as laboratory investigations and appropriate therapeutic measures. In addition to reviewing the available blood/plasma products and adjunct therapy, we also explore the role of the anesthesiologist in a massive transfusion protocol scenario.

Massive hemorrhage can be either anticipated or unexpected. The coinciding presence of acidosis, hypothermia, and hypotension contribute greatly to a poor outcome. Red blood cells not only increase oxygen carrying capacity, but they also play a role in providing hemostasis. While timely laboratory results, including point-of-care testing, are important, transfusion remains a clinical decision. Adjunct therapies other than blood components have contributed to improved outcomes. The pathophysiology of massive obstetric hemorrhage is unique when compared with the non-obstetric population. The approach to massive hemorrhage and its treatment vary considerably from institution to institution.

Massive hemorrhage is a multidisciplinary challenge that requires immediate response and communication between clinicians, nurses, other healthcare providers, laboratory testing, and blood banks. Basic knowledge and utilization of available products and therapies are inconsistent. A massive transfusion protocol can be used effectively to reduce chaos and ensure that correct treatments and proper dosing occur in a timely manner.

Managing the perioperative patient on direct oral anticoagulants

Vol. 64 | Number 6 / June 2017 | Pgs: 656–672

Patients are increasingly treated with direct oral anticoagulants (DOACs) for the prevention of stroke due to non-valvular atrial fibrillation and for the treatment of venous thromboembolism. When these patients present for urgent or emergent surgical procedures, they present a challenge to the anesthesiologist who must manage perioperative risk due to anticoagulation. The purpose of this module is to review the literature surrounding the perioperative management of DOACs. Timing, laboratory monitoring, and availability of reversal agents are important considerations to optimize patients being treated with DOACs who require emergent surgery.

Laboratory tests are not recommended for routine monitoring of DOACs since they do not correlate well with anticoagulant activity. The most widely available laboratory tests lack the sensitivity to detect anticoagulant effects at low plasma concentrations. However, a normal thrombin time for dabigatran excludes clinically significant drug levels. If the risk of bleeding is judged to be high because of a recent dose of DOAC, various options are available to mitigate bleeding. When possible, surgery should be delayed for at least 12 hr after the last dose of DOAC. Activated charcoal may mitigate the anticoagulant effect caused by DOACs if administered less than two hours after the drug was ingested. Four-factor prothrombin complex concentrates (PCCs) may be useful to reduce life-threatening bleeding associated with factor Xa inhibitors. Activated PCCs have been shown to reverse abnormal coagulation tests associated with all DOACs, but there is a lack of reported evidence of clinical benefit. Idarucizumab is a specific antidote that is effective for reversal of anticoagulation due to dabigatran. An antidote for rivaroxaban and apixaban (andexanet alfa) as well as a universal antidote for all DOACs and heparin (PER977) are in clinical development.

Perioperative management of anticoagulation due to DOACs is a growing concern as the number of patients prescribed these medications increases each year. These patients can be safely optimized for urgent or emergent surgery by giving appropriate consideration to timing, monitoring, and reversal agents.

The impaired anesthesiologist: what you should know about substance abuse

Vol. 64 | Number 2 / February 2017 | Pgs: 219–235

Despite our considerable experience with the problem of addiction in our specialty, most anesthesia care providers don’t know how to identify or help an impaired colleague. The purpose of this article to provide sufficient information on substance use disorder (SUD) to aid in its identification amongst colleagues and to assist in its management.

Depending on the region, 10-15% of the general population is prone to developing a SUD and will abuse drugs or alcohol at some point in their life. Physicians and other healthcare professionals are not immune to the disease of addiction and are just as prone to developing SUD as laypersons. Even so, the risk of mortality is significantly increased because of access to potent and highly addictive anesthetic agents with a narrow therapeutic index when self-administered. Also, the number of anesthesia residents who are identified as having SUD is currently increasing.

Due to the considerable morbidity and mortality associated with the abuse of anesthetic agents as well as the continuous increase in the rate of substance abuse by anesthesia providers, it is essential for anesthesia care providers to become familiar with the presenting signs and symptoms of substance abuse and impairment.

Hypertensive disorders of pregnancy

Vol. 63 | Number 9 / | September 2016 | Pgs: 1075–1097

In this continuing professional development module, we review recent Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines for the classification and diagnosis of hypertensive disorders of pregnancy (HDP) as well as review the clinical features, laboratory investigations, and outcomes of HDP. We explore the evidence for anesthetic management and prevention of end-organ damage in women with HDP and describe the role and contribution of anesthesiologists as part of a multidisciplinary care team.

Hypertensive disorders of pregnancy can have variable presentations with clinical signs and symptoms that often do not correlate with the underlying severity and progression of the disease. Failure of timely diagnosis and treatment contributes significantly to adverse maternal (neurologic complications, pulmonary edema, and postpartum hemorrhage) and neonatal (respiratory and neurologic complications and stillbirth) outcomes. In the Canadian context, improvements in medical care have led to better maternal and neonatal outcomes. Timing of delivery is crucial in balancing maternal risks and fetal benefits of ongoing pregnancy. Evidence-based SOGC guidelines regarding diagnosis and management of HDP address many aspects of clinical care relevant to anesthesiologists, who have an important role in the multidisciplinary care team.

Hypertensive disorders of pregnancy are on the rise worldwide, and this trend is expected to continue. The major contributors to maternal mortality are failure to recognize HDP promptly or to treat the condition adequately. It is essential that anesthesiologists understand the disease process and acquire knowledge of the guidelines governing current obstetrical care in order to provide evidence-based multidisciplinary quality care to these patients. Anesthetic management helps prevent potentially deleterious maternal and fetal outcomes.

An update on the prone position

Vol. 63 | Number 6/ June 2016 | Pgs: 737-767

The purpose of this Continuing Professional Development module is to provide information needed to prepare for and clinically manage a patient in the prone position.

Prone positioning is required for surgical procedures that involve the posterior aspect of a patient. We searched MEDLINE® and EMBASE™ from January 2000 to January 2015 for literature related to the prone position and retrieved only original articles in English. We reviewed the advantages and disadvantages of various equipment used in prone positioning, the physiological changes associated with prone positioning, and the complications that can occur. We also reviewed strategies for the safe conduct and management of position-related complications.

Increased age, elevated body mass index, the presence of comorbidities, and long duration of surgery appear to be the most important risk factors for complications associated with prone positioning. We recommend a structured team approach and careful selection of equipment tailored to the patient and surgery. The systematic use of checklists is recommended to guide operating room teams and to reduce prone position-related complications. Anesthesiologists should be prepared to manage major intraoperative emergencies (e.g., accidental extubation) and anticipate postoperative complications (e.g., airway edema and visual loss).

CPD module development is supported by:

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