Free
Anesthesiology CME Program  |   November 2007
Instructions for Obtaining Journal CME Credit
Article Information
Anesthesiology CME Program
Anesthesiology CME Program   |   November 2007
Instructions for Obtaining Journal CME Credit
Anesthesiology 11 2007, Vol.107, 865-866. doi:10.1097/01.anes.0000295066.74990.9b
Anesthesiology 11 2007, Vol.107, 865-866. doi:10.1097/01.anes.0000295066.74990.9b
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:
  1. Read the article by Rozet et al  . entitled “Effect of equiosmolar solutions of mannitol versus  hypertonic saline on intraoperative brain relaxation and electrolyte balance” on page 697 and the accompanying editorial by McDonagh and Warner entitled “Hypertonic saline for craniotomy?” on page 689 of this issue.

  2. Review the questions and other required information for CME program completion (published in both the print and online journal).

  3. When ready, go to the CME Web site: . 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 physiology of hyperosmolar therapy and its effect on brain relaxation.
Disclosure Information:
Authors  – Irene Rozet, M.D., Nuj Tontisirin, M.D., Saipin Muangman, M.D., Monica S. Vavilala, M.D., Michael J. Souter, M.B., Ch.B., F.R.C.A., Lorri A. Lee, M.D., M. Sean Kincaid, M.D., Gavin W. Britz, M.D., M.P.H., and Arthur M. Lam, M.D., F.R.C.P.C.
Grants or research support:  None
Consultantships or honoraria:  None
The article authored by Drs. Rozet, Tontisirin, Muangman, Vavilala, Souter, Lee, Kincaid, Britz, and Lam was supported solely from institutional and/or departmental sources.
Authors  – David L. McDonagh, M.D., and David S. Warner, M.D.
Grants or research support:  None
Consultantships or honoraria:  None
The article authored by Drs. McDonagh and Warner 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.
Article Questions
Based on the article by Rozet et al  . entitled “Effect of equiosmolar solutions of mannitol versus  hypertonic saline on intraoperative brain relaxation and electrolyte balance”and its accompanying editorial by McDonagh and Warner entitled “Hypertonic saline for craniotomy?”in the November issue of Anesthesiology, choose the one correct answer for each question:
1. Which of the following statements about the effects of hypertonic saline is most  likely true?
A. It crosses the normal blood–brain barrier.
B. It causes a diuresis.
C. It reduces brain bulk.
D. It is recommended for treatment of increased intracranial pressure in traumatic brain injury.
2. The shared physiologic effects of 20% mannitol and 3% hypertonic saline include all of the following except 
A. Reduction in blood cell size
B. Increase in cerebrospinal fluid sodium concentration
C. Reduction in cerebrospinal fluid production
D. Increase in serum osmolality
3. Which of the following statements about the reflection coefficient is most  likely true?
A. It measures the relative permeability of a solute through the blood–brain barrier.
B. Hypertonic saline has a lower reflection coefficient than mannitol.
C. Drugs that do not penetrate the blood–brain barrier have a reflection coefficient of 0.
D. The reflection coefficient of sodium indicates it readily crosses the blood–brain barrier.
4. When comparing the effect of administering equivolemic and equiosmolar solutions of 3% hypertonic saline or 20% mannitol on brain relaxation, which of the following statements is most  likely true?
A. They produce clinically equal degrees of brain relaxation.
B. More patients with subarachnoid hemorrhage require an additional dose of hypertonic saline.
C. More patients with subarachnoid hemorrhage require an additional dose of mannitol.
D. Mannitol provides better brain relaxation.
5. Which of the following statements about the administration of equivolemic and equiosmolar solutions of 3% hypertonic saline or 20% mannitol is most  likely true?
A. Arterial lactate concentrations are greater after hypertonic saline.
B. Arteriovenous oxygen differences are greater with mannitol.
C. A stepwise increase in serum potassium occurs with hypertonic saline.
D. Acute hyponatremia occurs with mannitol.