bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain Metastases
Authors: Robin Adam M. , Kalkanis Steven N.
Published: October 2018

A significant percentage of patients with systemic cancer will develop brain metastasis at some point in the course of their disease. Brain metastases should be suspected if patients with known cancer histories present with new neurologic symptoms. Treatment for brain metastasis typically involves radiation. Patients with large, symptomatic and/or solitary brain metastases may benefit from surgical resection in addition to radiation. The role of systemic therapy for brain metastases remains somewhat limited, but newer treatment strategies such as immune therapy and molecular targeted agents may play a role in the future.
Meningiomas
Authors: Hovinga K. E. , Esquenazi Y. , Gutin P. H.
Published: October 2018

Meningiomas are the most common primary central nervous system tumors and account for about one third of all primary brain and spinal tumors. They are classified according to the World Health Organization into 3 groups (I–III). Treatment strategies range from observation, surgery, and/or a radiation therapy. Many meningiomas are slow growing and discovered incidentally. Symptoms can vary widely, depending on the location. Patient’s specific factors and the location of the meningioma in relation to critical brain structures are all important factors in determining the optimal treatment. This chapter presents common clinical scenarios of meningioma. Differential diagnosis, perioperative workup, surgical nuances, and postoperative complications are discussed.
Skull Base Schwannoma
Authors: Lucas Joshua , Fishback Dawn , Giannotta Steven
Published: October 2018

This chapter presents a case example of a patient with progressive unilateral hearing loss who was ultimately diagnosed with a skull base schwannoma. The workup and differential diagnosis are presented and options for treatment are reviewed based on published evidence. Treatment options include observation, stereotactic radiosurgery, and surgical resection. The objective status of a patient’s hearing as well as the patient’s age influence treatment recommendations and the surgical approach. Intraoperative neuromonitoring provides real-time assessment of facial nerve irritation as well as cochlear nerve function and is an important component of surgery. Complication avoidance and management are also discussed in this chapter.
Intramedullary Spinal Cord Tumors
Authors: McCormick Paul C.
Published: October 2018

Intramedullary spinal cord tumors represent a heterogeneous group of neoplasms that may cause progressive spinal cord dysfunction. With few exceptions, however, most are slow-growing, biologically indolent neoplasms for which surgery is the treatment of choice. Long-term tumor control with preservation of neurological function is achievable in most patients. Challenges to the evaluation and management of these lesions include accurate differentiation of these tumors from inflammatory conditions such as transverse myelitis, sarcoidosis, and demyelinating conditions; the management of patients with asymptomatic tumors; and the timing and techniques of surgery to achieve the optimal patient outcome.
Low-Grade Gliomas
Authors: Sanai Nader
Published: October 2018

Low grade gliomas encompass multiple histologic diagnoses of primary brain tumors, most commonly grade 2 oligodendroglioma and grade 2 astrocytoma. This chapter presents a case of a patient with a left temporal low grade glioma who presented with seizures, which are a common presenting symptom for this tumor type. Management of patients with a newly diagnosed low grade glioma typically begins with maximal safe surgical resection for surgically accessible tumors. Surgical planning may involve functional imaging such as with fMRI. Genetic and molecular markers help distinguish subtypes of low grade gliomas, and this subtyping has implications for the type and timing of adjuvant therapy.
Awake Craniotomy
Authors: Rajan Shobana , Mahendra Vibha
Published: October 2018

Awake craniotomies are performed when the site of surgical instrumentation or resection directly involves or abuts eloquent areas of the brain and require a cooperative patient, a tailored neuroanesthetic technique, and good teamwork. Eloquent cortex refers to any cortical region in which injury produces a symptomatic cognitive or motor deficit and includes the primary sensorimotor cortex, essential speech areas, occipital visual areas, and mesial temporal regions crucial for episodic memory. An awake patient allows for intraoperative testing of motor, speech, or sensation function while removing or manipulating brain tissue. The two principal aims of resection of a brain tumor or an epileptic focus are to maximize excision of the offending lesion for better prognosis while minimizing or avoiding damage to surrounding brain tissue. Damage to adjacent brain tissue can be catastrophic, especially if the tumor or epileptogenic areas are located close to the eloquent regions of the brain.
Cerebral Aneurysm Clipping
Authors: Osborn Irene P. , Molina Jocelin Jones
Published: October 2018

Subarachnoid hemorrhage (SAH) is usually caused by the rupture of an intracranial aneurysm. Craniotomy and surgical management has been the traditional treatment for decades until the development and evolution of endovascular techniques. Operative clipping of cerebral aneurysms is performed less frequently, but the procedure is still required for aneurysms that are not amenable to endovascular coiling. Some centers do not have the skilled personnel to perform endovascular techniques, and craniotomy is therefore necessary to treat the aneurysm and prevent the problem of rebleeding and avoid vasospasm. This discussion will address specifically the perioperative management of surgical clipping for intracranial aneurysms.
Carotid Endarterectomy/Stenting
Authors: Yang Hui
Published: October 2018

Carotid endarterectomy and carotid artery stenting have been performed worldwide to reduce neurologic symptoms and prevent stroke. Preoperative cardiovascular and neurologic evaluations are essential to optimize a patient for surgery and guide the intra- and postoperative management. The primary goals of anesthetic management are to maintain cerebral perfusion and prevent perioperative myocardial ischemia. A shunt may be placed to provide antegrade cerebral blood flow if signs of cerebral ischemia develop during carotid cross-clamping. An awake patient is the gold standard for monitoring the adequacy of cerebral perfusion, although neurologic monitoring may be used if a patient is under general anesthesia. Rapid emergence allows immediate assessment of neurologic function. Any delayed emergence necessitates prompt management and communication to surgeon. All patients need to be closely monitored postoperatively for any neurologic, cardiovascular, or respiratory complications.
Anesthesia for Anterior/Posterior Spine Surgery
Authors: Pajewski Thomas N.
Published: October 2018

Surgical approaches to correct spine pathology are based on anatomical considerations along with a surgeon’s experience and preference. Beyond consideration of the actual anatomic level being addressed, the different areas of the spinal column, cervical, thoracic, lumbar, and sacral coccygeal regions are in proximity of a range of structures that must be appreciated during surgery. These considerations impact the anesthetic management of the surgical patient. Historically, spine pathology was initially approached posteriorly, but, since the mid-twentieth century, the anterior approach has been more frequently used, especially at the cervical level. Advances in surgical techniques, coupled with advances in anesthesia and postoperative care, have allowed an increasing patient population to benefit from surgical interventions that address various forms of spinal pathology, including neurological dysfunction, deformity (either hereditary or acquired), structural instability, pathologic lesions (including tumor and infections), and pain.
Pediatric Spine Surgery
Authors: Meigh Abigail E. , Fitz-James Antoine Ingrid A. , Carullo Veronica
Published: October 2018

In children, the most common indication for spinal fusion is significant scoliotic curvature, either idiopathic or as a result of neuromuscular disease. Spinal fusion is high-risk surgery, which can be further complicated by comorbid disease. It carries substantial risk for significant fluid shifts, high intraoperative blood loss, physiologic strain secondary to duration and positioning, severe postoperative pain, and potential spinal cord injury. To mitigate risk and optimize outcomes, these patients should be carefully evaluated by the anesthetic team preoperatively and a comprehensive perioperative plan established. To protect the spinal cord and predict poor neurologic outcomes, the majority of these cases employ intraoperative neuromonitoring. The specific anesthetic agents to allow maximal neuromonitoring signals while ensuring adequate anesthetic depth and pain control should also be established collaboratively. These patients experience severe postoperative pain, and a multimodal approach to therapy should be employed to allow for expedited recovery and decreased length of stay.
Deep Brain Stimulation/Stereotaxic Surgery
Authors: Machado Sandra
Published: October 2018

Deep brain stimulation (DBS) is now a widely accepted treatment option for patients with movement disorders such as parkinsonism and essential tremor. DBS surgery presents challenges to the anesthesiologist as often these patients are required to be awake for accurate placement of the stimulators. Additionally, patients with movement disorders often have comorbidities that increase their risk of perioperative and postoperative complications. DBS surgery is often divided into two stages (1) stereotactic implantation of the DBS leads and (2) internalization of the pulse generator, with each of these stages stage having distinct anesthesia demands. Ongoing studies are exploring other indications for the effective use of DBS surgery.
General: Obesity and Difficult Airway
Authors: Gupta Ruchir
Published: October 2018

In this chapter the essential aspects of difficult airway management in the obese patient are reviewed. In this case study, the patient is scheduled to undergo a laparoscopic gastric bypass. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include differentiating obstructive sleep apnea from obstructive sleep hypopnea. Intraoperative topics include monitoring, premedication, and intubation. Postoperative concerns include extubation, managing hyperglycemia, pain control, and the patient’s mental status. The use of different modalities for securing the airway as well as the difficult airway algorithm are reviewed in detail.
General: Liver Transplantation
Authors: Osorio Frederico
Published: October 2018

In this chapter the essential aspects of anesthesia for liver transplantation are reviewed. Subtopics include the systemic manifestations of cirrhosis and their effects on anesthesia planning. Additionally, the hemodynamic consequences of the different stages of liver transplantation—preanhepatic, anhepatic, and reperfusion—are reviewed. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include relevant means of assessing cardiac and liver function status. Ascites and hepatorenal syndrome are also discussed. Issues related to intraoperative management include choice of monitor, hematological considerations, and induction. Postoperative topics discussed are postoperative bleeding, and coagulopathy and anemia.
General: Renal Transplantation
Authors: Gupta Ruchir , Glassman Sheryl , Gupta Anita
Published: October 2018

In this chapter the essential aspects of anesthesia for renal transplantation are discussed. Subtopics include the anesthetic considerations of diabetes and renal disease. Emphasis is placed on understanding electrolyte abnormalities in patients with renal failure and strategies for optimizing patients with renal disease. The patient discussed here is on dialysis. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative issues discussed are assessment for chronic renal failure and hyperkalemia, and medications for renal failure and for transplantation. Intraoperative topics addressed include choice of anesthesia and monitors, and issues related to induction, maintenance, and graft attachment. Postoperative concerns discussed include oliguria and nausea.
Orthopedics: Hip Surgery in Aortic Stenosis
Authors: Gupta Ruchir
Published: October 2018

In this chapter the essential aspects of aortic stenosis are discussed. Specifically, the hemodynamic consequences of this disease as well as which drugs should be used or avoided are explored. The case discussed is of an older patient needing emergent open reduction internal fixation of a hip fracture. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative issues addressed include evaluation of the patient’s hypertension and cardiac status. Intraoperative topics include spinal versus epidural anesthesia, management of a difficult airway, and treatment of bone cement implantation syndrome and atrial fibrillation. Postoperative issues involve extubation and, in this case, managing hypertension.
Trauma: The Burn Patient
Authors: Kim Ethan , Gupta Ruchir
Published: October 2018

In this chapter the essential aspects of anesthetic management of the burn patient are discussed. Subtopics include use of the Parkland formula for calculating fluid requirements, airway considerations, and carbon monoxide toxicity. The differences between first-, second-, and third-degree burns are also discussed. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Issues discussed that are related to preoperative evaluation include initial assessment, calculating percentage of body area burned, and airway evaluation. Topics related to intraoperative management include muscle relaxation, monitoring, and fluid therapy. Postoperative issues involve extubation criteria and treatment to induce muscle relaxation.
Pediatrics: Foreign Body Aspiration
Authors: Kakascik Aimee
Published: October 2018

In this chapter the essential aspects of anesthesia for foreign body aspiration in the pediatric patient are reviewed. Subtopics include airway management in a patient with a foreign body aspiration, interventions to avoid, and drugs indicated for securing the airway in a patient with this condition. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Issues related to preoperative management include assessment of respiratory status, vascular access, and airway management. Intraoperative topics discussed include, inhalational anesthesia, induction, and the patient’s emergence from anesthesia. Postoperative concerns addressed are postoperative stridor and nausea.
Pediatrics: Tracheoesophageal Fistula Repair
Authors: Wingard Peggy
Published: October 2018

In this chapter the essential aspects of tracheoesophageal fistula repair are discussed. Subtopics include the classic signs of symptoms of this disease in the pediatric patient as well as airway management. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. In the preoperative section the various types (A-F) of tracheoesophageal fistula are outlined and assessment of the patient’s respiratory status reviewed. Issues discussed in relation to intraoperative management include monitors used, inhalation induction, intubation, and positioning of the patient. Postoperative concerns discussed include extubation of the patient and complications of tracheoesophageal fistula repair.
Pediatrics: Congenital Diaphragmatic Hernia
Authors: Wingard Peggy
Published: October 2018

In this chapter the essential aspects of anesthesia for congenital diaphragmatic hernia (CDH) are discussed. Subtopics include respiratory management of CDH patients, airway management, and postoperative considerations of CDH patients. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics addressed are assessment of respiratory and circulatory findings, including pulmonary hypertension. Discussion of intraoperative management includes monitoring, induction using inhalational induction, intubation, and maintenance of the patient, airway management, goals for ventilation, treating possible pneumothorax, and fluids used, such as glucose. Postoperative concerns addressed are decompensation and patient outcome.
Pediatrics: Tetralogy of Fallot
Authors: Khmara Kseniya , Gupta Ruchir
Published: October 2018

In this chapter the essential aspects of anesthesia for repair of tetralogy of Fallot (TOF) are reviewed. Subtopics include hemodynamic considerations in TOF patients such as right ventricular hypertrophy, components of TOF, and circulation in the TOF patient. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Issues discussed that are related to preoperative evaluation include differentiating between cyanotic and acyanotic cardiac lesions, recognizing Tet spells and systemic vascular resistance, and use of antibiotic prophylaxis. Intraoperative topics include induction, onset time of anesthetic agents, and blood therapy. Postoperative care addressed includes extubation, hypothermia, and hypoxia.
Neurological: Intracranial mass
Authors: Pisklakov Sergey
Published: October 2018

In this chapter the essential aspects of anesthesia for intracranial mass excision are discussed. The case presented is of a patient emergently scheduled for a posterior fossa intracranial tumor resection. Subtopics include diagnosis and treatment of ICP as well as appropriate ICP monitoring devices. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative evaluation addressed includes neurological assessment for ICP and cerebral perfusion pressure, cardiac assessment, and positioning of the patient. Issues addressed regarding intraoperative management include monitors used, anesthesia plan, maintenance, and use of furosemide vs. mannitol. Postoperative issues discussed are hypertension and peripheral nerve injury.
Neurological: Cerebral Aneurysm
Authors: Pisklakov Sergey
Published: October 2018

In this chapter the essential aspects of anesthesia for resection of a cerebral aneurysm are discussed. Subtopics include the different types of aneurysms and strategies for preventing rupture, including nimodipine use and triple H therapy. The case presented involves a patient emergently scheduled for subarachnoid hemorrhage evacuation and intracranial aneurysm clipping. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics discussed are neurological and cardiac assessment, including cerebral blood flow and how hypertension affects anesthetic preparation. Issues regarding intraoperative management include induction, monitors used, and blood pressure control. Postoperative concerns addressed include rebleeding and vasospasm and hyponatremia.
Cardiovascular: Aortic Dissection
Authors: Gupta Ruchir
Published: October 2018

In this chapter the essential aspects of anesthesia for aortic dissection are discussed. Subtopics include hemodynamic therapy, different dissection subtypes, and vasopressor support. The case presented is a patient with hypertension needing emergent repair of a thoracic aortic dissection. The chapter is divided into preoperative, intraoperative and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include heart murmur, classification for dissection, and assessment of cardiac, pulmonary, and renal status. Issues discussed related to intraoperative management include monitoring, airway management, and aortic cross-clamping. Postoperative concerns discussed include extubation, treatment of postoperative hypothermia, and diagnosing and responding to a patient’s delayed awakening from anesthesia.
Cardiovascular: Coronary Artery Bypass Graft (CABG)
Authors: Runyon Alec C. , Tran Minh Chau Joe
Published: October 2018

In this chapter the essential aspects of anesthesia for coronary artery bypass graft (CABG) surgery are discussed. Subtopics include monitoring, heparin dose, diagnosis of prolonged activated clotting time, cardiopulmonary bypass machine, and protamine administration. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include the pathophysiology of myocardial ischemia and complications due to chronic obstructive pulmonary disease and diabetes. Issues discussed related to intraoperative management include monitoring, induction, bypass considerations, and coagulation. Postoperative concerns discussed include ICU transfer of care and postoperative management.
Cardiovascular: Abdominal Aortic Aneurysm
Authors: Ying Carl , Tran Minh Chau Joe
Published: October 2018

In this chapter the essential aspects of anesthesia for abdominal aortic aneurysm (AAA) repair are discussed. Subtopics include airway management in expanding aneurysm, hemodynamic therapy, monitoring, vasodilator therapy, and bleeding. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include medications, assessment of cardiac status, and hemodynamic goals for this surgery. Issues discussed related to intraoperative management include monitoring, induction, maintenance, and aortic cross-clamping and unclamping. Postoperative concerns discussed include extubation, decreased renal function, spinal cord ischemia, and other complications affecting the cardiovascular, respiratory, renal, and gastrointestinal systems.
Obstetric: Hemorrhage
Authors: Belotte Edouard
Published: October 2018

In this chapter the essential aspects of anesthesia for obstetric hemorrhage are discussed. Subtopics include physiological changes of pregnancy, placenta previa, abruption placenta, and regional anesthesia in the obstetric patient. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include assessment of hemodynamic status, etiology of uterine bleeding, examination using a double setup, uterine rupture, and preoperative lab assessment. Issues discussed relate to intraoperative management include epidural technique, monitoring, induction, and intraoperative hemorrhage. Postoperative concerns discussed are assessment and treatment of postpartum hemorrhage and its differential diagnosis.
Additional Topics: Cardiac
Authors: Gupta Ruchir
Published: October 2018

In this chapter topics related to use of anesthesia in cardiac patients are discussed. Subtopics include use of heparin in a patient undergoing a coronary artery bypass graft, and management of a cardiac tamponade, hypertrophic cardiomyopathy, coarctation of the aorta, and bacterial endocarditis. Also addressed is management of a patient with an automatic implantable cardioverter-defibrillator (AICD). The mechanism of an intra-aortic balloon pump is discussed, along with its contraindications. The mechanism of the cardiopulmonary bypass machine is also outlined. Open repair of an abdominal aortic aneurysm is discussed, as are the cardiac considerations for surgery in a patient with Down syndrome. Each scenario is presented as a short, three- to four-question additional topic.
Additional Topics: Obstetrics
Authors: Gupta Anita , Weber Nicholas
Published: October 2018

In this chapter several topics related to use of anesthesia in obstetric patients are discussed. Subtopics include anticoagulation in the pregnant patient, surgery in the parturient patient, and anesthetic management in patients with epilepsy or multiple sclerosis. Also discussed is anesthetic management in patients with cystic fibrosis or pregnancy-induced hypertension, including pre-eclampsia. Absolute and relative contraindications to using epidural analgesia as well as associated physiological changes are discussed. Risk factors for and management of uterine atony are addressed. Anesthetic management in patients with aortic stenosis or von Willebrand disease is also discussed. Each scenario is presented as a short, three- to four-question additional topic.
Additional Topics: Pain Management
Authors: Gupta Ruchir
Published: October 2018

In this chapter several topics related to anesthesia for pain management are discussed. Subtopics include anesthetic management of patients with complex regional pain syndrome (CRPS) types 1 and 2, performing a stellate ganglion block, and prevention of local anesthetic toxicity. The chapter begins with a discussion of the mechanisms of pain onset. Next, evaluation and treatment of chronic pain are addressed. Trigger points in myofacial pain are outlined and the mechanism of transcutaneous electrical nerve stimulation (TENS) presented. A case involving a pregnant patient on chronic methadone therapy is presented. Management of cancer pain, post-amputation pain, and lower back pain and sciatica are also addressed. Each scenario is presented as a short, three- to four-question additional topic.
Additional Topics: Neuraxial and Anticoagulation
Authors: Gupta Ruchir
Published: October 2018

In this chapter several topics related to neuraxial anesthesia and anticoagulation are discussed. Subtopics include use of neuraxial technique in patients with coronary artery disease, congestive heart failure, or chronic obstructive pulmonary disease. Use of heparin and patient-controlled epidural analgesia is also discussed. The mechanism of action for warfarin (Coumadin) is discussed, as are ways of reversing its effects. Also discussed is whether to use an epidural in a patient with HELLP syndrome. Treatments for patients with post-dural puncture headache (PDHD) are presented. Placement of an epidural catheter for postoperative pain is discussed, and instructions for performing spinal technique are given. Each scenario is presented as a short, three- to four-question additional topic.
Additional Topics: Critical Care
Authors: Gupta Ruchir
Published: October 2018

In this chapter several aspects related to the use of anesthesia in the critical care setting are discussed. Subtopics include precautions to take in managing a patient with latex allergy, use of hetastarch and its complications, and diagnosing fat embolism syndrome. Also discussed are managing a patient with magnesium overdose, disseminated intravascular coagulation, or sarcoidosis. The mechanism of action for allergic reactions, including anaphylaxis, is presented. Use of blood transfusion and cell saver is addressed in the context of treating a Jehovah’s Witness patient. Management of aspiration in a patient is discussed. Finally, complications of total parenteral nutrition are presented. Each scenario is presented as a short, three- to four-question additional topic.
Clinical Scenario #1: Informed Consent
Authors: Gupta Ruchir , Tran Minh Chau Joe
Published: October 2018

In this chapter the essential aspects of informed consent are discussed. This chapter begins with a mock scenario of a patient who is scheduled for a left knee arthroplasty. The scenario is followed by a task statement that describes the specific action that the student must take. In this case, the task is to obtain informed consent for the nerve block. Included in this process is communicating to the patient the benefits, potential complications, and side effects of the procedure and alternatives to it. An action plan for the mock scenario is then presented in a stepwise manner with mock responses and a discussion of the responses. Grading points are also discussed and how to achieve a maximum score.
Clinical Scenario #5: Communication with Other Health Professionals
Authors: Gupta Ruchir , Tran Minh Chau Joe
Published: October 2018

In this chapter the essential aspects of communication with other health professionals are discussed. The chapter begins with a mock scenario involving a patient undergoing an elective right inguinal hernia repair. The mock scenario is followed by a task statement that describes the specific action that the student must take. In this case, the task is to present a recommendation to the surgeon to postpone the surgery and determine the best course of action. An action plan is then presented in a stepwise manner with mock responses and a discussion of the responses. Grading points are also discussed and how to achieve maximum score is presented.
General considerations
Authors: Merry Alan , Walker Isabeau , Wilson Iain , Batchelor Nicholas , Campbell Bruce
Published: October 2018

This chapter provides an overview of some helpful principles for the anaesthetist, including cultivating a culture of good practice and safety in the operating room, preoperative investigation (including cardiopulmonary exercise testing), preoperative fasting, and prophylaxis of venous thromboembolism.
Anaesthetic emergencies
Authors: McIndoe Andrew
Published: October 2018

This chapter discusses anaesthetic emergencies. It begins with a description of adult basic life support and advanced life support. It goes on to describe the management of acute problems, including narrow and broad complex tachycardia, severe hypo- or hypertension, severe hypoxia, laryngospasm, air/gas embolism, gastric aspiration, status asthmaticus, pulmonary oedema, failed intubation, the cannot-intubate-cannot-ventilate scenario, malignant hyperthermia anaphylaxis, intra-arterial injection, and unsuccessful reversal of neuromuscular blockade. It concludes with the management of paediatric emergencies, including paediatric advanced life support, ventricular fibrillation or tachycardia, neonatal resuscitation, the collapsed septic child, paediatric major trauma, acute severe asthma, and anaphylaxis, as well as with a discussion of paediatric drug doses and equipment.
Psychotherapy: General principles
Authors: Bhugra Dinesh , Ventriglio Antonio , Bhui Kamaldeep S.
Published: October 2018

Psychotherapy is a process based on different types of schools of thought, with patient and therapist working together through talking therapies to bring about a sustained change. Three types of psychotherapy have been described: supportive, re-educative, and constructive. Each has a specific set of rules and strategies that the therapist must follow. Once again, the explanatory models of patients and their families will influence whether they engage in therapy or not. Those from minority cultural groups may enter therapy with a pre-existing defence, such as seeing the majority population as the problem, and the therapist may find it difficult to engage them. It is worth recognizing that different schools of therapy may not always apply to other cultural groups. In addition, it may be that ethnic minority therapists have faced discrimination and this experience will affect their attitudes. Furthermore, they may not be willing to share negative experiences.
Radiation and percutaneous coronary intervention
Authors: Bhatia Gurbir , Nolan James
Published: October 2018

This chapter explores fluoroscopic procedures and the ways in which they are used by cardiologists to assist them in making a correct diagnosis and providing appropriate therapeutic measures to patients. These procedures are being performed more frequently and have become more complex over the past three decades. An overview of basic radiation physics and biology is provided, along with definitions of commonly used measurements of radiation dose. Specific factors influencing procedural radiation doses are also discussed. Particular attention is given to the potential hazards associated with increasing radiation exposure to patients and medical staff. In addition, a number of practical tips enabling operators to reduce delivered doses of radiation are described.
The ‘golden rules’ of percutaneous coronary intervention
Authors: Stables Rod
Published: October 2018

This chapter identifies general principles for the practice of interventional cardiology. The focus is on general strategic approach and the exposition of core concepts rather than details of equipment selection and manipulation. Although framed for percutaneous coronary intervention, the philosophy will translate to all forms of interventional cardiology. In contemporary activity adverse events are fortunately rare and it is very difficult for an individual operator to identify ‘best practice’ on the basis of personal experience and individual reflection. These ‘golden rules’ are based on lessons, sometimes learned at cost to patients and operators, over three decades. Knowledge of these issues and a more systematic approach may provide a framework for safe and effective practice.
Trial design and interpretation in interventional cardiology
Authors: Al-Saleh Ayman , Jolly Sanjit
Published: October 2018

This chapter covers information about the design and interpretation of interventional cardiology and focuses on why evidence-based medicine is important to clinicians. The shift to evidence-based medicine means that clinicians will need to be aware of how to interpret the information they have collected from the patient. Each method of data collection and presentation has its own strengths and weaknesses. Also in this chapter is a variety of case studies to help determine when best to apply a certain method.
Angiography: indications and limitations
Authors: Adlam David , Maznyczka Annette , Prendergast Bernard
Published: October 2018

This chapter discusses angiography to provide and record fluoroscopic assessment of coronary luminal anatomy, which can be used in a number of ways to provide clinicians with a guide for coronary intervention (PCI). It is vital to assess a patient for their suitability to have an angiograph and to know what information to provide them with from it, once having understood it as a team or independent clinician. As with other medical procedures, there are a number of different strengths and weaknesses to conducting an angiograph and these should always be considered.
The role of intravascular ultrasound in percutaneous coronary intervention
Authors: Okada Kozo , Honda Yasuhiro , Fitzgerald Peter J.
Published: October 2018

Intravascular ultrasound imaging is used to visualize the vessel wall structure, the information of which is not available by contrast angiography, which depicts only a two-dimensional silhouette of the lumen. This chapter outlines the principles and procedures of intravascular ultrasound imaging, the basics of image interpretation, and both common and specific interventional applications of the technique, followed by a discussion of possible future directions.
Intravascular ultrasound and optical coherence tomography in percutaneous coronary intervention
Authors: Bhindi Ravinay , Allahwala Usaid K. , Channon Keith M.
Published: October 2018

This chapter discusses the progression from the use of angiography to identify and characterize coronary atherosclerosis to novel intracoronary imaging techniques, which has enabled a greater appreciation of plaque composition in the pathogenesis of coronary artery disease. With particular focus on intravascular ultrasound and optical coherence tomography, the chapter highlights the different strengths and weaknesses of each technique, and potential future developments.
Cardiovascular magnetic resonance
Authors: Karamitsos Theodoros D. , Neubauer Stefan
Published: October 2018

This chapter covers cardiovascular magnetic resonance (CMR), a technique that has undergone significant advancement in imaging capability, ease of use, and speed of acquisition within recent years. Describing the fundamental principles of CMR imaging, clinical applications, and safety measures, the chapter showcases CMR as an area of active development and its emerging use as a guide for therapeutic processes.
Percutaneous coronary intervention in patients with impaired left ventricular function
Authors: Perera Divaka , Briceno Natalia
Published: October 2018

Changes in left ventricular (LV) function are an early manifestation of the ischaemic cascade, and often precede well-recognized markers of ischaemia. Prolonged post-ischaemic myocardial dysfunction can persist for hours or days after bloodflow is restored. Patients with impaired LV function at the outset face potentially hazardous clinical consequences from percutaneous coronary intervention (PCI). This chapter explores the options for optimizing PCI when LV function is impaired, different uses of percutaneous mechanical circulatory support (including intra-aortic balloon counterpulsation and LV assist devices) with the aim of preventing the development of cardiogenic shock, and the impact of revascularization in ischaemic cardiomyopathy and the role of viability testing.
Chronic total occlusions
Authors: Hanratty Colm G. , Spratt James C. , Walsh Simon J.
Published: October 2018

Chronic total occlusion (CTO) of a coronary artery remains one of the most challenging scenarios in cinical practice. There is much debate about whether opening a CTO is clinically indicated and the procedures are often considered too risky. As a result many patients with a clinical indication for percutaneous coronary intervention (the presence of angina despite medical therapy, with proven ischaemia and viability) are not offered treatment. This chapter will aim to demystify the procedure by explaining how pathophysiological features can help understand the anatomy and how cath lab set-up can increase procedural efficiency, safety, and overall success rates. There are four methods by which a CTO can be opened and we will describe these methods and the anatomically salient features to help select the most appropriate method with which to start.
Current status of glycoprotein IIb/IIIa inhibitors
Authors: Lockie Tim
Published: October 2018

Atheromatous plaque rupture is the crucial event that underlies most acute coronary syndromes (ACS). The immediate and often catastrophic result of plaque rupture is intracoronary thrombosis resulting in vessel occlusion and myocardial infarction. Over the past 30 years there has been a steady decline in the mortality rates from ACS. This has resulted from the successful implementation of therapies to attenuate the effects of plaque rupture that include antiplatelet drugs, fibrinolysis, percutaneous coronary intervention (PCI), antithrombotic therapy, and plaque stabilization. Glycoprotein (GP) IIb/IIIa receptor inhibitors are agents that were developed to block the final common pathway that results in platelet aggregation, a key process in coronary thrombosis. GP IIb/IIIa inhibitor usage in interventional cardiology has reduced significantly in recent years and there is a need for critical appraisal of their role as adjunctive therapy in contemporary PCI, including a summary of the latest trial evidence and guidelines.
Stent loss and retrieval
Authors: Saha Mrinal , de Belder Adam
Published: October 2018

In the right hands, percutaneous coronary intervention (PCI) is a relatively straightforward technique that is rewarding for both the operator and the patient. Success rates are high, and complications of PCI are unusual. When complications occur, the consequences can be significant, and understanding how to deal with them to give satisfactory outcomes is key. One such complication is stent embolization, whereby a stent becomes dislodged from the delivery balloon platform. Fortunately the phenomenon is rare, but the consequences and the struggles that come with the methods used to deal with stent loss can be associated with significant morbidity. In this chapter we discuss the incidence, classification, and strategies for dealing with stent loss.
Laser
Authors: O’Kane Peter , Redwood Simon
Published: October 2018

The first medical application of laser was reported by Dr Leon Goldman who, in 1962, reported the use of ruby and CO2 lasers in dermatology. In cardiovascular disease, early laser use was confined to cadaver vessels, animal models, and arteries located in freshly amputated limbs until eventually work progressed to the use of laser energy to salvage an ischaemic limb in 1984. The concept of using laser to remove atherosclerotic material in coronary arteries developed as an alternative strategy to simply modifying the shape of an obstructed lumen, as occurs with simple balloon angioplasty. Further work demonstrated that the ultraviolet radiation emitted by an excimer laser could be used to inscribe exceptionally clean and precise etching cuts in cardiovascular tissue, including atherosclerotic coronary artery segments, and subsequently in vein grafts and native coronary artery disease. Expectations grew that this new biomedical technology may overcome the low success rate and high complication rate of lesions considered non-ideal for balloon angioplasty.
Access routes and the transcatheter aortic valve implantation procedure
Authors: Tamburino Corrado , Tamburino Claudia Ina , Immè Sebastiano
Published: October 2018

When performing transcatheter aortic valve implantation (TAVI), the access route of choice is transfemoral (TF) access since it is less invasive compared to other approaches and it is feasible in the majority of patients undergoing this procedure. Although new devices with smaller sheath sizes are available for TF-TAVI, a minority of patients still do not represent good candidates for this access route and, because of unfavourable iliofemoral arteries, need an alternative approach. Among the access site options are the transapical, direct aortic, transaxillary, or subclavian and, less frequently, transcarotid approaches. Moreover, when TF access is not feasible, the most common approaches are the transapical for the balloon-expandable Edwards SAPIEN XT valve, the subclavian for the Medtronic self-expandable CoreValve, and the transaortic for both prostheses. This chapter provides a detailed overview of all the access sites available for TAVI.
Selection of transcatheter aortic valve implantation prostheses
Authors: Abdel-Wahab Mohamed , Jose John
Published: October 2018

Transcatheter aortic valve implantation (TAVI) has evolved into a highly effective treatment option for inoperable patients or those with high and intermediate operative risk with symptomatic severe aortic stenosis. Several factors determine the success of a TAVI procedure, and patient and prosthesis selection are considered the most crucial among them. A plethora of TAVI devices is currently available for implantation, owing to the substantial design modifications and technological advancements of both prostheses and their delivery systems in the past decade. In this chapter, we provide a comprehensive overview of currently available devices, and discuss potential patient-related factors that may influence their selection for TAVI.
Transcatheter aortic valve implantation and the management of coronary artery disease
Authors: Khawaja Muhammed Zeeshan , Redwood Simon
Published: October 2018

The advent of transcatheter aortic valve implantation (TAVI) has provoked a paradigm shift in the treatment of senile calcific aortic stenosis (AS), the most common valvular disease in the developed world. Its benefits in high-risk and inoperable patients and its comparable outcomes to surgical aortic valve replacement are well established, and there is now evidence supporting use of the technique in intermediate-risk patients. AS often coexists with coronary artery disease (CAD) and, in seeking to further improve outcomes and minimize risks in the TAVI procedure, the management of concomitant CAD is an important consideration.
Transcatheter mitral valve repair
Authors: Bellamy Michael , Baker Christopher
Published: October 2018

Transcatheter therapy has emerged as an option for the treatment of mitral regurgitation (MR) for selected, predominantly high-risk, patients. Most transcatheter procedures are less invasive modifications of existing surgical approaches with a lower procedural risk. The complex anatomy of the mitral valve and varying mechanisms of MR has led to a range of devices being developed that vary in their indications, complexity of delivery, efficacy, and potential complications. This chapter will discuss the treatment of MR using transcatheter leaflet repair and mitral annuloplasty techniques. Transcatheter mitral valve replacement is covered separately. The aetiology and mechanism of MR will determine the type of therapy possible. In primary MR, a leaflet disease, mitral leaflet plication using the edge-to-edge technique, MitraClip is the only currently available percutaneous device. Leaflet repair is also possible using the Neochord device, but this requires a transapical surgical approach with insertion of neochordae that are anchored to the left ventricular apex. In secondary MR, which may be ischaemic or non-ischaemic, the mitral leaflets are usually normal but are tethered and tented secondary to changes in left ventricular size, geometry, and annular size. Transcatheter repair options for secondary MR include MitraClip and percutaneous annuloplasty devices (direct and indirect). It is worth noting that a number of new transcatheter devices are currently in development and the field is likely to expand significantly in the future as these technologies develop.
Transcatheter mitral valve replacement
Authors: Garibo Ricardo Boix , Uzzaman Mohsin , Ghosh-Dastidar Michael , Bapat Vinayak
Published: October 2018

Mitral valve regurgitation is a common disease affecting a large number of patients with heart failure. It is more prevalent in Europe and North America and predominantly in older ages. It has been estimated that moderate to severe mitral regurgitation will double its prevalence by 2030, affecting more than 4 million people. Mitral regurgitation is the second most common valve disease requiring surgery in Europe.
Percutaneous device closure of atrial septal defect and patent foramen ovale
Authors: Calvert Patrick A. , Rana Bushra S. , Hilling-Smith Roland , Hildick-Smith David
Published: October 2018

Structural heart disease interventions look set to form an increasing proportion of the interventional cardiologist’s workload. Device closure of atrial septal connections, both patent foramen ovale (PFO) and atrial septal defect (ASD), are the most commonly performed adult structural interventional procedures in the UK, with 428 PFO and 545 ASD closure procedures performed in adults in 2014. Device closure of ASDs and PFOs are elegant procedures which combine technical and imaging skills with a detailed understanding of cardiac anatomy. More importantly, they also provide tangible clinical benefits to patients.
Mitral balloon valvuloplasty
Authors: Vahanian Alec , Himbert Dominique , Brochet Eric , Ducrocq Grégory , Iung Bernard
Published: October 2018

Although the prevalence of rheumatic fever has greatly decreased in western countries, mitral stenosis (MS) still results in significant morbidity and mortality worldwide. The treatment of MS has been revolutionized since the development of balloon mitral valvuloplasty. Until the first publication by Inoue in 1984, surgery was the only treatment for patients with mitral stenosis. Since then, the technique has evolved considerably. A large number of patients with varied conditions have now been treated worldwide, enabling us to assess the efficacy and risk of the technique, and long-term results make us better able to select the most appropriate candidates for treatment using this method.