bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain Management
Authors: Ahmad Noor , Shilo Dan , Siddiqui Sadiah
Published: October 2018

Image guided interventions play a critical role in the multifactorial approach to acute and chronic pain management. In this chapter we discuss the indications, contraindications, patient evaluation, procedural technique, periprocedural care, and expected outcomes associated with various pain interventions. Interventions covered in this chapter include sacroiliac and facet joint injections, facet joint ablation, epidural injection, and nerve plexus blockade (celiac, lumbar sympathetic, and superior hypogastric). For each intervention, a comprehensive approach to the patient is discussed, including pertinent physical exam findings, providing the proceduralist with an algorithm to provide the appropriate intervention for their patient. In addition, detailed descriptions of optimal technique with referenced images are provided to guide the novice interventionalist first approaching pain interventions.
Peroneal Neuropathy—Fibular Tunnel Syndrome
Authors: Wilson Thomas J. , Spinner Robert J.
Published: October 2018

Common peroneal neuropathy is the most common compressive neuropathy of the lower extremity, often presenting with acute, progressive foot drop. The most common site of compression of the peroneal nerve is at the point that it courses around the neck of the fibula beneath the fascia of the peroneus longus. This chapter aims to help the surgeon evaluate for peroneal neuropathy using a combination of clinical history, physical examination, electrodiagnostics, and imaging. The chapter also discusses surgical and nonsurgical management of peroneal neuropathy, including a detailed discussion of the operative technique for decompression of the peroneal nerve at the fibular tunnel.
Lateral Femoral Cutaneous Neuropathy—Meralgia Paresthetica
Authors: Chiravuri Srinivas
Published: October 2018

Meralgia paresthetica is characterized by anterolateral thigh pain, paresthesia, or dysesthesia without motor weakness. This is due to idiopathic or iatrogenic injury to the lateral femoral cutaneous nerve (LFCN, dorsal rami of L2-L3). Risk factors include obesity, diabetes, and external compression near the inguinal ligament’s attachment to the anterior superior iliac spine. Diagnosis is based on clinical presentation and electrodiagnostic studies. Initial management includes behavioral modification, physical therapy, and pharmacotherapy. More invasive treatment modalities include LFCN infiltration, pulsed radiofrequency, direct nerve stimulation, and spinal cord stimulation. Ultrasound-guided neurectomy is also an effective way to localize the nerve structure and ensure complete nerve transection.
Axillary Nerve Injury
Authors: Payne Russell A. , Rizk Elias B.
Published: October 2018

Axillary nerve injury has been associated with sports injuries, especially those involving anterior shoulder dislocation. The nerve injury leads to weakness of the deltoid and teres minor muscles, which impairs abduction and external rotation of the arm at the shoulder. Electrodiagnostic studies are helpful for determining extent of reinnervation and recovery after injury. In the absence of clinical or electrodiagnostic signs of recovery 3 to 6 months after injury, it is appropriate to offer surgical exploration. The options for surgical repair include direct nerve repair, nerve grafting, and nerve transfer. In appropriately selected individuals, outcomes are favorable.
Nerve Transfers for Spinal Cord Injury
Authors: Hafez Daniel , Bevan Adam , Ray Wilson Z.
Published: October 2018

In spinal cord injury, nerve transfers represent a potential adjunct in the comprehensive clinical management of patients. Unlike tendon transfers, nerve transfers preserve the native muscle biomechanics and provide greater than a 1:1 functional exchange. Nerve transfers can provide improved upper extremity function by capitalizing on the preserved upper motor neurons below the zone of spinal cord injury. One goal in reconstruction is to restore movement. Major movements that have been targeted for restoration include elbow extension (to allow the patient to assist in transfers) and pinch, grasp, and release, which can aid in controlling a motorized wheelchair as well as in feeding oneself. Other major goals are restoration of hand sensation and diaphragm reinnervation to allow ventilator weaning and spontaneous respiration.
Integrity
Authors: Rushton Cynda Hylton
Published: October 2018

Integrity or moral wholeness is the foundation of moral resilience. Integrity arises when intentions, words, thoughts, and actions align and there is fidelity in adherence to ethical commitments, norms, and conscience. It includes a robust notion of moral agency that includes considerations of the congruence of intentions, character, choices, behavior, and actions as well as responsibility for them. It requires a well-honed conscience; moral sensitivity, perception, and imagination; self-regulatory capacities; ongoing reflection to evaluate one’s intentions, motivations, and actions; cognitive judgment; the ability to devise reasonable solutions to internal conflicts; and steadfast commitment to responsibly enact considered decisions. Clinicians have dual obligations to those they serve and to themselves. Personal and relational integrity are fundamental considerations for clinicians. This dynamic interplay requires attunement to the issues of personal and relational integrity that are at play in clinical practice, including relationships with patients, families, colleagues, leaders, organizations, and the broader society.
Strategies to Restore Integrity
Authors: Rushton Cynda Hylton
Published: October 2018

Restoring integrity involves strategies aimed at heeding the call of conscience, giving voice to moral adversity, and speaking up with clarity and confidence. Strategies to respond to moral adversity by leveraging properly bounded moral courage, acknowledging limitations, and connecting to meaning and purpose can help clinicians to respond to imperiled integrity. Skills and practices of moral repair based on Reich’s three phases of suffering offer clinicians a path of healing to repair or mitigate the consequences of moral adversity and suffering. The phases are voiceless suffering, expressive repair including narrative repair, and liberation. When clinicians are able to combine personal practices aimed at restoring their integrity with enabling and supportive work environments, transformation is possible.
Thoracic Spine Pain
Authors: Jones Mark R. , Novitch Matthew , Hadley Graham R. , Kaye Alan D. , Diwan Sudhir A.
Published: October 2018

Thoracic spinal pain (TSP) tends to receive less attention from clinical, epidemiologic, and genetic research communities owing to a reduced incidence in comparison to pain arising from cervical and lumbar derangement. Nevertheless, TSP can be similarly disabling to other forms of spinal pain, imposing significant burdens on the individual and society. Thoracic pain may arise from a multitude of underlying pathologies, including angina pectoris, herpes zoster infection, thoracic disc herniations, pulmonary or pleural tumors, and aneurysms. This chapter focuses on TSP of musculoskeletal origin; however, a thorough history and physical are imperative to avoid overlooking a potentially life-threatening condition.
Advances in Intrathecal Drug Delivery
Authors: Grider Jay S. , Harned Michael E. , Nagar Vital
Published: October 2018

Intrathecal drug delivery has become a commonplace means to treat recalcitrant chronic pain of malignant and nonmalignant origins. Although intrathecal drug delivery systems (IDDS) and intrathecal drug delivery (IDD) itself rapidly established themselves in the treatment of malignant pain at the end of life, these therapies are also utilized for treatment of pain of nonmalignant origin. While the only US Food and Drug Administration (FDA)-approved medications for use in the intrathecal space are morphine, baclofen, and ziconotide, this chapter will also address commonly used medications such as clonidine and local anesthetics such as bupivacaine as well. While this chapter serves as general overview of the topic’s long history and rapidly developing literature, a basic understanding of the modality and medications used is important.
Theories, Frameworks, and Models in Implementation Science in Cancer
Authors: Skolarus Ted A. , Tabak Rachel G. , Sales Anne E.
Published: October 2018

This chapter describes implementation theories, models, and frameworks and justifies their systematic use to build understanding of implementation science across the cancer care continuum and, ultimately, facilitate stewardship of effective cancer care and spending across complex clinical and public health contexts. The chapter discusses several previously developed taxonomy and categorization schemes as well as resources to aid implementation researchers and practitioners in their cancer-related implementation science efforts. The importance of precision implementation using systematic theoretical approaches to coincide with precision oncology efforts and funding is also discussed. After providing concrete examples of theory, model, and framework use across the continuum from prevention to palliative care, relevant implementation science opportunities for collaboration, patient-reported outcomes research, de-implementation, and measurement are highlighted as future directions. A case is constructed for the systematic use of theories, models, and frameworks in implementation science and practice.
Implementation Science in Retail Tobacco Control Policy
Authors: Combs Todd B. , Brossart Laura , Ribisl Kurt M. , Luke Douglas A.
Published: October 2018

This case study considers how expanding implementation science in retail tobacco policy can help reduce the availability and accessibility of tobacco products and ultimately decrease the burden of smoking and tobacco use on public health. Tobacco control strategies are increasingly focused on the retail environment, in which policies can be categorized into four domains: place, price, promotion, and product availability. This case study provides a brief overview of retail tobacco policy in the United States and then examples and guidance for (1) assessing tobacco retailers in communities, (2) connecting specific retail tobacco problems with policies, and (3) translating and disseminating evidence to various stakeholders and policymakers. It concludes with a discussion of emerging opportunities for D&I research in tobacco retail policy.
Treatment for Early Stage Prostate Cancer
Authors: Kobrin Sarah C. , Conway Alex
Published: October 2018

Men diagnosed with early stage prostate cancer will very likely survive many years after their prostate cancer treatment, regardless of which standard treatment is used. This case study describes a situation in which all standard treatments are supported by evidence but side effects vary greatly. In this situation, a partnership is needed between the doctor and the patient to choose the best option. This case study gives a brief overview of the complexities of choosing a treatment for early state prostate cancer and how implementation science is needed to (1) consider effectiveness and implementation together and (2) identify factors that inhibit and enhance the implementation and sustainability of shared decision-making.
Using Precision Medicine to Improve Health and Healthcare
Authors: Clyne Mindy , Kennedy Amy , Khoury Muin J.
Published: October 2018

Implementation science can be incorporated within genomics precision medicine research across the cancer care continuum. Cancer is at the forefront of precision medicine. To move the field forward, the use of implementation science frameworks, theories, models, strategies, and outcome measures is essential so that we can consistently explore how precision medicine discoveries are optimally integrated into care delivery systems. Learning health care systems are model systems for adoption, uptake, and sustainability of precision medicine throughout the cancer care continuum, with both systematic processes in place for research to inform practice, and capacity for a multilevel research agenda, including the utilization of implementation strategies across and among multiple levels. This chapter explores precision medicine across the cancer care continuum and describes implementation science challenges and opportunities.
Scaling-Up Cancer Control Innovations
Authors: Edwards Nancy C. , Riley Barbara L. , Willis Cameron D.
Published: October 2018

This chapter examines characteristics of and approaches to scaling-up innovations and programs, with illustrations from the field of cancer control. It summarizes definitions of scale-up, emphasizing the introduction of innovations with demonstrated effectiveness and the aims of scale-up: improving coverage and equitable access to the innovation(s) and its intended benefits. The chapter proposes a typology to help guide scaling-up activities. The typology includes five dimensions: the object of scale-up, how this object may be adapted, horizontal and vertical directions for scale-up, linear and nonlinear pathways for scale-up, and factors influencing scale-up. Featuring examples of tobacco control and human papillomavirus vaccination, the typology is applied and key scaling-up actions are described, including media campaigns, engaging key stakeholders, mobilizing political support, and investing in a monitoring and evaluation system. Systemic challenges to scale-up are discussed. Future priorities for research on scaling up cancer control initiatives are proposed.
Partnerships and Networks to Support Implementation Science
Authors: Ramanadhan Shoba , Kohler Racquel E. , Viswanath K.
Published: October 2018

Partnerships between researchers and stakeholders offer an opportunity to bring scientific and practice-based knowledge and experience together to improve the quality, value, and relevance of implementation science efforts and increase the application of findings. The chapter covers (1) a continuum of engagement for research–practice partnerships, including the benefits and challenges of engaged implementation science; (2) challenges and opportunities for partnerships in implementation science in community, policy, public opinion, and public–private partnership domains; (3) implementation science partnership evaluation, with an emphasis on social network analysis; and (4) a series of questions for the field as increasing attention is paid to partnerships for implementation science.
Preoperative Anxiety Management
Authors: Shaw Thomas L.
Published: October 2018

Children presenting for surgery are often significantly more anxious compared to adults. This may occur during a new exposure to an unfamiliar environment or repeat exposures to the hospital setting. Pediatric anesthesiologists must utilize a variety of creative and traditional and nontraditional strategies to help alleviate this feeling of anxiety prior to proceeding to the operating room. Knowledge of the consequences of preoperative emotional distress, combined with knowledge of available pharmacological and behavioral interventions, can help enhance the patient’s and the parents’ experience, as well as perioperative outcomes. Both pharmacologic and nonpharmacologic strategies have been successfully utilized perioperatively.
Anesthesia for MRI
Authors: Du Trung , Mahmoud Mohamed A.
Published: October 2018

Over the past two decades, recent advances in technological innovation have led to an increased demand for pediatric noninvasive procedures. This clinical demand has resulted in tremendous growth in pediatric sedation in non-operating room anesthesia (NORA) locations. Providing anesthesia in these locations challenges anesthesia providers to gain familiarity with the procedures, tailor an anesthesia plan to the procedure and location, and plan for the management of life-threatening situations in these challenging locations. Anesthesiologists are the final arbiter of whether the child is optimized for the procedure or not in NORA location with potentially limited access to backup help. This chapter explores the current and important safety issues for anesthetic administration in magnetic resonance imaging (MRI) suite, the available anesthetic techniques for MRI anesthesia/sedation and finally discuss some specialty-specific considerations for children with history of obstructive sleep apnea and difficult airway.
Laryngeal Papillomatosis
Authors: Rodriguez Carlos L.
Published: October 2018

Laryngeal papillomas may present in a variety of ways; hoarseness and stridor are indications of severe disease. This disease is of varying severity in each patient, and treatment is typically by serial laser resection of papillomas until they eventually stop recurring. Anesthetic management of a patient for resection of these airway papillomas is challenging in that a deep plane of anesthetic that will allow the surgeon to work in the airway is necessary. Laser surgery for papillomas is a risk for fire in the airway, and adequate precautions must be taken to ensure this does not occur. This chapter presents a case study of a 2-year-old by with a history of laryngeal papillomatosis to illustrate.
Anesthetic Implications for Surgical Correction of Pectus Excavatum
Authors: Glover Chris D. , Muhly Wallis T.
Published: October 2018

Pectus excavatum is the most common congenital chest wall deformity in children. It is characterized by a posterior depression of the sternum resulting from defective growth of the surrounding rib cartilage. This abnormality in thoracic architecture can lead to a progressive reduction in cardiopulmonary capacity. An early surgical approach popularized by Ravitch involved an open repair with removal of abnormal rib cartilage to allow for regrowth of the rib cartilage to the sternum in a more anterior position. Subsequently, Nuss popularized a minimally invasive repair of pectus excavatum which involves the internal bracing of the chest wall and anterior displacement of the sternum without cutting of the rib cartilage. It is now the most common surgical approach for pectus excavatum correction. Anesthesiologists should acutely be aware of the potential intraoperative complications associated with this procedure as well as the postoperative challenges this procedure poses in terms of pain management.
Tetralogy of Fallot
Authors: Trivedi Premal M. , Motta Pablo
Published: October 2018

Congenital heart conditions can be characterized as cyanotic or acyanotic. This chapter discusses one of the most common cyanotic congenital cardiac conditions: tetralogy of Fallot. Tetralogy of Fallot is composed of distinct anomalies which result in left-to-right shunting of blood resulting in cyanotic spells, under certain conditions such as pain (and associated tachycardia) decreased oxygenation, decreased venous return, or hypotension. Recognizing factors that accentuate the left-to-right shunting of blood in this condition is essential for adequate management of a TET spell which is frequently observed in children with tetralogy of Fallot.
Cardiac Catheterization
Authors: Lin Erica P. , Loepke Andreas W. , Mossad Emad B.
Published: October 2018

Cardiac catheterization plays an increasing role in the management of pediatric and adult patients with congenital heart disease. These days, the catheterization laboratory often also functions as a satellite operating room with hybrid capabilities that involve both the surgeons and interventional cardiologists. Delivering anesthesia in this environment is challenging, and the physical space is limited. Exposure to ionizing radiation increases in proximity to the patient during fluoroscopy. Furthermore, the medical complexity of the patient population cared for in this setting continues to broaden, as a wider range of interventions becomes available. In order to plan the safest anesthetic management, it is imperative for anesthesiologists to have a firm understanding of each patient’s physiology and how it will be affected by both the sedation/anesthesia and the proposed procedure. Teamwork and situational awareness are essential, as are anticipation and preparation for the rare occurrence of a major, life-threatening complication.
Perioperative Management of Pheochromocytoma
Authors: Liu Yang
Published: October 2018

Pheochromocytomas are rare neuroendocrine tumors that arise from catecholamine producing cells in the adrenal glands. In the pediatric population, catecholamine-secreting tumors typically present around ages 11 and 12 and occur in 0.8% to 1.7% of hypertensive children. Pheochromocytomas represent significant management challenges to the anesthesiologist, particularly when undiagnosed. Many different anesthetic techniques and various antihypertensive agents have been successfully used to attenuate the intraoperative variations in blood pressure. After resection, periodic follow-up is highly recommended for all patients with pheochromocytoma because of the high incidence of recurrence and malignancy. This chapter uses a case study of a 12-year-old boy who presents for a scheduled laparoscopic cortical sparing adrenalectomy for unilateral pheochromocytoma.
Cerebral Palsy
Authors: Kanjia Megha
Published: October 2018

Cerebral palsy (CP) is a neurologic disorder characterized by spasticity and is strongly associated with prematurity and low birth weight. Patients with CP often have other related comorbidities including but not limited to gastroesophageal reflux disease, chronic aspiration, immobility, pulmonary conditions, epilepsy, and contractures. These conditions contribute to the need for repeated surgical procedures and also affect the patient’s anesthetic management. Special consideration should be placed on temperature homeostasis, patient positioning, procedural analgesia, and pulmonary support. This chapter defines CP and discusses its clinical manifestations, anesthetic considerations in a pediatric patient requiring surgery, and anesthetic plans for patients with CP and existing comorbidities.
Emergence Delirium
Authors: Chandrakantan Arvind , Watcha Mehernoor
Published: October 2018

Emergence agitation/emergence delirium is a self-limited, postanesthesia complication occurring in anywhere between 10% and 80% of children. It is important to recognize that emergence agitation/emergence delirium represents a continuum of increasing severity. While there are no long-term sequelae as a result of emergence delirium, the short-term consequences can be trying for parents and caregivers alike. While no uniform “treatment” exists for emergence delirium, there are various approaches in treating and preventing the condition. This chapter defines the features of emergence delirium and the associated risk factors; describes the different rating scales for measuring emergence delirium and the differences between them, and lastly discusses the measures for the prevention and treatment of pediatric emergence delirium.
Stridor after Extubation
Authors: Gore Cheryl , Wu Junzheng , Kurth C. Dean
Published: October 2018

Postextubation stridor arises from glottic and subglottic edema caused by ischemia of the tracheal mucosa from pressure by the endotracheal tube. Multiple risk factors have been described; preventive measures include appropriate tube sizing, air leak tests, administration of steroids, and smooth airway management techniques, such as atraumatic intubation. When stridor does occur, cool humidified air as well as racemic epinephrine may be used as treatment. The patient is safe for discharge once symptoms have dramatically improved and the window for potential “rebound effect” from racemic epinephrine has passed with no further stridor.
Patent Ductus Arteriosus
Authors: Dalal Priti G. , Grap Shannon M.
Published: October 2018

The ductus arteriosus has a significant role in the fetal circulation connecting the main pulmonary artery to the aorta. Normally, after birth, it functionally closes within few hours but complete obliteration occurs at 2 to 3 weeks of age. Failure of the ductus arteriosus to close leads to the condition patent ductus arteriosus. This may be an isolated condition or associated with other congenital cardiac anomalies. Untreated patent ductus arteriosus may be a cause for failure to thrive and pose a risk for infective endocarditis. Management may include pharmacotherapy, nonsurgical closure, and surgical closure. Nonsurgical closure entails using the transcatheter technique. The surgical correction, via a left thoracotomy incision, may be done in the neonatal intensive care unit as a bedside procedure or in the operating room. The anesthetic management is challenging and may depend on the type of intervention.
Transposition of the Great Arteries
Authors: Waberski Andrew T. , Deutsch Nina
Published: October 2018

Transposition of the great arteries is a congenital cardiac abnormality that presents in the neonatal period, most commonly as cyanosis. While variations in anatomic features exist, dextro-transposition of the great arteries, the most common form, results in 2 separate circulatory systems in parallel, such that the right ventricle pumps deoxygenated blood to the systemic circulation, and the left ventricle sends oxygenated blood back to the pulmonary circulation. To ensure survival, early diagnosis and intervention to allow for adequate mixing of blood is necessary. The arterial switch operation is the definitive treatment, usually undertaken in the first few days of life. Known complications of surgery include ischemia, bleeding, hemodynamic compromise, and arrhythmias. Anesthetic management must take these factors into account.
Tonsillectomy and Adenoidectomy in the Pediatric Patient with Down Syndrome
Authors: Choi Ellen Y.
Published: October 2018

Down syndrome or Trisomy 21 is the most common chromosomal abnormality, affecting some 250,000 individuals, with life expectancy reaching into the fifth decade of life for some. It has characteristic physical features, with associated congenital conditions affecting almost every organ system. While all abnormalities must be taken into account during the preoperative evaluation, conditions of particular significance to the anesthesia provider include obstructive sleep apnea, congenital heart disease, and atlantoaxial instability. This chapter presents for discussion a case of a pediatric patient with Down syndrome undergoing adenotonsillectomy. Additional topics covered include attenuation of the risk of airway fire and management of post-tonsillectomy hemorrhage.
Anesthetic Management of Chiari Decompression
Authors: Boudreau Eric , Egan Brian
Published: October 2018

Chiari malformation is a congenital neurodevelopment abnormality affecting the cerebellum and the brainstem. This chapter looks at the etiology, history, diagnostic criteria, physical exam findings, pathophysiology, and treatment for this disease process from the perspective of an anesthesiologist. The signs and symptoms stemming from Chiari malformations including syringomyelia, respiratory dysfunction, and vasomotor instability will be discussed. Preoperative considerations will be examined as well as ways to optimize these patients prior to surgery. Intraoperative anesthetic goals for patients undergoing Chiari decompression will be presented and postoperative objectives will be examined in detail. The ultimate purpose of this chapter is to review relevant literature and put forth a set of recommendations regarding the anesthetic care of complicated patients undergoing intracranial surgery.
Vein of Galen Malformation
Authors: Eastburn Elizabeth C. , Landrigan-Ossar Mary
Published: October 2018

Vein of Galen malformation (VGM) is a high-flow intracranial vascular malformation, presenting in utero or after birth with a range of initial symptoms. The natural history of untreated VGM is grave, with progressive permanent neurological dysfunction, developmental delay, seizures, intracranial hemorrhage, and death. Presentation varies with age, with more severe manifestations resulting in earlier presentation and poorer outcome. The mainstay of treatment is medical stabilization followed by endovascular embolization. The goal is to reduce flow through the malformation such that normal development can proceed without neurological deficit. The past 20 years have seen great advances both in the technical treatment of the vascular lesion and in the overall prognosis of patients treated for this condition. Key to a good outcome is appropriate selection of patients and treatment by physicians familiar with this pathophysiology.
Idiopathic Hypertrophic Pyloric Stenosis
Authors: Mashman Darlene , Mays Carmen
Published: October 2018

Idiopathic hypertrophic pyloric stenosis (IHPS) is a common cause of nonbilious, projectile vomiting in the infant. Progressive hypertrophy of the pyloric muscle leads to an obstruction of the gastric outlet. The condition is easily corrected with a pyloromyotomy. Mortality is <0.5% in most specialty centers when hydration and normal electrolyte status is restored prior to surgery, appropriate precautions are taken preoperatively, and the patient is carefully monitored for known postoperative complications. This chapter discusses the related epidemiology and etiology; clinical presentation; use of imaging studies; preoperative preparation; and anesthetic, surgical, nonsurgical, and postoperative management of these patients. Topics covered include metabolic alkalosis, electrolyte abnormality, dehydration, pulmonary aspiration, and pyloromyotomy.
Neuronal Ceroid Lipofuscinoses (Batten Disease)
Authors: Uffman Joshua C.
Published: October 2018

Neuronal ceroid lipofuscinoses (NCL) are a group of autosomal recessive genetic disorders which represent the most common form of childhood neurodegenerative disease. Classically the disease was described according to the age of diagnosis resulting in four common phenotypes: (i) infantile or Santavuori-Haltia, (ii) late infantile or Jansky-Bielschowsky, (iii) juvenile or Spielmeyer-Vogt, and (iv) adult or Kufs. With advances in genetic mutational analysis techniques and improved understanding of NCL disease as a whole, disease classification now focuses on which of the known genetic defects is responsible for the disease. Regardless of genetic defect or age of onset, patients typically present with language delay, seizures, blindness, and ataxia. The term “Batten disease” is used to refer to the group as a whole in addition to specifically referring to the juvenile form. Anesthetic implications focus on disease symptoms at presentation, with special attention to maintaining normorthermia and the possibility of bradycardia.
Glycogen Storage Diseases
Authors: Wang Tammy , Wong Jocelyn , Honkanen Anita
Published: October 2018

Glycogen storage diseases result from deficiencies of various enzymes or proteins in the pathways of glycogen metabolism. The reduction in effective glucose storage and/or mobilization results in hypoglycemia and accumulation of glycogen in tissues. Diagnosis can occur at any age, from infancy to adulthood, depending on the pathway affected and the degree of enzyme deficiency. The clinical presentation varies, but the most commonly affected organ systems include the heart, liver, and skeletal muscles. In addition to the morbidity that can occur from dysfunction of these organs, important anesthetic implications include administration of glucose-containing fluids to avoid hypoglycemia, monitoring for acidosis, and caution with use of depolarizing muscle relaxants because of the potential risk of hyperkalemia and rhabdomyolysis. Inheritance is commonly autosomal recessive.
Multimodal Approach to Acute Pain Management after Nuss Bar Placement and Other Pain Scenarios
Authors: Diaz Christina D. , Weisman Steven J.
Published: October 2018

Acute pain management can involve regional blocks with local anesthetics, neuraxial blocks such as caudal blocks and epidurals, oral and intravenous opioids, and nonsteroidal anti-inflammatory drugs. Other pain management modalities include neuropathic pain medications, muscle relaxants, antidepressants, acupuncture, techniques for stress relief, and behavioral modification therapy. While there are many options for treating a patient’s pain, the best approach is to understand the symptoms, attempt to determine the cause of the pain, and understand the patient’s goals with regard to treatment. This chapter discusses the multimodal acute pain management for a case of Nuss bar placement, utilizing an epidural, patient-controlled analgesia, and oral pain medication. The chapter has an additional scenario discussing neuraxial analgesia and nerve blocks for a hypospadias repair in an infant. Finally, the third case-based discussion focuses on the treatment of common types of headaches.
Peripheral Nerve Blockade in the Pediatric Patient
Authors: Stockman Joel , Lee Lisa
Published: October 2018

Peripheral nerve blockade among the pediatric and adult population has seen continuous growth over the past decade. Improvements in ultrasonography and proven safety with minimal complications further the utilization of upper and lower extremity blockade. Procedures can safely be completed under general anesthesia in the pediatric patient. Catheters can be left in place to prolong blockade, allowing the patient to decrease narcotic pain medication for longer time periods. Contraindications include patient refusal, coagulopathy, and local infection. Continuous peripheral nerve blocks deliver prolonged analgesia and offer an alternative to opioid-based pain therapy for procedures with all projected pain types—mild to severe. Appropriate patient selection is necessary for ensuring safety when sending patients home with a catheter/delivery system.
Burns
Authors: Bhananker Sanjay , Bhalla Paul
Published: October 2018

Burns injuries are a leading cause of morbidity and mortality in children. A significant burn injury affects every major organ system of the body. Initial management focuses on resuscitation along the ABCDE approach, with particular vigilance for the possibility of airway burn causing progressive edema and narrowing. Smoke inhalation is associated with carbon monoxide poisoning and possible cyanide toxicity. Fluid management depends on accurate estimation on the extent of the burn and use of a formula to calculate infusion rate, with careful monitoring of end-organ perfusion. Significant burn injuries are associated with hypermetabolic changes and a catabolic state, and burn victims are at high risk of developing sepsis. Treatment of a burn injury with debridement and skin grafting can involve multiple visits to the operating room with frequent need for sedation and anesthesia. Providers need a thorough understanding of potential anesthetic issues in burn-injured pediatric patients.
Hemangiopericytoma
Authors: Weaver Bradley D. , Jensen Randy L.
Published: October 2018

Hemangiopericytoma (HPC) represents a rare, diagnostically challenging tumor for neurosurgical oncologists. Often, HPC appears as a dural-based, extra-axial mass lacking the characteristic hyperostosis and calcification of meningioma. Rapidly growing unconfirmed meningioma-like masses warrant increased suspicion of HPC. These tumors differ significantly from meningiomas in natural history and implications for patient morbidity and mortality. Histopathological analysis is required for proper diagnosis. MRI with and without contrast is recommended for operative planning, and angiography and preoperative embolization may be necessary for highly vascular HPCs. Operative goals include maximal, safe gross total resection. Evidence suggests adjuvant radiosurgery or radiation therapy benefits patients regardless of the extent of surgical resection.
Dermoid/Epidermoid Tumors
Authors: Shah Ashish H. , Morcos Jacques J.
Published: October 2018

Epidermoid tumors of the central nervous system are typically found in the cerebellopontine angle or parasellar space and comprise approximately 1% of all intracranial tumors. Dermoid cysts tend to occur in midline locations. Both are derived from embryonal tissue and have classic imaging findings on computed tomography and magnetic resonance imaging. Epidermoid tumors and dermoid cysts are benign and grow slowly, although epidermoid cysts can undergo malignant transformation. Surgical decisions and approaches are based on the presenting symptoms and anatomic location of the tumor. Mollaret meningitis is a unique complication of these cysts and may occur if the cyst ruptures preoperatively or during surgery.
Neuroanesthesia: A Problem-Based Learning Approach
Authors: Anitescu Magdalena
Published: October 2018

Neuroanesthesia: A Problem-Based Learning Approach provides a comprehensive review of the field of neuroanesthesia. Its format, inspired by the American Society of Anesthesiologists model of Problem-Based Learning Discussions, incorporates a pool of practical, ABA board-exam-style multiple choice questions for self-assessment. Each of its 29 case-based chapters start with a case description, usually a compilation of several actual cases; it then branches out through case-based questions to increasingly complex situations. The structure is designed to create an authentic experience that mirrors that of an oral board examination. The discussion sections that follow offer a comprehensive approach to the chapter’s subject matter, thus creating a modern, complete, and up-to-date review of the topic. This book is equally a solid reference compendium of neuronesthesia topics and a comprehensive review to assist the general anesthesiologist both in day-to-day practice and during preparation for certification exams.
Arteriovenous Malformation
Authors: Spinelli Allison , Huang Liang
Published: October 2018

Arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system, which may occur in the brain or the spinal cord. AVMs are challenging to diagnose, and the symptoms may be subtle or dramatic. The location and extent of the lesion will determine its potential for morbidity as these lesions also affect a young population. Most importantly, the technology and evolution of treatment for AVMs has changed dramatically over the past two decades and now incorporates interventional neuroradiology and stereotactic radiation. Management options include conservative management, surgical resection, endovascular embolization, and stereotactic surgery. This chapter’s discussion will cover surgical and interventional modes of treatment of cerebral AVMs.
Endovascular Thrombectomy in Acute Ischemic Stroke
Authors: Abramowicz A. Elisabeth
Published: October 2018

Endovascular thrombectomy (EVT) for acute ischemic stroke is a new and powerful treatment modality that restores functional independence to many victims. Although it has been proved of value in large-vessel occlusion of the anterior circulation, it is also used in basilar artery embolism. Time to successful reperfusion is a major determinant of recovery. A subset of patients has robust collaterals and will benefit from treatment up to 24 hours after stroke onset; the presence of salvageable brain tissue (penumbra) must be ascertained by specialized imaging. The number of patients who can benefit from EVT is estimated at 100,000/year in the United States alone in more than 300 designated Thrombectomy-Capable Stroke Centers. EVT is a new anesthetic emergency. Anesthesiologists must be actively involved in creating protocol-driven care for acute ischemic stroke patients.
Chiari Malformations
Authors: Maurtua Marco , Lyons Mathew , DaPrano Nicholas
Published: October 2018

Chiari malformations are structural defects in the base of the skull and cerebellum. These conditions are characterized by the abnormal displacement of part of the cerebellum and brainstem through the foramen magnum into the upper spinal canal causing autonomic dysfunction, neurologic deficits, and hydrocephalus. Chiari malformations are classified into several types based on their severity and the parts of the brain affected by the herniation. In neonates, Chiari malformations are commonly associated with spina bifida and myelomeningocele. Anesthesia for surgical correction of Chiari malformations presents a unique set of challenges and demands that requires knowledge of both the neurophysiology of the condition and the surgical process.
Elevated ICP
Authors: Pisklakov Sergey , Ibrahim Haitham , Antoine Ingrid A. Fitz-James
Published: October 2018

Perioperative management of a patient with elevated intracranial pressure (ICP) is of paramount importance in neuroanesthesiology. Should this clinical emergency remain unaddressed, disability and death will ensue. Suboptimal care of a patient with elevated ICP is associated with avoidable morbidity and predictable mortality unless timely medical interventions, a focused history, targeted physical findings and a high degree of clinical suspicion confirmed by selective imaging result in medical stabilization and more definitive neurosurgical intervention. This may require interinstitutional transport. Understanding the physiologic and pathologic concepts that underlie elevated ICP permit anticipatory interventions to avert inexorable deterioration. The etiology of elevated intracranial pressure is often multifactorial. The deleterious effects of rising ICP demand a clear understanding of the relationship between ICP, mean arterial pressure (MAP), cerebral perfusion pressure (CPP), and cerebral autoregulation. Maintaining optimal CPP to prevent cerebral ischemia is the neuroanesthesiologist’s ultimate goal while managing a patient with an elevated ICP.
Neurophysiology/Neuroprotection
Authors: Beheiry Hossam El
Published: October 2018

Intracerebral hemorrhage (ICH) is a catastrophic event that may lead to severe disability or death. It is associated with major disruption of intracranial neurophysiology and subsequent neuronal tissue injury. The etiology of ICH may be primary (e.g., hypertensive) or secondary (e.g., traumatic). Treatment options include conservative management or neurosurgical intervention in selected patients. In order to manage these challenging cases, the anesthesiologist and the intensivist should have thorough knowledge pertaining to neurophysiologic concepts of cerebral blood flow, cerebral autoregulation, and neuroprotection principles. Additionally, the specialized team managing the patient with ICH should be cognizant of the most recent evidence-based guidelines recommended by the pertinent associations.
Neurophysiologic Monitoring
Authors: Koht Antoun , Sloan Tod B.
Published: October 2018

Intraoperative neurophysiologic monitoring is used for monitoring and mapping of neurological structures during surgery and procedures where the neurological structures are at risk. Among the most commonly used techniques are electrophysiologic techniques, which include spontaneous and evoked electromyography, somatosensory evoked potentials, motor evoked potentials, electroencephalography, and auditory brainstem responses. These methods differ in their responses to anesthesia and in their clinical contribution to monitoring because of differing anatomy. Their use in spinal corrective surgery highlights the role of the anesthesiologist during cases when these techniques are utilized. Optimization of anesthesia, position, and physiology provide better monitoring conditions, enhance signal evaluation, and may lead to better neurological outcome.
General: The Asthmatic Patient
Authors: Javeed Sana Na , Kogan Anna
Published: October 2018

In this chapter the essential aspects of managing the asthmatic patient before, during, and after surgery are reviewed. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. The case involves a woman with type 2 diabetes mellitus who is scheduled for urgent laparoscopic, possibly open, cholecystectomy. Issues addressed for preoperative evaluation include assessment for whether the patient is optimized for urgent surgery, hemoglobin A1C test, and premedication. Intraoperative topics include induction, selecting a ventilator mode, and managing complications. Postoperative concerns discussed include extubation criteria and management of glucose levels.
Endocrine: Carcinoid Tumor
Authors: La Dieman , Tran Minh Chau Joe
Published: October 2018

In this chapter the essential aspects of anesthesia for carcinoid disease are reviewed. Specifically, the pathophysiology of this syndrome and its effect on anesthesia care are reviewed in detail. Drugs that should be avoided in the carcinoid patient are discussed, as well as therapy. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. The preoperative section discusses assessment of carcinoid tumor using somatostatin analog scintigraphy and of related cardiac, pulmonary, and metabolic issues. Intraoperative topics discussed include monitoring, induction, and maintenance of the patient, as well as potential complications such as bronchospasm and hypotension. Postoperative concerns mentioned include pain management and tapering of octreotide.
Orthopedics: Shoulder Surgery
Authors: Madison Sarah
Published: October 2018

In this chapter the essential aspects of anesthesia for shoulder surgery are reviewed. Specifically, regional nerve blocks that are most appropriate and the techniques, indications, and complications of such blocks are discussed. Alternatives to regional nerve blocks are also reviewed. The patient is to undergo arthroscopic rotator cuff repair in an ambulatory setting. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Discussion of preoperative evaluation includes the patient’s cardiac status and history of hypertension. Intraoperative issues addressed include choice of anesthesia (interscalene nerve block) and induction, use of laryngeal mask airway, and management of hypotension. Postoperative concerns discussed are pain management, dyspnea, and nausea.
Trauma: Traumatic Brain Injury
Authors: Gupta Ruchir
Published: October 2018

In this chapter the essential aspects of anesthesia for traumatic brain injury are discussed. Subtopics include manifestations and treatment of elevated intracranial pressure (ICP), Glasgow Coma Scale (GCS), drugs used to lower ICP, and patient monitoring. The case presented is an emergent craniotomy. 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 evaluation of trauma, use of the GCS in this case, assessing intracranial hypertension, history of substance abuse, and clearing the cervical spine. Issues related to intraoperative management in this case include induction and use of blood products. Postoperative concerns addressed include polyuria and acute respiratory distress syndrome.
Urology: TURP Syndrome
Authors: Slomovits Mark
Published: October 2018

In this chapter the essential aspects of anesthesia for transurethral resection of the prostate (TURP) syndrome are discussed. Specifically, the role of general versus regional anesthesia, the treatment of hyponatremia, and ways to prevent the development of TURP syndrome are reviewed. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Aspects of preoperative management that are discussed include assessment of comorbidities and use of laser therapy. Intraoperative topics are monitoring, anesthesia used, definition of and concerns related to TURP, bladder perforation, and hyponatremia. Central pontine myelinolysis, glycine toxicity, and oliguria are addressed under postoperative management.