bluuebunny/crossref_metadata_2025 huggingface dataset:
Panic and Phobic Disorders
Authors: North Carol S. , Yutzy Sean H.
Published: January 2019

Panic and phobic disorders are among the most common psychiatric syndromes. Panic disorder is a chronic illness characterized by recurrent, acute panic attacks, which are discrete episodes of anxiety or fearfulness with definite onset, rapid increase, and spontaneous termination. Phobic disorder is a chronic condition dominated by one or more phobias. Different types of phobias include specific phobias (e.g., fear of animals), social phobias (e.g., fear of public speaking), and agoraphobia (fear of being in places where help might not be available in the event of an anxiety attack). Panic disorder and agoraphobia are currently diagnosed independently of one another, but previously these diagnoses were linked diagnostically (panic disorder with or without agoraphobia and agoraphobia without panic disorder).
Somatization Disorder
Authors: North Carol S. , Yutzy Sean H.
Published: January 2019

Somatization disorder is a more recent name for hysteria, which has been described for more than 4,000 years. This chapter formally reviews the last 160 years’ descriptions (Briquet’s syndrome) and recent conceptualizations, with emphasis on the most recent 60 years. The debate over the most recently proposed 2013 relabeling/criteria change is reviewed. The epidemiology of various criteria sets and divergent presentations are reviewed. The natural history, family studies, and potential dramatic complications, including death, are considered. This chapter describes in-depth the potential for the disorder to masquerade as a multitude of potential medical illnesses and it covers formal efforts of clinical management.
Contraindications, Risks, and Safety Precautions for Stress Testing
Authors: Thomas Gregory S. , Ellestad Myrvin H.
Published: January 2019

The chapter Contraindications, Risks, and Safety Precautions for Exercise Testing details the absolute and relative contraindications to exercise testing. A common contraindication is exercise testing within 48 hours of a myocardial infarction (MI). Indications for termination the exercise test are reviewed to maximize patient safety and include development of moderate angina, a progressive decrease in systolic blood pressure with continued exercise, ≥1 ST segment elevation in an electrocardiographic lead without Q waves, and generally if a patient develops a ≥2 mm increase in ST depression from baseline. The mortality rate for exercise testing approximates 0.3 per 10,000 (0.03%).
Rhythm and Conduction Disturbances in Stress Testing
Authors: Thomas Gregory S. , Balouch Maryam
Published: January 2019

The chapter Rhythm and Conduction Disturbances in Stress Testing reviews the frequency and significance of arrhythmias and conduction abnormalities precipitated by exercise. Case examples are provided. PVCs occurring prior to, during exercise, or during recovery all modestly increase the risk of all-cause mortality in patients with and without known coronary artery disease (CAD). Ventricular tachycardia and premature ventricular complexes are often not reproducible on a subsequent exercise test. Exercise induced left bundle branch block (LBBB) predicts increased risk of the presence of CAD, all cause mortality, and often permanent LBBB. Differentiating wide complex tachycardia during exercise testing between supraventricular tachycardia and ventricular tachycardia can be challenging. The Wellens, Brugada, and Vereckei algorithms to distinguish between these arrhythmias are detailed and compared.
Achondroplasia and Related FGFR3 Conditions
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter discusses achondroplasia and related FGFR3 conditions and explores thanatophoric dysplasia (Types 1 and 2), achondroplasia, hypochondroplasia, and severe achondroplasia with developmental delay and acanthosis nigricans (SADDAN). Each discussion includes major clinical findings, major radiographic features, genetics, major differential diagnoses, and a bibliography.
Dysplasias with Predominant Metaphyseal Involvement
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter discusses metaphyseal eysplasias and explores metaphyseal chondrodysplasia (Schmid type), cartilage-hair hypoplasia, metaphyseal dysplasia (Spahr type), metaphyseal anadysplasia, Shwachman syndrome, metaphyseal chondrodysplasia (Jansen type), Eiken dysplasia, and chronic infantile neurologic cutaneous and articular syndrome (CINCA). Each discussion includes major clinical findings, major radiographic features, genetics, major differential diagnoses, and a bibliography.
Spondyloepiphyseal Dysplasia Congenita and Related Type 2/Type 11 Collagen Disorders
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter further discusses bone dysplasias, and explores achondrogenesis II (hypochondrogenesis), platyspondylic dysplasia (Torrance type), spondyloepiphyseal dysplasia congenita, spondylo-epi-metaphyseal dysplasia (Strudwick type), Kniest dysplasia, spondyloepiphyseal dysplasia (Stanescu type), spondyloperipheral dysplasia, spondyloepiphyseal dysplasia with short metatarsals, Stickler dysplasia, fibrochondrogenesis, and oto-spondylo-megaepiphyseal dysplasia. Each discussion includes major clinical findings, major radiographic features, genetics, major differential diagnoses, and a bibliography.
Metatropic Dysplasia and Other TRPV4-Related Skeletal Dysplasias
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter discusses metatropic dysplasia and other TRPV4-related skeletal dysplasias, including spondyloepiphyseal dysplasia (Maroteaux type), spondylometaphyseal dysplasia (Kozlowski type), brachyolmia (autosomal dominant), and familial digital arthropathy with brachydactyly. Each discussion includes major radiographic features, major clinical findings, genetics, major differential diagnoses, and a bibliography.
Spondylo-Epi-Metaphyseal and Spondylo-Metaphyseal Dysplasias
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter further discusses bone dysplasias and explores achondrogenesis type 1A, odontochondrodysplasia, Schneckenbecken dysplasia, opsismodysplasia, spondylometaphyseal dysplasia (Sedaghatian type), spondyloenchondrodysplasia, SEMD (PAPSS2 type) and brachyolmia (autosomal recessive type), Dyggve-Melchior-Clausen dysplasia, spondylometaepiphyseal dysplasia (short limb-abnormal calcification type), spondylometaphyseal dysplasia with cone-rod dystrophy, dyssegmental dysplasia, Schwartz-Jampel syndrome, spondyloepiphyseal dysplasia tarda (X-linked), aggrecan-associated skeletal dysplasias, Wolcott-Rallison syndrome, Schimke immunoosseous dysplasia, progressive pseudorheumatoid chondrodysplasia, spondylometaphyseal dysplasia (corner fracture type), sponastrime dysplasia, CODAS syndrome, N-acetyl-neuraminic acid synthase (NANS) deficiency, and spondylo-epi-metaphyseal dysplasia with immune deficiency and developmental disability (EXTL3-deficient type). Each discussion includes major radiographic features, major clinical findings, genetics, major differential diagnoses, and a bibliography.
Diastrophic Dysplasia and Related Conditions, and Dysplasias with Joint Dislocations
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter further discusses bone dysplasias and includes discussion on achondrogenesis (type IB), atelosteogenesis type 2, diastrophic dysplasia, multiple epiphyseal dysplasia (recessive type [rMED]), Desbuquois dysplasia, chondrodysplasia with joint dislocations (IMPAD1/gPAPP type), Catel-Manzke syndrome, chondrodysplasia with congenital joint dislocations (CHST3-type), temtamy preaxial brachydactyly syndrome (TPBS), B4GALT7 deficiency, B3GAT3 deficiency, XYLT1 deficiency, spondyloepimetaphyseal dysplasia with joint laxity Beighton type, spondyloepimetaphyseal dysplasia with joint laxity (leptodactylic type), pseudodiastrophic dysplasia, and Steel syndrome. Each discussion includes major radiographic features, major clinical findings, genetics, major differential diagnoses, and a bibliography.
Filamin-Associated Dysplasias/Dysostoses and Related Disorders
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter discusses filamin-associated dysplasias/dysostoses and related disorders and includes discussion on otopalatodigital syndrome type 1, otopalatodigital syndrome type II, Melnick-Needles osteodysplasty, frontometaphyseal dysplasia, boomerang dysplasia/atelosteogenesis type I, atelosteogenesis type III, Larsen syndrome (autosomal dominant), spondylocarpotarsal synostosis syndrome, and Frank-ter Haar syndrome. Each discussion includes major radiographic features, major clinical findings, genetics, major differential diagnoses, and a bibliography.
Osteogenesis Imperfecta and Other Disorders with Decreased Bone Density
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter discusses osteogenesis imperfecta and other disorders with decreased bone density and includes discussion on osteogenesis imperfecta itself, osteogenesis imperfecta (type I), osteogenesis imperfecta (type IIA), osteogenesis imperfecta (type IIC), osteogenesis imperfecta (type III/IIB), osteogenesis imperfecta (type IV), osteogenesis imperfecta (type V), idiopathic juvenile osteoporosis, Bruck syndrome, Cole-Carpenter syndrome, Stüve-Wiedemann syndrome, osteoporosis-pseudoglioma syndrome, spondyloocular dysplasia, geroderma osteodysplasticum, calvarial doughnut lesions-osteoporosis syndrome, and gnathodiaphyseal dysplasia. Each discussion includes major radiographic features, major clinical findings, genetics, major differential diagnoses, and a bibliography.
Dysorders with Defective Mineralization
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter further discusses bone dysplasias and includes discussion on hypophosphatasia, neonatal severe primary hyperparathyroidism, and hereditary rickets. Each discussion includes major radiographic features, major clinical findings, major laboratory findings, genetics, major differential diagnoses, and a bibliography.
Dense Bone Dysplasias with Normal Bone Shape
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter discusses dense bone dysplasias with normal bone shape and includes discussion on osteopetroses, Raine dysplasia, infantile osteopetrosis, osteopetrosis (intermediate), osteopetrosis (late onset forms), osteopetrosis with renal tubular acidosis, dysosteosclerosis, pyknodysostosis, osteomesopyknosis, osteopetrosis (lymphedema, ectodermal dysplasia, immune defect), osteopoikilosis, melorheostosis, and osteopathia striata with cranial sclerosis. Osteoclasts play important roles during bone growth and in maintaining bone health and bone homeostasis. Dysfunction or lack of osteoclasts is under the control and interaction of many genes and leads to increased bone mass and osteopetrosis phenotypes. Increased bone density in osteopetrosis is also accompanied by some loss of modelling resulting in widening of the affected sclerotic transverse striations. The intermittent nature of the sclerosis results in areas of normal bone density and normal modelling in between the sclerotic bands. The mechanisms related to the apparent “switching off” of the abnormal osteoclastic activity has not yet been elucidated. Most of the conditions in this section are related to a failure of osteoclast function. Each condition discussed includes major radiographic features, major clinical findings, genetics, major differential diagnoses, progress, complications and potential therapies, and a bibliography.
Disorders Caused by Disorganization of Skeletal Constituents
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter discusses disorders caused by disorganization of skeletal constituents and includes discussion on fibrous dysplasia, cherubism, progressive osseous heteroplasia, multiple cartilaginous exostoses, osteoglophonic dysplasia, fibrodysplasia ossificans progressiva, enchondromatosis, metaphyseal chondromatosis with 2-hydroxyglutaric acidura, genochondromatosis, and metachondromatosis. Each discussion includes major radiographic features, major clinical findings, genetics, major differential diagnoses, and a bibliography.
Disorders with Prenatal Short Stature and Slender Bones
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter further discusses bone dysplasias and includes discussion on 3M syndrome, Kenny-Caffey syndrome, osteocraniostenosis, microcephalic osteodysplastic primordial dwarfism (types 1 and 3), microcephalic osteodysplastic primordial dwarfism (type 2), and IMAGE (intrauterine growth retardation, metaphyseal dysplasia, adrenal hypoplasia congenita, and genital anomalies) syndrome. Each discussion includes major radiographic features, major clinical findings, genetics, major differential diagnoses, and a bibliography.
Limb Aplasias and Hypoplasias (Selected)
Authors: Spranger Jürgen W. , Brill Paula W. , Hall Christine , Nishimura Gen , Superti-Furga Andrea , Unger Sheila
Published: January 2019

This chapter further discusses bone dysplasias and includes discussion on Al-Awadi Raas-Rothschild syndrome, Roberts/SC phocomelia syndrome, ectrodactyly, ectodermal dysplasia and cleft lip/palate syndrome, split-hand/split-foot malformation with long bone deficiency (SHFLD), femoral-facial syndrome (FFS), femur-fibula-ulna syndrome, Poland syndrome, and Nager syndrome. Each discussion includes major radiographic features, major clinical findings, major radiographic features, genetics, major differential diagnoses, and a bibliography.
Education, Medical Studies, Medical Practice
Authors: Walusinski Olivier
Published: January 2019

After his classical high school education in Chatellerault, Gilles de la Tourette moved to Poitiers for his medical studies, which he then pursued in Paris. This chapter covers his student days and his career path within the hospital and university hierarchies and brings additional interesting information on the system of university examinations and French medical education. The author also discusses Gilles de la Tourette’s relationships with other notables of the time, for example, with Jules Claretie and Sigmund Freud, and his opinions regarding the legal affairs that marked his time. Unpublished archives are used to explore Georges Gilles de la Tourette’s numerous literary and medical activities.
Doctoral Thesis
Authors: Walusinski Olivier
Published: January 2019

On December 28, 1885, Gilles de la Tourette defended his doctoral thesis in medicine with his teacher, Jean-Martin Charcot, presiding over the jury. The subject, proposed by Charcot himself, involved studying footprints made on sheets of white paper and establishing gait anomalies during various stages of neurological disorders. Gilles de la Tourette spent 1884 and 1885 working on his thesis. His footprints graphical study, which may appear simplistic, is the first of its kind in neurology, making it innovative and valuable. It drew on similar orthopedic studies previously conducted in other European countries. These studies are reviewed here, and the genesis, technical aspects, and results of Gilles de la Tourette’s study are analyzed. The impact of his thesis is examined based on summaries published in the medical press and the fact that Gilles de la Tourette was awarded a prize by the Académie de Médecine for this work.
Clinical and Therapeutic Treatise on Hysteria
Authors: Walusinski Olivier
Published: January 2019

The second part of Gilles de la Tourette’s Traité de l’Hystérie, on “paroxysmic hysteria,” is a vast catalogue of numerous pathologies. The author analyzes select chapters on hysteria in children, hysterical sleep, and a series of pathologies erroneously attributed to hysteria (with adverse consequences for the patients). The chapter also examines Gilles de la Tourette’s efforts to establish a biological test for distinguishing hysteria from epilepsy. There are multiple references to works and theses of students and colleagues of Gilles de la Tourette and Charcot who today have been forgotten. This considerable compilation bears witness to Gilles de la Tourette’s prodigious capacity for hard work.
Commentator for La Revue Hebdomadaire, 1892–1900
Authors: Walusinski Olivier
Published: January 2019

La Revue Hebdomadaire, a general cultural publication that first appeared in 1892, asked Gilles de la Tourette for articles on medical themes. He provided thirteen articles between 1892 and 1900, first using the pen name Paracelse, then his own name. Two of the articles were biographical. Of the eleven remaining articles, two dealt with hygiene and alcoholism and another with the “human calculator” examined by Charcot, Jacques Inaudi. But, most often, Gilles de la Tourette enjoyed giving his interpretation, as an alienist fascinated with hypnotism and hysteria, of the dramatic works produced in the theaters of the Parisian boulevards. This chapter presents and analyzes Gilles de la Tourette’s various articles within the political, cultural, and medical context of the time as well as his involvement with a famous trial, the Cauvin affair.
Assessing Patient State and Efficacy
Authors: Cravero Joseph P.
Published: January 2019

Pediatric procedural sedation is required for a wide variety of interventions ranging from nonstimulating imaging procedures to painful minor surgeries and other tests. The measurement of how well a given sedation strategy has met the requirements for a procedure is not well codified by simply noting the depth of sedation provided. Patients may be deeply sedated but thrashing about during a painful procedure, and they may be almost awake and perfectly tolerating a minor procedure. Procedural sedation must be measured using a rubric that appreciates the “state” of the patient and qualifies his or her movement, stress, pain, and safety at any specific time point during the procedure. The ability to control these factors and provide an acceptable state for the patient and the proceduralist should be the standard for measuring the quality of sedation provision for children.
Sedation Effects
Authors: Landrigan-Ossar Mary , Vanderhoek Samuel
Published: January 2019

In order to safely provide sedation, the practitioner must have a complete understanding of the range of effects of the medication regimens. While these drugs provide anxiolysis, hypnosis and analgesia, these actions come at a price. Sedatives and analgesics have specific, generally depressive effects on the central nervous control of respiratory drive. Peripherally they act on the control and tone of airway musculature and depress airway reflexes. These actions vary according to class of drug and may act in synergy. This section will review some of the common effects on the airway of most sedation medications. A brief discussion of patients with special airway considerations is also included.
Techniques for Managing the Airway
Authors: Landrigan-Ossar Mary , Vanderhoek Samuel
Published: January 2019

Most if not all sedation medications negatively affect the patency of the airway, most commonly secondary to soft tissue obstruction, although central apnea may also occur. The techniques available for managing the pediatric airway during sedation are myriad, and deciding which one to use depends on a variety of considerations. These include factors such as the level of sedation required for the procedure, the anticipated duration of the procedure, the remoteness of the patient from the provider, the child’s medical condition, and any airway conditions the child may have. The overarching goal is to maximize the child’s safety and mitigate the risk of airway consequences that the sedation may pose. This section discusses effective positioning, oxygen administration, chin left, jaw thrust, and use of oropharyngeal and nasopharyngeal airways, along with laryngeal mask airway placement and (briefly) endotracheal intubation.
Prescreening
Authors: LaViolette Deborah
Published: January 2019

The process of prescreening procedural sedation patients has a critical impact on the safety, efficiency, and quality of a sedation service. Prescreening is a multilevel process that ideally starts at the time of scheduling and allows the sedationist to discern physical or mental health issues that may put the patient at higher risk during a sedated procedure. Foreknowledge of risk indicators enables the sedationist to be better prepared or to refer the patient to a different setting for the procedure. Prescreening also ensures that the patient and family have the logistical information needed for them to be in the correct place at the correct time and properly prepared so that the sedation can be completed safely and efficiently. Prescreening also affords excellence in patient satisfaction.
Observation
Authors: Faulk Debra J.
Published: January 2019

Assessing a child’s level of sedation is critical to the safe provision of sedation for diagnostic and therapeutic procedures. Providers must recognize when patients enter deeper than intended levels of sedation where cardiorespiratory compromise can occur and promptly intervene to prevent clinical deterioration. Observational scales and processed EEG monitors have been used to assess levels of sedation. In circumstances where there is physical separation of provider and patient, increased vigilance and frequency of monitoring physiologic parameters is critical. The use of capnography to monitor respiratory function should be employed in these situations.
Follow-up
Authors: Reilly Lorie
Published: January 2019

Follow-up is an important part of the pediatric sedation process. Follow-up may be performed in several different ways, such as a telephone call, direct contact with the patient and family, a mailed questionnaire, or an in-person visit (e.g., inpatient). Adverse events that occur after the postsedation discharge and are reported during the follow-up process should be documented in the medical record, because this is important and useful information for future sedation encounters. During follow-up some of the topics for discussion with the parent may include any change in the child’s activity level, appetite, sleep pattern, or behavior. An evaluation of patient/family satisfaction may be incorporated into the follow-up.
Minor Adverse Events
Authors: Chumpitazi Corrie E.
Published: January 2019

The incidence of sedation-related adverse events depends on the medications administered, the characteristics of the procedure, and preexisting patient factors. Minor adverse sedation-related events may present inconvenience or transient discomfort to the patient and, if recognized and supported in a timely manner by the sedationist, will not usually result in physiologic or psychological harm to the patient. Postprocedure vomiting, transient hypoxemia, mild hypotension, emergence reactions, and prolonged recovery times are examples of minor events. The relative likelihood of events of this type (1 of every 200 sedation episodes) provides significant impetus for effective preparation and training for sedationists to effectively respond to or preempt them. These “minor” events can still progress to more significant harm.
Procedural Aspects Affecting Sedation Care
Authors: Stormorken Anne
Published: January 2019

The goals of sedation for both diagnostic and therapeutic procedures are to manage preprocedural anxiety, minimize pain, and allow for successful completion of the procedure without adverse patient outcomes. To plan the appropriate way to achieve these goals, the sedationist must decide whether the procedure will cause the patient pain (invasiveness), the degree of immobility required for the procedure to be completed effectively, and the duration of time for which sedation is needed. If systemic medications are needed to manage the patient and procedural goals, they should be selected based on the duration of sedation necessary. Pain control can often be effectively managed with local injectable or topical techniques. It is the sedationist’s responsibility to choose a medication, or combination of medications, that allows for administration of the lowest dose of drug(s) possible while providing the greatest effective therapeutic effect.
The Child with Cerebral Palsy
Authors: Gillen Jennifer K. , Hojsak Joanne M.
Published: January 2019

Cerebral palsy is a nonprogressive disorder resulting from an injury to the brain before, during, or slightly after birth that affects motor function. Patients with cerebral palsy have a wide range of symptomatology that can affect their risk for complications during anesthesia and procedural sedation. The inherent issues of spasticity and hypotonia affecting skeletal muscle, oropharyngeal muscle function, and gut motility create an increased risk for airway-related adverse events in particular. Contractures may affect the positioning requirements of any procedure or test, thereby affecting the level of sedation needed for patient comfort and procedure completion. Careful preprocedure planning is crucial.
The Premature Infant
Authors: Havidich Jeana E. , Evans Rebecca H.
Published: January 2019

Preterm and former preterm infants present unique challenges for sedation providers. These children represent a heterogeneous high-risk population who frequently require sedation or anesthesia for diagnostic and therapeutic procedures. They have limited physiologic reserve and immature metabolic functions. Prematurity is associated with an increased risk for sedation adverse events, including death. Understanding the anatomic and physiologic differences between preterm and term children is necessary for the development of a sedation plan. One of the most important differences pertains to the airway and respiratory system, so airway management is a critical component of the sedation plan. Preterm neonates have altered pharmacokinetics and pharmacodynamics, so titration of sedative drugs is recommended.
Magnetic Resonance Imaging and Computed Tomography Imaging Sedation
Authors: Rogers Amber
Published: January 2019

Magnetic resonance imaging (MRI) and computed tomography (CT) are among the most common procedures to require some level of pediatric sedation. Although painless, they necessitate immobility for adequate imaging quality. Many children can complete these diagnostic procedures without sedation, and this should be encouraged. If sedation medications are needed, propofol is commonly used to administer deep sedation for these procedures given its fast induction and recovery times, but particularly careful ventilation monitoring with capnography is important for the sedation provider who is physically separated from the patient in the MRI suite. Dexmedetomidine use is increasing in both MRI and CT sedation; its advantages are maintenance of airway tone and possible neuroprotective effects, but its disadvantages are longer induction and recovery times. Safety, efficacy, and efficiency should be carefully considered when coordinating sedation care for MRI and CT procedures.
Radiation Therapy
Authors: McKee Bryan P. , Johnson Nicole M.
Published: January 2019

Radiation therapy is a therapeutic option in the treatment of many childhood cancers. It involves the use of high-energy waves and/or matter that injure and kill cancer cells. Radiation therapy may be delivered to a patient via external, internal, and systemic methods. Procedural sedation is most frequently requested for external radiation therapy. Regardless of the method of external radiation used, patient immobility contributes greatly to successful therapy. The goal of the sedationist in the management of a child undergoing radiation therapy is to maintain the optimal environment in terms of patient safety and immobility so that the radiation oncology team can provide the most effective treatment.
Oncology
Authors: Gale Gordon
Published: January 2019

Pediatric hematology/oncology patients present a unique challenge for procedural sedation because they frequently require repeated painful procedures (lumbar punctures and bone marrow testing) as part of their therapy. These procedures require specific positioning and some degree of immobility for successful completion. This section is a guide to accomplish these procedures with a minimum amount of anxiety and pain. Specifics for local anesthesia, positioning, sedation, and postprocedure care are outlined. Ideally, the children and parents can accept these procedures without the additional fear brought to bear by the anticipation of discomfort. The techniques described are also applicable to any infant or child undergoing these procedures.
Orthopedic
Authors: Hegenbarth Mary A.
Published: January 2019

Sedation is commonly required for orthopedic procedures in children. Typical procedures include reduction and casting of acute injuries such as fractures and dislocations and joint injection and/or aspiration for treatment of juvenile arthritis or diagnosis of infection. Most of these procedures are painful. Adequate analgesia, whether administered systemically or via local/topical anesthesia, is essential. Depending on patient and procedure factors, sedation regimens vary from minimal sedation with agents such as nitrous oxide or midazolam up to deep sedation with agents such as ketamine or propofol.
Neurology
Authors: Sedillo Daniel J. , Zuckerman Samuel L.
Published: January 2019

5Electroencephalograms (EEGs) and brainstem auditory evoked response (BAER) are two types of neurophysiologic tests that are not infrequently performed in the pediatric population. Many children, particularly those older than 5 years, may be able to undergo an EEG or BAER without sedation. However, toddlers and children with autism or pervasive developmental disorder may not be capable of cooperating with the audiologist and thus will require sedation. When selecting a sedative, the sedationist needs to remember that some medications may alter the reliability of the EEG interpretation secondary to direct central nervous system effects. There are more options for sedation medications for a BAER test than for an EEG.
The NICE Guidelines and Pediatric Sedation in the United Kingdom
Authors: Sury Michael , Greenaway Sarah
Published: January 2019

Pediatric procedural sedation is required for children across the globe in a wide variety of circumstances. In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) is a government organization whose purpose is to provide guidelines to help ensure that patients receive effective, good-value healthcare across the whole of the National Health Service. In 2010 NICE published a guideline for the use of pediatric sedation. The overarching aims were to review the safety and efficacy of sedation for common procedures and to form a consensus view on the necessary resources to do this safely. This chapter summarizes the key recommendations and describes how pediatric sedation has since evolved in the UK.
Physician Training and Perspective
Authors: Carberry Andrea R. , Hollman Gregory A.
Published: January 2019

Institutions vary in their requirements for determining competency and granting privileges for providing moderate and deep procedural sedation. Several specialties outside of anesthesiology routinely provide pediatric procedural sedation services. Attaining sedation competency requires a multitiered approach to education, training, and assessment that encompasses factual knowledge and higher-level cognitive functioning such as clinical decision-making, communication skills, psychomotor skills, and ability to function as a member of a multidisciplinary team. Educational and training methods used to teach procedural sedation include written materials, didactic lectures, interactive small-group sessions, medical simulation, and clinical experience with mentoring. Assessment of procedural sedation knowledge and skills includes written examinations, medical simulation, proctoring, and multisource evaluations.
A Sedation Unit Approach
Authors: Kopec John S.
Published: January 2019

The concept of a pediatric sedation unit developed as the need for a sedation service outside of the operating room became legitimized and essential to hospitals with a large pediatric population. The pediatric sedation unit is an area of a hospital specifically designed and staffed to provide safe sedation to children for invasive and noninvasive procedures outside of the operating room. A well-organized unit offers many benefits to the hospital, including efficiency, cost savings, and patient/family/provider satisfaction. The unit’s design and administration will vary based on the local medical climate and needs of a given region. The unit is highly integrated into the hospital and, once established, is virtually essential to the provision of safe and efficient care of children. Integration with the hospital, study modalities, and subspecialties can be facilitated by easy access to the unit for inpatients and outpatients, enhanced communication using the electronic medical record, an organized scheduling and screening process, and attention to improvement and growth.
A Sedation Team Approach
Authors: Turmelle Michael
Published: January 2019

The administrative organization of a pediatric procedural sedation service is guided by Center for Medicare and Medicaid Services (CMS) regulations. CMS specifically allows, within the broader regulations, institution-specific policies and structures to be developed and applied to the needs of the patient population served and institutional staff available. The sedation team approach has both advantages and disadvantages when compared to a sedation unit approach. A sedation team allows more flexibility to function outside the four walls of one set unit. The providers who deliver the sedation may vary within the team. Although there are many ways to structure a sedation team, the key to success is having a flexible yet well-organized approach that works in the given system and meets the needs of the patients who need procedural sedation care.
Perioperative Anesthetic Management of Anterior Mediastinal Mass
Authors: Bastien Alexandra
Published: January 2019

Patients with an anterior mediastinal mass pose as anesthetic challenges for the unsuspecting anesthesiologist. They are fraught with potential life-threatening issues during the patient’s perioperative course secondary to both the disease state and the mechanical effects of these masses. Once discovered, anterior mediastinal masses should involve planning with experienced anesthesia personnel skilled at complex airway management and in dealing with intraoperative and postoperative emergent complications. This chapter uses a case study of a 45-year-old male patient presenting for preoperative evaluation for an anterior mediastinal mass biopsy via Chamberlain procedure to illustrate the concepts associated with perioperative anesthetic management of anterior mediastinal mass.
Gastric Ulcer Bleed with a History of Coronary Artery Disease, Hypertension, and Hyperlipidemia
Authors: Kelly Sean P. , Grandhe Radhika P.
Published: January 2019

Gastrointestinal (GI) bleed may be encountered fairly commonly by anesthesiologists in routine clinical practice in various settings such as the emergency room, operating rooms, remote nonoperating room locations, and intensive care units. The most common cause of GI bleed is peptic ulcer bleed from the duodenum or stomach. GI bleed can quickly progress to a shock state if not managed promptly and adequately. These patients also suffer from various comorbidities such as coronary artery disease, pulmonary issues, malnutrition, liver disease, hematologic abnormalities, and so on, which calls for comprehensive evaluation and management despite time constraints. Care coordination and communication among various specialists and across multiple settings is essential for optimal outcome in this subset of patients. With advent of advanced endoscopic and interventional radiology techniques, the need for open surgery to control GI bleed is rare in modern-day clinical practice.
Anesthetic Management for Patients with Severe Cervical Myelopathy
Authors: Teen Mark , Ting Michael , Farag Ehab
Published: January 2019

Patients with cervical myelopathy undergoing surgery present several disparate challenges to an anesthesiologist, but the overarching goal of anesthetic management is to avoid injury to the spinal cord. To achieve this goal, it is imperative that an anesthesiologist secure the airway safely without any new injury to the central nervous system, provide adequate perfusion pressure and oxygen delivery to the at risk nerve tissue, and employ intraoperative neurophysiologic monitoring to monitor the fidelity of the spinal cord. This chapter illustrates the best and safest method of securing the airway in these patients as well as provides background on the pathophysiology of cervical myelopathy and the tools for monitoring nerve function during surgery.
Anaphylaxis in the OR—Causes, Recognition, and Treatment
Authors: Sharma Surangama , Arora Lovkesh
Published: January 2019

Anaphylaxis in the operating room is a life-threatening condition that can evolve rapidly. As an anesthesiologist, it is important to understand the pathophysiology, diagnose the condition, recognize the inciting agent/agents, and manage it appropriately. It is equally important to confirm the diagnosis for preventing a catastrophic event from happening in future. This chapter defines anaphylaxis, discusses the clinical manifestations and most common causes, and describes ways it can be diagnosed. It also considers treatment and preventative measures. The chapter uses a case study of a 55-year-old female, weighing 85 kg and a body mass index of 36 with no other known comorbidities, who is scheduled to undergo elective laparoscopic cholecystectomy.
Obstructive Sleep Apnea
Authors: Chamberlain Scott , Ehlers Melissa
Published: January 2019

Obstructive sleep apnea (OSA) is a highly prevalent disease, with physiologic disturbances encompassing the pre-, intra-, and postoperative periods. Unlike many comorbid conditions that surgical patients present with, increased risk remains despite the anesthetic approach. Beginning with the preoperative period, patients with known OSA must have thorough assessments of their pulmonary, cardiac, and endocrine systems. Initial planning should also assess the suitability of the patient for the operative facility. With regards to intraoperative concerns, difficult airway and intravenous access supplies should be available, generally along with bariatric equipment. Intraoperative planning should also involve early intervention for postoperative pain management. The transition to the postoperative period should continue to focus on appropriate analgesia and respiratory support. Throughout this process, communication with the surgical team is of utmost concern given the complexity of this patient population and the many potential pitfalls.
Anesthesia in a Patient on Anticoagulant Dabigatran Presenting for Emergency Surgery
Authors: Kapoor Indu , Mahajan Charu , Prabhakar Hemanshu
Published: January 2019

Dabigatran is an anticoagulant which acts by directly inhibiting the specific coagulation factors. It is used as a safe alternative to warfarin. This agent provides multiple benefits over warfarin which includes fixed dosing, lower incidence of hemorrhagic stroke, and no need of routine monitoring. Dabigatranetexilate (prodrug) is a direct thrombin inhibitor whereas rivaroxaban, edoxaban, and apixaban act by inhibiting factor Xa. Dabigatran is excreted through kidney (80%), so the dosage should be adjusted according to the creatinine clearance value. Life-threatening bleeding caused by dabigatran can be managed with its specific antidote idarucizumab to reverse its action. Factor 3 or 4 prothrombin concentrate complex may still be required in patients who bleed even after idarucizumab. Detailed knowledge about this medication can contribute to decrease in morbidity and improved outcome.
Methemoglobinemia
Authors: Aquino Melinda
Published: January 2019

Methemoglobin is a form of hemoglobin that contains the ferric form of iron rather than the ferrous form. The ferric form hampers the ability of blood cells to carry oxygen and deliver it to the tissues throughout the body. When there is a large fraction of Methemoglobin in the blood, clinical symptoms appear. Cyanosis, abnormal blood tests, and, depending on how high the methemoglobin levels are, seizures, coma, and cardiac anomalies may ensue. Methemoglobinemia may be caused by congenital causes or may be acquired by toxic levels of certain chemicals. Acquired methemoglobinemia is the most common form, and anesthesiologists may induce this issue if they inadvertently administer toxic doses of certain drugs including benzocaine and lidocaine. Prompt recognition, diagnosis, and early treatment are necessary to prevent permanent sequelae from occurring.
Perioperative Care of the Bariatric Surgery Patient
Authors: Afthinos John N. , Gibbs Karen E.
Published: January 2019

Morbid obesity is an increasingly common condition encountered across the entire surgical population. Obstructive sleep apnea (OSA) is frequently present among the morbidly obese population. Patients with OSA are at increased risk for sudden cardiac death and perioperative complications. They exhibit significantly reduced pulmonary reserve, which dramatically decreases the safety margin at induction of general anesthesia. The morbidly obese patient is often at higher risk for being difficult to mask ventilate and possibly to intubate. An additional consideration in the care of this population includes possible difficult intravenous access. An accurate preoperative assessment, proper positioning, and immediate availability of airway adjuncts are strongly recommended. Appropriate preparation at the time of induction and emergence is imperative to maintaining patient safety. Intraoperative communication between the surgeon and anesthesiologist during gastric procedures can prevent intraoperative complications.
Anesthetic Considerations in Autonomic Hypereflexia
Authors: Patel Roshan , Singh Suzette
Published: January 2019

Autonomic hypereflexia (AH) is a life-threatening condition that affects individuals who have sustained spinal cord injuries. Typically the lesions are at or above the sixth thoracic vertebral level but have been found in patients with lesions as low as the 10th thoracic vertebral level. An acute episode of AH is a reaction of the autonomic nervous system to stimulation that is characterized by bradycardia, paroxysmal hypertension below the lesion, and hypotension above the lesion. This phenomenon can result from traumatic injury to the spinal cord or from pathologic illnesses such as multiple sclerosis. The injury to the spinal cord results in an interruption of neuronal input below the lesion resulting in an imbalanced reflex sympathetic surge, leading to life-threatening hypertension below the level of the spinal cord lesion. This condition is considered a medical emergency and requires immediate intervention and removal of noxious stimuli. Caregivers must be trained to recognize and treat the symptoms of AH expeditiously as it can lead to severe, life-threatening consequences.
Concepts and Principles of Integrative Nursing
Authors: Koithan Mary
Published: January 2019

The discipline of nursing has always had a holistic ontology and epistemology that aligns with the unitary paradigm. Yet nursing practice has not always been consistent with these perspectives. This chapter describes concepts and principles of integrative nursing, which offer a way of being-knowing-doing that advances the health and wellbeing of persons, families, and communities through caring/healing relationships in a manner that honors historical roots and transforms nursing care delivery. Six principles provide a framework that can shape the way nurses use evidence to select therapeutic strategies from the full range of possible interventions to support whole person/whole systems healing.
Advancing Wellbeing in People, Organizations, and Communities
Authors: Kreitzer Mary Jo , Delagran Louise , Uptmor Andrea
Published: January 2019

Wellbeing goes beyond the management of disease or illness; it is a larger concept that is characterized by a general contentment in life and the way things are. This chapter uses the framework of the University of Minnesota Wellbeing Model to explore the evidence-based factors that influence wellbeing, including health, relationships, security, purpose, environment, and community. Mindfulness, a way of being that provides another core component of wellbeing, is defined and its evidence based discussed. Exemplars of wellbeing at the individual, organizational, and society level are described. Some applications of similar models in towns such as Albert Lea, Minnesota, Austin, Texas, and Santa Monica, California, are discussed, as well as initiatives in Canada and the UK.
Precision Health and Integrative Nursing
Authors: Austin Robin R.
Published: January 2019

Precision or personalized health is an emerging trend that has implications for integrative nursing. Incorporating precision health through the principles of integrative nursing allows for a whole-person-centered care approach. Precision health focuses on prevention and provides for a holistic view of the patient that takes into account all factors such as environment, health behaviors, genetic potential, and current lifestyle choices. The focus on the whole person has the ability to shift the paradigm of health to look upstream and has implications for personalized wellness by combining biometric, genetic, and environmental data to develop a scientific personalized wellness plan. This chapter discusses the precision health initiative and the alignment of precision health and integrative nursing. Specific exemplars along with resources are used to highlight the intersection of precision health and integrative nursing.
Integrative Nursing Management of Fatigue
Authors: Drake Diana
Published: January 2019

This chapter focuses on the prevalent and complex disorder of fatigue as both a companion symptom to acute and chronic conditions and a persistent and debilitating disorder without a clear etiology. The fatigue experience is a persistent state of weariness— a multifactorial discord and imbalance that has roots in the physical, psychological, spiritual, energetic, and/or environmental dimensions of the patient’s life. Utilizing the integrative nursing principles, a whole-person approach to fatigue assessment and treatment is described. Emerging evidence for therapeutic modalities that are inclusive of movement therapies and restorative practice, meditation and relaxation, herbal treatment, and energy conservation management are explored.