bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wrist Pain After Slip and Fall
Authors: Spielman Amanda , Lessard Anne-Sophie , Sankaranarayanan Sriram 
Published: May 2021

Abstract
The wrist is a very complex structure, and its radiographic evaluation requires very specific views. This chapter discusses the classical findings associated with injuries to ligaments of the wrist. It reviews three common wrist sprains: triangular fibrocartilage complex sprains, scapholunate ligament injuries, and lunotriquetral ligament injuries. The chapter describes the anatomy and common mechanisms of injury to the region, associated with each main class of sprains, as well as patient symptoms. It reviews the steps to follow to allow for appropriate diagnosis, including imaging studies and classification guides. The chapter also provides information for management of patients’ conditions and counseling advice for patients in the outpatient setting.
The High-Risk Obstetric Patient
Authors: Curbelo Jacqueline 
Published: May 2021

Abstract
“The high-risk obstetric patient: pregnancy-induced conditions” focuses on maternal pathophysiological conditions which develop only in the pregnancy state. Gestational diabetes mellitus (GDM) is discussed, including the role of progressive insulin resistance, maternal risk factors for GDM, diagnostic criteria, recommendations for managing hyperglycemia, maternal and fetal complications, recommendations for obstetric management, and anesthetic implications and management. The chapter focuses on hypertensive disorders of pregnancy, including gestational hypertension (GHTN), preeclampsia, the syndrome of hemolysis, elevated liver enzymes, low platelets (HELLP), and eclampsia. Emphasis is placed on the significant maternal morbidity and mortality related to hypertension in pregnancy and the importance of recognizing and responding to ominous, multisystemic manifestations associated with hypertensive disorders of pregnancy. Recommendations for obstetric management are reviewed, and anesthetic implications and recommendations are discussed. Intrauterine fetal demise (IUFD) is introduced, including causes of fetal demise, obstetric management, and anesthetic implications.
Cesarean Delivery
Authors: dos Santos Thais Franklin , Ghosh Arina , Zbeidy Reine 
Published: May 2021

Abstract
Severe postoperative pain is reported in 20% of patients in the initial period following the cesarean delivery, and multimodal analgesic regimens provide better analgesia and allow for reducing total neuraxial and systemic opioid use, thus reducing the risk of side effects. Inadequately treated pain is associated with increased risk of developing chronic pain, postpartum depression, difficulty with breastfeeding, increased healthcare cost, and other complications. Neuraxial opioids are considered the main component of multimodal analgesia after cesarean since they provide better pain control than systemic opioids, non-neuraxial regional techniques, and oral analgesics. Neuraxial morphine is the gold-standard option for postcesarean analgesia. Systemic opioids, nonopioid adjuvants, and peripheral nerve blocks have an important role as part of a multimodal regimen for postcesarean analgesia.
Trauma and Critical Care During Pregnancy
Authors: Best Gavin T. , Nikolaidis Melissa A. , Deng Yi 
Published: May 2021

Abstract
Trauma is the leading nonobstetric cause of death in pregnant patients, and parturient women have unique physiologies, pathologies, and considerations. The aim of this chapter is to discuss these differences and address ways to treat these patients immediately following trauma and in the critical care setting. The chapter addresses blunt, penetrating, and burn trauma in the pregnant patient. Additionally, it will highlight several common critical pathologies seen in pregnancy such as eclampsia; hemolysis, elevated liver enzymes, and low platelets syndrome; and acute respiratory distress syndrome, as well as some pre-existing conditions made more complicated by the pregnant state.
Axon and Myelin
Authors: Benarroch Eduardo E. 
Published: May 2021

Abstract
Axons allow the initiation and conduction of the action potential and neurotransmitter release and have unique structure and physiology. Myelin has a unique composition of lipids and proteins. Each compartment of myelinated axons expresses a unique repertoire of ion channels, adaptor molecules, and adhesion molecules. There is a reciprocal interaction between the axons and myelinating cells. Axons are also vulnerable structures, as they may extend for long distances away from the cell body, which renders them highly dependent on mitochondrial energy metabolism, cytoskeletal integrity, and axonal transport for their maintenance and response to injury. Immune, metabolic, or degenerative disorders affecting these interactions result in a wide variety of peripheral neuropathies and leukoencephalopathies.
Ion Channels and Channelopathies
Authors: Benarroch Eduardo E. 
Published: May 2021

Abstract
Ion channels are the basic elements regulating activity and communication in the nervous system. They consist of several subunits forming a central pore and are subdivided on the basis of their ion selectivity, gating mechanisms, and kinetics of activation and inactivation. Ion channels form part of macromolecular complexes restricted to specific membrane domains via interactions with scaffold proteins, lipid rafts, and actin cytoskeleton. The selective expression and distribution of ion channels define the electrophysiological properties of the neurons, their axons, and muscle cells. The interactions among different types of sodium, calcium, and potassium channels determine cell excitability, firing pattern and conduction of the action potential, and probability of neurotransmitter release at presynaptic terminals. Central nervous system channelopathies manifest with epilepsy, episodic ataxia, paroxysmal movement disorders, or hemiplegic migraine, frequently in several combinations. Peripheral channelopathies produce myotonia, periodic paralysis, myasthenic syndrome, paroxysmal pain disorders, or congenital insensitivity to pain.
Microenvironment in the Central Nervous System
Authors: Benarroch Eduardo E. 
Published: May 2021

Abstract
The regulation of the microenvironment in the CNS is critical for neuronal and glial survival, function, and response to injury. This regulation occurs via components of a neurovascular unit that control the functional coupling between neuronal activity and local cerebral blood flow and maintain the blood-brain barrier. Cerebrospinal fluid production, circulation, and interchange with the interstitial fluid are also major factors maintaining the cerebral microenvironment and have an important role in removal of toxic products from the CNS. Impaired regulation of the local blood flow, disruption of the blood-brain barrier, and altered cerebrospinal fluid dynamics are common pathophysiological consequences of traumatic, vascular, inflammatory disorders and have an important role in epilepsy and neurodegeneration.
Brainstem Mechanisms of Motor Control
Authors: Benarroch Eduardo E. 
Published: May 2021

Abstract
Brainstem function is affected in many neurologic disorders and has a major impact in quality of life and survival. The brainstem harbors gaze-control mechanisms that maintain optimal visual acuity during binocular vision by ensuring that the images of objects remain steady and stimulate corresponding areas of the retina. The control of ocular motor neurons depends primarily on feedforward commands in response to head movement, object motion, or behavioral relevant stimuli. Vocalization, speech, swallowing, and control of the upper airway during respiration require coordinated motor plans via central pattern generator networks in the pons and medulla. Knowledge of brainstem circuits involved in these function is not only helpful to localize lesions in the CNS but also provide insight about potential targets of treatment.
Basal Ganglia Circuits
Authors: Benarroch Eduardo E. 
Published: May 2021

Abstract
The basal ganglia circuits have a central role in reward-based action learning, goal-directed behaviors; and habit formation. These processes largely depend on dopamine signals in the striatum, which controls the activity of the other components of the basal ganglia circuits, including the globus pallidus, substantia nigra, and subthalamic nucleus. Reward signals trigger a dopamine peak in the striatum, which promotes selection of a rewarding action and prevents initiation of competing actions. Dopamine also prevents abnormal synchronized oscillatory activity in the basal ganglia circuits. Loss of dopaminergic signaling triggers changes that underlie the motor manifestations of Parkinson disease (PD), including akinesia and levodopa-induced dyskinesia. Imbalance between dopaminergic and cholinergic signaling in the striatum underlies hyperkinetic movement disorders.
Peripheral and Spinal Mechanisms of Nociception
Authors: Benarroch Eduardo E. 
Published: May 2021

Abstract
Pain is a conscious subjective experience driven by activity of nociceptors. Pain includes not only nociception but also abnormal transmission and processing of painful stimuli. Nociception involves unmyelinated and small myelinated fibers from small dorsal root ganglion neurons that respond to noxious heat, mechanical, or chemically stimuli. These neurons are functional and biochemically heterogeneous in terms of their sensitivity to stimuli, type of afferent axons, neurochemical composition, and targets in the dorsal horn. They activate both second-order projection neurons and different subsets of excitatory and inhibitory interneurons that have a major role in processing of sensory information. Mutations affecting ion channels in nociceptors, inflammatory mediators, or peripheral nerve injury trigger changes and expression of ion channels and receptors. This results in increased excitability of nociceptors, known as peripheral sensitization. Abnormal activity in nociceptors triggers plastic channels in the dorsal horn resulting in altered balance between excitation and inhibition, resulting in central sensitization. Local activation of microglia and astrocytes plays a major role in this process. Elucidation of mechanisms of peripheral and central sensitization provide insight into the pathophysiology of neuropathic pain and potential therapeutic targets for its treatment.
Central Processing and Modulation of Pain
Authors: Benarroch Eduardo E. 
Published: May 2021

Abstract
Pain is a complex sensation that has sensory-discriminative, cognitive, and affective-emotional dimensions. The different aspects of the pain experience engage a complex network of cortical areas activated by ascending pathways that relay on several nuclei of the thalamus. These cortical areas, frequently referred to as the pain matrix, include the primary and secondary somatosensory cortex, insula, anterior and midcingulate cortex, and prefrontal cortex. The areas interact with subcortical regions involved in pain modulation, such as the periaqueductal gray, rostral ventromedial medulla, and brainstem monoaminergic groups. The experience of pain is strongly affected by attention and emotion. The pain modulatory system closely interacts with the reward and motivation system. Abnormal functional connectivity and aberrant plasticity in these areas have a major role in the pathophysiology of chronic pain.
Language
Authors: Benarroch Eduardo E. 
Published: May 2021

Abstract
Language, speech, and semantic knowledge are fundamental cognitive functions critical for human communication and knowledge of the world. Language comprehension and production involve core areas in the left temporoparietal cortex and inferior frontal gyrus that participate in separate but interacting networks for semantic and syntactic processing. Voice and speech production are controlled by separate corticobulbar systems that are hierarchically organized. Semantic knowledge about world objects and their action primarily involves ventrolateral portions of the anterior temporal lobe. Disturbances of these processes manifest with different forms of primary progressive aphasia, apraxia of speech, or semantic variant primary progressive aphasia.
Bronchoscopy and Mediastinoscopy Procedures
Authors: Wilson Justin W. 
Published: May 2021

Abstract
Thoracic and diagnostic procedures such as bronchoscopy and mediastinoscopy are fairly common especially for patients with thoracic cancer. The typical surgical progression for thoracic cancer patients is performance of bronchoscopy to demonstrate airway anatomy and check tumor burden throughout the airway and then proceed with mediastinoscopy to sample mediastinal lymph nodes and send to pathology, if the nodes are negative for cancer then subsequent tumor resection is warranted. Standard preoperative workup includes the usual preoperative labs (hematology and chemistry), electrocardiogram, chest X-ray, and computed tomography scan to determine location of tumor especially to adjoining structures. The authors will discuss bronchoscopy and mediastinoscopy in detail and the difficulties and challenges these patients can present from the anesthetic perspective, including preoperative and intraoperative management.
Bronchopleural Fistula
Authors: Humanez Jose C. , Shah Saurin , Graham Thimothy , Patel Kishan , Mongan Paul 
Published: May 2021

Abstract
Bronchopleural fistula (BPF) is a pathological communication between bronchial tree and pleural space. BPF has multiple etiologies but postsurgical ones carry the highest incidence and the worst prognosis. Diagnosis is based on the clinical presentation and confirmation with radiological imaging (chest X-ray, computed tomography scan) or bronchoscopy. Management of BPF involves a combination of surgical procedures, medical therapy and diagnostic and therapeutic bronchoscopy. Anesthetic considerations and management focus in perioperative optimization of intravascular volume status, proper and careful isolation of the affected lung to avoid spillage of contaminated material into the unaffected lung, and assurance of proper ventilation (either by conventional or special ventilatory techniques) during and after the operation.
Visit 5
Authors: Ferguson Robert J. , Gillock Karen Lee 
Published: May 2021

Abstract
In this visit, of Memory and Attention Adaptation Training (MAAT), the clinician will first review the survivor’s homework, asking about what strategies the survivor has used since the prior visit and how successful they have been. Specifically, both will review how keeping a schedule is improving daily task performance and follow through and review of memory routines. The clinician will then introduce the external strategies of external cueing and distraction reduction (auditory and visual distractions) and will advise the survivor to limit multitasking, which adversely affects the learning of new information, and reduce use of electronic devices and social media, especially passive scrolling through social media pages. The rationale for and concepts involved in activity scheduling and pacing are explained to the survivor. The survivor is asked to apply the chosen compensatory strategy and practice it, and homework is assigned.
Visit 7
Authors: Ferguson Robert J. , Gillock Karen Lee 
Published: May 2021

Abstract
The first goal of the penultimate visit is to review active listening and verbal rehearsal skills for socializing by asking about what strategies were used, for what, when, and where and modifying as needed. The second goal is to review fatigue management and sleep quality improvement by asking what strategies were used, for what, when, and where and modifying as needed. The third goal is to introduce the internal strategy of visualization, including the rationale and reviewing visual–auditory associations, as well as reviewing visualization strategies and emphasizing novelty and humor to evoke emotion and deepen memory. The strategies taught are simple visualization, name–face mnemonic, and the method of loci. The final goal, as customary, is to assign homework, including identifying, practicing, and applying relevant visualization strategies. The clinician asks the survivor how they might use the strategy or strategies and how they may practice in the “real world.”
Pharmacokinetics and pharmacodynamics in obesity
Authors: Moon Tiffany Sun , Ogunnaike Babatunde O. 
Published: May 2021

Abstract
Drug dosing in obese patients has been a challenge because the change in weight can be a source of errors, both of underdosing and overdosing the patient, with serious ramifications. Different scalars are used to calculate drug dosing—total body weight, lean body weight, ideal body weight, and so on. Some drugs should be dosed on total body weight and others on ideal body weight. This chapter elaborates on dosing in common classes of drugs used in anaesthesia as well as the pharmacological principles applied to achieve therapeutic aims of administration.
Continuous positive airway pressure
Authors: Lenhardt Rainer , Businger Jerrad R. 
Published: May 2021

Abstract
Given the increased risk prevalence of coronary artery disease, inflammatory disease, and cancer, morbidly obese patients are frequently scheduled for various types of surgery. In addition, the number of bariatric surgeries has risen almost exponentially. Therefore, the anaesthesiologist is more frequently challenged with providing general anaesthesia for this patient population. General anaesthesia comes with increased risks of events such as perioperative morbid cardiac events and postoperative respiratory failure. Postoperative respiratory failure is particularly common after cardiac, thoracic, and major abdominal surgery. Anaesthesiologists have a range of support mechanisms at their disposal to reduce postoperative respiratory failure including emergent reintubation. Apart from simple oxygen delivery via nasal cannulas or face masks, Venturi masks, and Mapleson circuits, there are various positive pressure systems available. These systems are commonly referred to as non-invasive ventilation (NIV) systems. NIV can be non-invasive continuous positive airway pressure or non-invasive intermittent positive pressure ventilation. Both types of NIV have been shown to improve oxygenation and hypercapnia in morbidly obese patients in the perioperative environment. This chapter presents the physiology and pathophysiology of the respiratory system in the morbidly obese patient. In addition, it illustrates the impact and implications of NIV systems on this patient population in the perioperative setting.
Perioperative paediatric obesity
Authors: Doll Alissa , Ambardekar Aditee P. 
Published: May 2021

Abstract
Paediatric obesity is a worldwide epidemic with estimations of the prevalence of overweight and obese as high as 23.8% and 22.6% in paediatric and adolescent males and females, respectively. In the United States, significant increases in the prevalence of obesity in children were noted in the 1980s and 1990s but have since levelled off in 2010 at 16.9% overall. Moreover, about 12% of infants 6–23 months of age in the United States are considered overweight. The World Health Organization and the United States Centers for Disease Control have slightly different definitions of paediatric obesity based on body mass index, which leads to somewhat varied estimations of prevalence. Despite this, recent trends suggest the number of overweight and obese children presenting for elective and emergent procedures is increasing. A serious public health concern, paediatric obesity can accompany congenital or genetic comorbidities or be the cause of accelerated comorbidities such as cardiovascular disease, diabetes, and cancers that are typically associated with adult morbidity and mortality. This chapter describes the comorbidities that are typically associated with paediatric obesity as they become relevant in the perioperative period, summarizes surgical procedures in which paediatric obesity is common, and discusses peri-anaesthetic implications of the obese child or adolescent.
Obesity in pregnancy
Authors: Onuoha Onyi C. 
Published: May 2021

Abstract
In both affluent and developing countries, obesity continues to approach epidemic proportions and has become a major contributor to the global burden of chronic disease and disability. Although recent data may indicate the exponential increase in obesity in the United States may be levelling off, the prevalence of obesity remains high. The National Health and Nutrition Examination Survey in 2010 estimated the incidence of obesity in adult women as 35.8%. Unfortunately, women of reproductive age are not spared by this epidemic. Particularly in pregnancy, obesity is a public health issue of concern. Maternal obesity is defined as a body mass index of greater than 30 kg/m2 at the first antenatal consultation. According to one study, 50% of pregnant women are overweight or obese and as many as 8% of women in their reproductive childbearing age are morbidly obese with a body mass index of over 40 kg/m2. Indisputably, obesity has been associated with significant obstetric and anaesthetic risk including being identified as an independent risk factor for maternal mortality by the CEMACH Maternal Death Enquiry. A basic understanding of the general impact of obesity on pregnancy is therefore critical. The goal of this chapter is to (1) discuss the physiological changes that occur in the obese parturient, (2) highlight the resulting implications or challenges encountered, and finally (3) review the potential strategies to ensure the delivery of safe anaesthetic care in this patient population.
Obesity and non-operating room anaesthesia
Authors: Gargya Akshat , Troum Matthew , Goldberg Marc 
Published: May 2021

Abstract
Obesity, the modern-day epidemic, comes with many physiological consequences that make the job of an anaesthesiologist challenging. When an obese patient presents to the operating room, the anaesthesiologist needs to take many different variables into account. These variables include, but are not limited to, airway management, comorbid conditions, safest anaesthetic technique, physiological and mechanical changes that occur in the obese patient, positioning, and postoperative care. When a similar patient presents for anaesthetic care outside the operating room, sometimes called ‘out-of-operating room anaesthesia’ or ‘non-operating room anaesthesia’, these factors are compounded for multiple reasons. These include distance from the ‘mother ship’ (the main operating room), colleagues who can provide back-up, and availability of all emergency equipment, among others.
Intensive care
Authors: Tsai Andrea L. , Schumann Roman 
Published: May 2021

Abstract
The evidence for best practices and outcomes for the intensive care unit (ICU) patient with obesity is slowly emerging but is often still expert consensus derived. A critical care environment with appropriate equipment and personnel is essential to maintain caregiver and patient safety as well as to allow for early mobilization. Sedation strategies may favour dexmedetomidine for its relative absence of respiratory depression, and for most sedation agents, a titration-to-effect dosing strategy applies, rather than weight-based dosing. Vascular access is best facilitated with ultrasound guidance and should avoid the femoral site when possible. Despite obesity, techniques such as prone positioning and venovenous extracorporeal membrane oxygenation should be an option for those who would benefit. Best practice recommendations or guidelines are available for nutritional support and venous thromboembolism prophylaxis in the ICU patient with obesity. Antimicrobial dosing remains a challenge, is drug specific, and guided by drug level monitoring where available. Despite increased complications in ICU patients with obesity, the relationship of the latter to mortality is not clear. Possibly an obesity classification other than body mass index, integrating adipose tissue distribution, would help to answer this question in future research.