bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coexisting Disease and the Parturient: Part Two
Authors: Aquino Benjamin F. , Heidari Afshin , Haghi Leila 
Published: May 2021

Abstract
Coexisting medical conditions in pregnancy significantly increase the risk of adverse outcomes for both the mother and fetus. Understanding and managing these conditions is essential to mitigating this risk. Because the issues mentioned herein tend to be less common, is it all the more imperative that they be recognized quickly, identified correctly, and treated appropriately when they do occur. These include autoimmune thrombocytopenic purpura (ATP), therapeutic anticoagulation with neuraxial anesthesia, multiple sclerosis, myasthenia gravis, HIV infection, systemic lupus erythematosus (SLE), and abuse of substances such as cocaine and marijuana. All of these can have considerable implications on peripartum physiology and the subsequent anesthesia management of pregnant patients with these conditions. The goal here is not for comprehensiveness, but rather to give the reader concise, pertinent details that can be referenced quickly to guide appropriate peripartum management of anesthesia.
Local Anesthetics
Authors: Eddins Michelle 
Published: May 2021

Abstract
Local anesthetics are used in obstetric practice to achieve analgesia and anesthesia via neuraxial procedures (spinal or epidural). Local anesthetics exhibit their effect by blocking voltage-gated sodium channels on neurons, thereby inhibiting the achievement of an action potential which is required for nerve impulse propagation. There are two major groups of local anesthetics—the aminoamides and the aminoesters. The most commonly used aminoamide local anesthetics in obstetric anesthesia are lidocaine, bupivacaine, and ropivacaine. The most commonly used aminoester local anesthetics in obstetric anesthesia are 2-chloroprocaine and tetracaine. Epinephrine can be added to local anesthetics to prolong their duration of action. The addition of sodium bicarbonate to local anesthetics hastens their onset of action. Local anesthetic systemic toxicity (LAST) can occur when large doses of local anesthetic are administered. Systemic toxicity from local anesthetics can be fatal and must be treated promptly with 20% lipid emulsion. Rarely, anaphylaxis can occur after the administration of local anesthetics. This occurs most commonly with the aminoesters.
Non-pharmacologic Labor Analgesia
Authors: Marotta Michael , Gutman David 
Published: May 2021

Abstract
Non-pharmacologic labor analgesia techniques have been shown to have questionable and variable efficacy but are noninvasive and overall appear to be safe. The individual experience of labor pain is multifactorial and has both physiologic and psychosocial components. Distinct approaches to labor analgesia target one or more of labor pain’s contributing factors. Pharmacologic approaches aim to relieve the pain of labor by blocking physiologic sources. Non-pharmacologic labor analgesia attempts to help women cope with or distract them from labor pain by targeting psychosocial and physiologic sources. The psychosocial contributions to labor pain are not well understood, and their presence and impact vary greatly between individuals. As such, they are difficult to define, difficult to study, and difficult to treat. This has led to a paucity of high-quality data on the subject, but non-pharmacologic techniques are likely an important and useful component of labor analgesia. Various approaches to non-pharmacologic treatment include, but are not limited to, biofeedback, continuous labor support, hypnosis, relaxation, acupuncture, water immersion, and sterile water injections. Generally speaking, these techniques have been shown to have questionable and variable efficacy but are non-invasive and overall appear to be safe.
Neuraxial Techniques and Medications for Cesarean Delivery
Authors: Baron Elvera L. , Katz Daniel 
Published: May 2021

Abstract
Neuraxial anesthesia is the preferred anesthetic technique for cesarean delivery. Several options are available for medications and for neuraxial anesthetic delivery. This chapter begins by reviewing the advantages of neuraxial anesthesia as compared to general anesthesia, contraindications of neuraxial placement, and potential complications with recommended management strategies. Additionally, it provides a detailed overview of each neuraxial technique for cesarean delivery: epidural, spinal, and combine spinal epidural anesthesia. Advantages, disadvantages, and common medications with suggested doses are summarized for each technique. Finally, an anatomically based approach with appropriate patient positioning is reviewed and strategies for supplementation of inadequate neuraxial blockade are discussed.
Airway Management
Authors: Sirianni Joel , Mester Robert 
Published: May 2021

Abstract
Airway management during pregnancy is covered in this chapter as maternal airway manipulation is high risk, requiring expert knowledge and experience in planning for the maternal airway, maternal physiology, aspiration prophylaxis, and the difficult airway. This chapter describes the many changes to the maternal gastrointestinal tract and respiratory system commonly seen in pregnancy, which elevate risks to the mother and fetus that are not typically seen in the nonparturient. It reviews the changes that lead to a higher risk of aspiration, hypoxemia, airway friability, and difficult intubation during induction of general anesthesia. It covers the keys to providing safe anesthesia to the parturient through mitigation of risks by focusing on prophylactic medications, aspiration treatment, airway preparation, planning for the difficult airway and emergence, and the postpartum airway.
Anesthesia for Fetal Surgery
Authors: Evans Beata , Quinn Kevin , Petersson Rajanya S. , Wills Timothy , Kromah Fatoumata 
Published: May 2021

Abstract
Over the past decade, advancements in prenatal ultrasound and availability of fetal MRI have allowed for early diagnosis of congenital anomalies, and anesthetic and surgical developments have facilitated successful management and interventions of fetal anomalies. Fetal anomalies such as twin to twin transfusion syndrome, neural tube defects, and malformations impacting the fetal airway, cardiac, thoracic, abdominal, and urological systems affect the smallest and most vulnerable patient population. Minimally invasive, open, and ex-utero intrapartum procedures are three types of interventions available for the treatment of correctable fetal anomalies. These fetal procedures halt further progression of congenital anomalies early in fetal development and decrease fetal/neonatal morbidity and mortality.1 Open fetal surgical procedures are indicated for neural tube defect and congenial diaphragmatic hernia repair. These open surgical procedures improve fetal conditions, and impact postdelivery disability and fetal/neonatal death.2 Conditions in which the fetus’ airway may be compromised by a head or neck mass increase the newborn’s risk for respiratory and cardiovascular failure. In such situations, an ex utero intrapartum therapy (EXIT) procedure may be performed. During the EXIT procedure, the fetus remains dependent on placental oxygenation provided by the maternal circulation. Anesthetic choice for fetal surgery depends on maternal comorbidity, airway evaluation, type of fetal surgery, and surgical needs.
Cytoskeleton
Authors: Benarroch Eduardo E. 
Published: May 2021

Abstract
The cytoskeleton consists primarily of microfilaments, microtubules, and intermediate filaments. Actin microfilaments have major role in growth, maintenance, and dynamic changes of growth cones and dendrites; stabilization of proteins at specific membrane locations; and vesicle dynamics during endocytosis and exocytosis. Microtubules provide the major tracks for intracellular transport and local cues for positioning of mitochondria and other organelles. The intermediate filaments in neurons are the neurofilaments that have a major role in regulating axonal caliber and mechanical stability. Glial fibrillary acid protein is a primary component of intermediate filaments in astrocytes. Nuclear lamins participate in regulation of the chromatin organization, trafficking of transcription factors across the nuclear envelope, and transduction of mechanical signals. Mutations affecting these cytoskeletal proteins produce a wide range of neurologic disorders, including neurodevelopmental disorders, peripheral neuropathies, myopathies, and leukodystrophy. All components of the cytoskeleton are involved in adult-onset neurodegenerative disorders.
Homeostasis and Adaptation
Authors: Benarroch Eduardo E. 
Published: May 2021

Abstract
Central control of homeostasis and adaptation to internal challenges or external challenges requires interactions among the hypothalamus, amygdala, and several areas of the cerebral cortex. These areas directly or indirectly provide input to brainstem autonomic areas. The hypothalamus is critical for basic vital functions, including energy metabolism, fluid and electrolyte balance, thermoregulation, wake–sleep cycle, responses to internal or environmental stressors, and reproduction. The amygdala provides automatic tagging of the valence (positive or negative) and intensity of innate or conditioned environmental stimuli and triggers automatic survival responses. The insula integrates multiple sensations to create a feeling of the body. The anterior cingulate provides subjective relevance to these feelings and initiates predictive visceromotor commands that are compared to interoceptive inputs reaching the insular cortex. Disorders of these circuits, for example, in the setting of seizures or limbic encephalitis, are potentially life-threatening.
Emotion and Social Cognition
Authors: Benarroch Eduardo E. 
Published: May 2021

Abstract
Emotion is a cognitive and behavioral state critical for survival. Processing of emotions includes a network that encompasses the amygdala and the orbitofrontal, insular, and cingulate cortices, and their connections with the other cortical areas, basal forebrain, ventral striatum, hypothalamus, and brainstem. These areas interact to assess the positive or negative valence of environmental stimuli and bodily feelings and initiate survival responses, promote arousal, attribute value for decision-making, and guide action selection and social behavior. Focal, degenerative, or psychiatric disorders affecting components of this emotion network manifest with profound disturbances in affect, decision-making, and social behavior.
Epidemiology and Radiologic Imaging of Vascular Disease
Authors: Arora Harendra , Kumar Priya Ajit , McLean Duncan 
Published: May 2021

Abstract
Vascular disease is one of the leading causes of morbidity and mortality in the United States and throughout the world. One of the key offending factors in the pathogenesis of vascular disease is atherosclerosis, which involves endothelial damage as a result of generalized inflammation of the vasculature. The clinical sequelae related to atherosclerosis are varied based on the extent and anatomic location involved. Typically, atherosclerotic disease exists in multiple sites, even if it clinically presents in one location. Aortic atherosclerosis results in aneurysms, dissections, penetrating ulcers, intramural hematomas, and occlusive disease. Carotid artery stenosis, which is caused predominantly by atherosclerosis, is associated with an increased risk of stroke. Peripheral arterial disease results in insufficient blood flow to the lower extremities, which manifests as intermittent claudication. The risk of limb loss from poor circulation is often overshadowed by the risk of mortality from coexistent coronary artery and cerebrovascular atherosclerosis.
Vascular Surgery of the Upper Extremity
Authors: Canonico Andrew , Jones Cameron , Lutzker Tatiana N. , Gage Parr K. 
Published: May 2021

Abstract
Upper extremity and hand ischemia may be caused by several factors, the most common of which is arterial occlusion/peripheral vascular disease. Compared to vascular surgery for the lower extremity, upper extremity intervention is quite rare, accounting for approximately 4% of all vascular bypass procedures. This may be due to the more robust collateral circulation in the upper extremity. This chapter examines the main conditions, treatments, anesthetic concerns, and management in the field of upper extremity vascular surgery, including revascularization for both acute and chronic upper limb ischemia and other common interventions, such as hemodialysis access for patients with end-stage renal disease.
Perioperative Management of Combined CABG and CEA Procedures
Authors: Nguyen Hieu , Lutzker Tatiana N. , Gage Parr K. 
Published: May 2021

Abstract
Combined coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) procedures can be done in individuals who have concomitant coronary and carotid artery disease. This chapter reviews briefly the history of revascularization procedures (endarterectomy, carotid artery stenting). It also discusses risk factors that increase mortality in individuals who undergo these procedures, as well as the selection criteria for identifying individuals who would be appropriate candidates for combined CABG/CEA procedures. The perioperative management, including preoperative optimization, intraoperative concerns, and postoperative complications of these patients, also are reviewed. Finally, a brief survey of the current literature is provided to examine the current recommendations on whether or not combined procedures should be done compared to staged procedures.
Vascular Surgery
Authors: Yoon Jeongae , Sankova Susan K. 
Published: May 2021

Abstract
Endovascular surgery has gone through remarkable advancement since its inception, and its capacity to perform complex vascular surgeries with a minimally invasive approach has gained popularity. This advancement has afforded surgery on patients who were deemed to be too high risk for open procedures and lowered the risk of complex procedures with extensive disease burden. This chapter discuss two of the most commonly performed endovascular procedures of the neck/chest/upper extremities: carotid artery stenting for carotid stenosis and thoracic endovascular aortic repair for thoracic aortic aneurysm or dissection. The continued advancement of endovascular devices and techniques is changing the landscape of the management of vascular disease.
Anesthesia for Amputation Surgery
Authors: Little Michael B. 
Published: May 2021

Abstract
This chapter examines the perioperative anesthetic concerns for patients undergoing amputation surgery of the upper or lower extremity. Most amputation surgeries, particularly of the lower extremity, are the result of peripheral artery disease (PAD). This chapter discusses multiple comorbid conditions associated with PAD, such as diabetes mellitus, hypertension, tobacco use, and sepsis and how they impact risk stratification and anesthetic management. It also discusses pertinent anatomical considerations, intraoperative management with general anesthesia, neuraxial anesthesia, and/or regional anesthesia. It also discusses short- and long-term postoperative outcomes, including major adverse cardiac events and chronic phantom limb pain as well as strategies to improve outcomes.
Lung Isolation Techniques
Authors: Johnson William , Nikolaidis Melissa , Saied Nahel 
Published: May 2021

Abstract
Lung isolation can be used during thoracic surgery to selectively ventilate a single lung for a discrete purpose. There are several indications for lung isolation, with the strength of each indication varying from absolutely indicated to preferable. Indications for lung isolation are reviewed in this chapter. Three main techniques for achieving lung isolation are also reviewed in detail. These include intentional mainstem with a single-lumen endotracheal tube, use of a double-lumen endobronchial tube and use of a bronchial blocker. The benefits and drawbacks of each technique are discussed. Finally, specific steps to troubleshoot hypoxia during one-lung ventilation are reviewed.
Anterior Mediastinal Masses
Authors: Sidoran Kevin , Tafeese Hanan , Perry Tiffany D. , Desvarieux Tricia 
Published: May 2021

Abstract
Anterior mediastinal masses can affect the airway, breathing, and circulation (ABC) and often entail a well-planned multidisciplinary team approach with regard to management. The anesthetic management of these cases depends on the individual’s risk and symptomology. Anesthesia can range from standard general to awake cannulation for extracorporeal membrane oxygenation depending on severity of presentation and extent of airway and cardiovascular compromise. It is crucial to avoid an “intubate, cannot ventilate” situation or cardiovascular collapse. Patients who present with the superior vena cava syndrome can be particularly challenging. The goal of this chapter is to describe a case-based approach to anterior mediastinal masses focused on the ABCs. By reviewing the etiology of mediastinal masses, examining the presentation of symptoms, exploring the pathophysiology and the risks to the ABCs, the authors emphasize the need for a multidisciplinary approach to care for these patients effectively.
Postoperative Management and Complications in Thoracic Surgery
Authors: Demos Daniel , McGough Edward 
Published: May 2021

Abstract
The goal of this chapter is to provide the necessary framework to manage thoracic surgery patients in the intensive care unit (ICU) during the initial postoperative visit. Thoracic surgery impairs postoperative respiratory function, which can lead to postoperative complications. Complications are commonly associated with specific risk factors such as age, results of preoperative pulmonary function tests, cardiovascular comorbidity, smoking status, and chronic obstructive pulmonary disease. The authors focus on immediate postoperative concerns, including ventilator management and weaning, as well as postoperative hemorrhage. After the patient arrives at the ICU and is immediately assessed, the focus pivots to analgesia and resuscitation with an emphasis on goal-directed fluid management. Last, a basic understanding of common postoperative complications, including diagnosis and management, is paramount to quality ICU care.
Pulmonary Pathophysiology in Anesthesia Practice
Authors: Haynes Gary R. , McClure Brian P. 
Published: May 2021

Abstract
This chapter compares normal and abnormal pulmonary function and discusses clinical considerations when evaluating patients for surgery and anesthesia. Basic pulmonary physiology and the effect that positive pressure ventilation has on lung function are reviewed. The action of anesthetic drugs on the control of ventilation, and the pathophysiologic effect of the common pathophysiologic conditions of pulmonary hypertension and pulmonary embolism are discussed.
Anesthetic Management Techniques (Regional Anesthesia)
Authors: Kabes Tyler , Przkora Rene , Mora Juan C. 
Published: May 2021

Abstract
This chapter provides an overview of the different blocks and procedures available to control the perioperative pain of patients undergoing thoracic surgical interventions. The authors describe each procedure, as well as its clinical indications, limitations, key anatomical structures, procedural techniques, and required equipment and medications. The procedures covered here include neuraxial procedures such as the thoracic epidural, in addition to blocks such as the paravertebral, intercostal, serratus anterior plane, erector spinae, transversus thoracis muscle plane, and Pecs I and II. Also included are images of skin landmarks, sonoanatomy, and a step-by-step procedure description. An overview of the regional techniques can be found in the chapter’s provided tables.
Visit 4
Authors: Ferguson Robert J. , Gillock Karen Lee 
Published: May 2021

Abstract
In Visit 4, the survivor and clinician focus on four goals. First, they conduct a review of the verbal rehearsal strategies taught in the last visit—which verbal rehearsal strategies were used, for what, when, and where, and modify as needed. Second, the clinician and survivor work together to review the cognitive restructuring skills of realistic probabilities and decatastrophizing, primarily reviewing how helpful these methods are in re-thinking memory problems or barriers, and which method appeared to aid coping. Next, the external strategies of keeping a schedule and memory routines are taught, including the rationale for keeping a day planner; simplifying the schedule; and assuring daily review of the schedule. Finally, memory routines are discussed and homework is assigned to apply a chosen compensatory strategies.
Visit 5
Authors: Ferguson Robert J. , Gillock Karen Lee 
Published: May 2021

Abstract
In this visit, the survivor and clinician will first review homework such as what strategies the survivor has used since the prior visit and how successful they have been. The clinician and survivor will also review external strategies of external cueing and distraction reduction (auditory and visual distractions) and the importance of limiting multitasking which adversely affects the learning of new information. They will also cover the topic of distraction reduction with respect to 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 also discussed. The survivor is asked to apply the chosen compensatory strategy and practice it in daily life.
Memory and Attention Adaptation Training
Authors: Ferguson Robert , Gillock Karen 
Published: May 2021

Abstract
Memory and Attention Adaptation Training (MAAT) is a cognitive-behavioral therapy (CBT) designed to help cancer survivors self-manage and mitigate the late and long-term effects of cancer and cancer therapy on memory function. Cancer-related cognitive impairment (CRCI) is a set of mild to moderate memory and attention impairments that can have an adverse influence on quality of life. CRCI symptoms tend to present during active treatment, but for some individuals cognitive changes can persist for years. While the exact prevalence of CRCI is unknown, review of the literature estimates that nearly half of all survivors may experience some form of CRCI. Causes of CRCI are multiple and are the subject of continued research. Chemotherapy, genetic vulnerability, neurovascular damage, inflammation, and hormonal/endocrine disruption have all been identified as candidate mechanisms of persistent cognitive change. Given the multiple causal mechanisms, finding a biomedical treatment for CRCI remains elusive. MAAT was developed as a CBT to help cancer survivors make adaptive behavioral and cognitive changes to improve performance in the valued activities that CRCI hinders. MAAT consists of eight visits and has been designed for administration through telehealth technology, improving access to survivorship care that so many cancer survivors may lack after the time and expense of cancer treatment. Survivors are provided a workbook they can use to work with their clinician and to reinforce learning and adaptive coping. This clinician manual guides the clinician step by step on MAAT administration and provides background on the theoretical underpinnings of CRCI and MAAT.