bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Monitoring
Authors: Fedeles Benjamin T. , Galvagno Samuel M. , Kodali Bhavani 
Published: October 2018

Abstract
The outside of the operating room (OOOR) environment is fraught with challenges and often requires a great deal of flexibility without compromising patient care. The expertise and skill of the modern anesthesiologist is increasingly required when anesthesia is administered for procedures performed OOOR. This chapter focuses on the physics, physiology, limitations, and recommendations for standard physiological monitors that should be utilized in the OOOR environment. A special emphasis is placed on pulse oximetry and capnography. By implementing standards for monitoring that are similar to standards used in the operating room, the safe delivery of an anesthetic for procedures in the OOOR environment can be consistently achieved.
Management of Staffing and Case Scheduling for Anesthesia Outside of the Operating Room
Authors: Macario Alex , Sharma Deepak 
Published: October 2018

Abstract
What does a manager need to think about when scheduling cases requiring anesthesia outside the operating room (OOOR)? This chapter aims to answer that question by discussing some key strategic points that can facilitate a more efficient workday. The concepts of block scheduling and utilization apply in the OOOR setting as they do in the operating room, but there are added challenges given the increased physical distance to the main operating room suite. These challenges will be identified and recommendations will be provided on how to evaluate and improve OOOR efficiency. With more procedures being done OOOR, it is important for anesthesia groups to be mindful of these challenges and position themselves appropriately.
Financial Analysis and Competitive Strategies for NORA
Authors: Vig Sanjana , Boggs Steven 
Published: October 2018

Abstract
The scientific and technical principles that form the basis of anesthesia practice are transferrable to any location where patients require monitoring, analgesia, and hypnosis. Most growth seen in anesthesia services in the past decade has occurred in non–operating room anesthesia locations. Anesthesiologists are critical for the safe and efficient functioning of these locations. However, with the ever-increasing pressure to reduce total health care delivery costs, anesthesiologists need to understand some of the financial metrics that will be used to measure their contribution to these locations. Moreover, anesthesiologists must be willing to articulate the rationale for their presence in these areas: patient safety, patient comfort, and increased throughput, to name a few.
Procedural Sedation by Nonanesthesia Providers
Authors: Metzner Julia , Domino Karen B. 
Published: October 2018

Abstract
Although anesthesiologists and certified registered nurse anesthetists are experts in sedation/analgesia outside of the operating room, extensive demand in the face of limited resources has resulted in sedation being routinely performed by nonanesthesia health care providers. Safe administration of procedural sedation/analgesia by nonanesthesia professionals requires an understanding of the continuum of sedation/general anesthesia; extensive training and credentialing of personnel performing sedation; appropriate patient preparation and selection, with an anesthesia consult for higher-risk patients; adherence to fasting guidelines, standard equipment, and monitoring procedures; and a thorough knowledge of the pharmacologic and physiologic properties of sedative and analgesic drugs. This chapter briefly reviews the essential elements needed to develop a safe policy for sedation by nonanesthesia practitioners.
Magnetic Resonance Imaging and Ultrasound-Guided Percutaneous Interventional Radiology Procedures
Authors: Bhagavatula Sharath K. , Patel Bijal , Tuncali Kemal , Silverman Stuart G. , Shyn Paul B. 
Published: October 2018

Abstract
Diagnostic and therapeutic interventions guided by magnetic resonance imaging (MRI) are performed in clinical practice with increasing frequency and for an increasing number of indications. Ultrasound (US) guidance remains a very common, relatively inexpensive, and versatile option for guiding percutaneous interventions. The need for procedural sedation and anesthesia for minimally invasive procedures continues to grow as the number of procedures and interventional applications increase. This trend will continue as the population ages and the complexity and array of imaging-guided interventional procedures expand. This chapter discusses common interventional procedures that are performed under MRI and US guidance and outlines patient issues, procedural techniques, safety, and other clinical considerations that pertain to both interventionalists and anesthesiologists.
Interventional Neuroradiology
Authors: Thiex Ruth , Frerichs Kai U. 
Published: October 2018

Abstract
Interventional neuroradiology evolved as a new medical subspecialty in the 1980s and focuses on the treatment of cerebrovascular, head and neck, and spinal diseases by using endovascular or other percutaneous routes to reach the target. This field has since tremendously expanded as a result of improved imaging capabilities, technical equipment, and safer contrast media, which brought it to the forefront in the management of aneurysms and various vascular malformations. Anesthesiologists are instrumental in ensuring patient safety and cooperation, thus allowing the interventionalist to focus on the procedure. This chapter is intended to provide the clinical practitioner with background information and specific descriptions of the anatomy, techniques, disorders, and procedures most commonly encountered in interventional neuroradiology.
Interventional Radiology Procedures
Authors: Scorza Leslie B. 
Published: October 2018

Abstract
Interventional radiology (IR) is a specialty often called on to help solve many different clinical problems. Sometimes, that help comes by obtaining a diagnosis, other times by treatment, and still other times by both. The array of problems for which an IR consultation can be helpful is quite broad. Some IR procedures, which are described in more detail in this chapter, include, Abscess drainage, Arterial procedures and interventions, Biliary procedures and interventions, Gastrointestinal procedures and interventions, Genitourinary procedures and interventions, Intraoperative cases, Noninvasive vascular imaging, Percutaneous oncologic interventions, Percutaneous biopsies, Venous procedures and interventions, Venous access. The anesthesia needed to accomplish these procedures, just like the procedures themselves, varies widely. Anesthesia support can range from none at all up to and including general anesthesia. However, the majority of these procedures can be successfully accomplished with the use of “sedation and analgesia,” also known as moderate sedation.
Radiation Safety
Authors: Maddy Erin M. , Abnet Kevin , Scriver Geoffrey , Shukla Mrinal 
Published: October 2018

Abstract
Exposure to ionizing radiation is increasing in modern anesthesia practice, due to both the number of procedures facilitated and the expanding role of imaging in surgical practice. International Commission on Radiological Protection (ICRP) recommends that physicians who assist with radiation procedures be educated on the basics of radiation including units, effects of radiation exposure, and radiation protection for both providers and patients. This chapter will mirror the recommendations of the ICRP and include an introduction to radiation production, terminology, units, effects on the human body, dose limits, best practices for radiation protection, and safety infrastructure.
Anesthesia for Interventional Pulmonology
Authors: Abdelmalak Basem 
Published: October 2018

Abstract
This chapter on anesthesia for interventional pulmonology (bronchoscopic) procedures addresses the anesthetic considerations and management for these procedures that are frequently performed in bronchoscopy suites outside of the operating room (OOOR). These include endobronchial ultrasound (EBUS) and electromagnetic navigational bronchoscopy (ENB) diagnostic procedures, as well as bronchoscopic therapeutic procedures. It discusses anesthesia techniques, different airway and ventilation options, anesthesia adjuvants, and helpful tips and clinical pearls aimed at ensuring patient safety while providing the best conditions to facilitate completion of the procedure. Utilizing standardized yet individualized protocols may help improve safety and clinical outcomes in these non–operating room anesthesia (NORA) service locations.
New Challenges for Anesthesiologists Outside of the Operating Room: The Cardiac Catheterization and Electrophysiology Laboratories
Authors: Gross Wendy L. , Cooper Lebron , Faillace Robert T. , Shook Douglas C. , Daves Suanne M. , Savage Robert M. 
Published: October 2018

Abstract
Invasive cardiology procedures have changed dramatically over the past 5–10 years. With technological advancement, diagnostic and therapeutic procedures have become broader in scope and complexity, and patient acuity has escalated dramatically. In parallel, the involvement of anesthesiologists has grown. In this chapter, we present an overview of the laboratory environment(s), the evolution and future pathways of current practice(s), cases performed in each venue, and current anesthetic approaches. In this new and changing arena, collaboration and planning between cardiologists and anesthesiologists maximizes patient safety and increases the probability of procedural success. A thorough understanding of the procedure to be performed is required in order for anesthesiologists to define and delineate the extent of their involvement, and is a clear prerequisite for the formulation of a safe and effective anesthetic plan. A common knowledge base and mutual respect for each contributing discipline form the basis for integration of cardiology and anesthesia services in pursuit of optimized patient care.
Office-Based Anesthesia
Authors: Hausman Laurence M. 
Published: October 2018

Abstract
An anesthetic performed in a surgical or medical office, as opposed to a standard operating room within a hospital or ambulatory surgery center, is known as an office-based anesthetic. This venue for surgery and anesthesia has been widely utilized for past several decades. The practitioner generally has improved ease in scheduling of cases and convenience of performing surgery within the same office as preoperative and postoperative care; sometimes, the proceduralist will receive an enhanced professional fee from insurance companies. Surgery in an office has become increasingly overseen by both state and federal governmental agencies. This oversight often has been driven by concerns for patient safety and suitability of the patient and the procedure for this surgical venue. Three accrediting bodies can accredit an office for use as a surgical site. Ultimately, safety will rest on the preparedness of the anesthesiologist, proceduralist, office staff, and suitability of the office itself.
Pediatric Anesthesia Outside of the Operating Room
Authors: Mahmoud Mohamed , Holzman Robert S. , Mason Keira P. 
Published: October 2018

Abstract
This textbook provides an important tool to cover major aspects of anesthesia care in non–operating room anesthesia (NORA) locations. It outlines perioperative concerns for the most commonly performed procedures in NORA settings. An overview of various anesthesia delivery techniques and tools required to optimize the patient before endoscopy, cardiac, and neuroradiology procedures are provided. The text also covers specialized situations, including a pediatric update on anesthesia/sedation strategies for dental procedures, electroconvulsive therapy, cosmetic procedures, ophthalmologic surgery, procedures in the emergency department, and infertility treatment. Practical recommendations based on current literature and author experience are presented, and current practice guidelines are reviewed.
Identification of hypocrealean reptile pathogenic isolates with MALDI-TOF MS
Authors: Schneider Juliane , Heydel Tilo , Pees Michael , Schrödl Wieland , Schmidt Volker 
Published: October 2018

Abstract
Biotyper analysis of Nannizziopsis guarroi, a fatal fungal pathogen in lizards, was described recently. Hypocrealean fungal infections in captive reptiles appear with an increasing frequency during the last decade. Therefore, the aim of this study was to proof Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) as diagnostic tool for the identification of reptile pathogenic hypocrealean fungi. Ten fungal isolates obtained from nine reptiles with fungal glossitis, disseminated visceral mycosis, pneumomycosis, and fungal keratitis were analyzed. Phylogeny consisted of fragments of the large subunit of nuclear encoded ribosomal DNA (D1/D2, LSU) and the internal transcribed spacer region 1 of nuclear encoded ribosomal DNA (ITS1) as well as the protein coding gene translation elongation factor 1 alpha (TEF). Results revealed unanimously two Metarhizium granulomatis genotypes in a total of three isolates, various M. viride genotypes (n = 3), two different Purpureocillium lilacinum isolates as well as one isolate of each P. lavendulum and Beauveria bassiana. Purpureocillium lilacinum and B. bassiana are likewise frequently employed as a mycoinsecticide and mycoacaricide in agriculture on a worldwide scale and have occasionally been reported in man, causing fungal keratitis, sclerokeratitis, nosocomial infections in immunosuppressed patients, as well as cavitary pulmonary disease and cutaneous hyalohyphomycosis in immunocompetent patients. According to the results establishment of Biotyper analysis for faster differentiation of reptile-associated fungal pathogens is entirely justified.
Impaired urinary concentration ability is a sensitive predictor of renal disease progression in Joubert syndrome
Authors: Nuovo Sara , Fuiano Laura , Micalizzi Alessia , Battini Roberta , Bertini Enrico , Borgatti Renato , Caridi Gianluca , D’Arrigo Stefano , Fazzi Elisa , Fischetto Rita , Ghiggeri Gian Marco , Giordano Lucio , Leuzzi Vincenzo , Romaniello Romina , Signorini Sabrina , Stringini Gilda , Zanni Ginevra , Romani Marta , Valente Enza Maria , Emma Francesco 
Published: October 2018

AbstractBackgroundJoubert syndrome (JS) is an inherited ciliopathy characterized by a complex midbrain–hindbrain malformation and multiorgan involvement. Renal disease, mainly juvenile nephronophthisis (NPH), was reported in 25–30% patients although only ∼18% had a confirmed diagnosis of chronic kidney disease (CKD). NPH often remains asymptomatic for many years, resulting in delayed diagnosis. The aim of the study was to identify a biomarker able to quantify the risk of progressive CKD in young children with JS.MethodsRenal features were investigated in 93 Italian patients, including biochemical tests, ultrasound and 1-deamino-8D-arginine vasopressin test in children with reduced basal urine osmolality. A subset of patients was followed-up over time.ResultsAt last examination, 27 of 93 subjects (29%) presented with CKD, ranging from isolated urinary concentration defect (UCD) to end-stage renal disease. Both normal and pathological urine osmolality levels remained stable over time, even when obtained at very early ages. Follow-up data showed that the probability of developing CKD can be modelled as a function of the urine osmolality value, exceeding 75% for levels &lt;600 mOsm/kg H2O, and significantly increased in patients with an early diagnosis of isolated UCD.ConclusionsWe conclude that the frequency of CKD in JS increases with age and is higher than previously reported. Urine osmolality represents an early sensitive quantitative biomarker of the risk of CKD progression.
Microsurgical Resection of Anaplastic Ependymoma of the Cerebellopontine Angle in an Adult: 3-Dimensional Operative Video
Authors: Sayyahmelli Sima , Baskaya Mustafa K 
Published: October 2018

Abstract
Infratentorial ependymomas usually arise in the fourth ventricle and extend into the cerebellopontine angle (CPA) through the foramina of Luschka is well described. A primary CPA location of an ependymoma is distinctly uncommon.
In this 3-dimensional video, we present a 38-yr-old woman with a 1-mo history of vertigo and slow left sided gaze drift. She underwent microsurgical gross total resection of the CPA ependymoma via retrosigmoid approach. The histopathology was grade III anaplastic ependymoma. She tolerated the surgery well and her postoperative course was uneventful. She received radiation therapy and there was no recurrent disease in follow-up studies.
Important steps of the surgical approach and microsurgical techniques in resection of these challenging tumors are demonstrated in this 3-dimensional surgical video. The patient consented to publication of her image.
A Pilot Comparison of Multispectral Fluorescence to Indocyanine Green Videoangiography and Other Modalities for Intraoperative Assessment in Vascular Neurosurgery
Authors: Nickele Chris , Nguyen Vince , Fisher Winfield , Couldwell William , Aboud Emad , David Carlos , Morcos Jacques , Charalampaki Cleopatra , Arthur Adam 
Published: October 2018

Abstract

BACKGROUND
Digital subtraction angiography (DSA) is the gold standard for vascular imaging, but is not easily integrated into a continuous microsurgical environment. Other available modalities for intraoperative vascular assessment have their own limitations.

OBJECTIVE
To investigate multispectral fluorescence (MFL), a new technology based on indocyanine green (ICG) fluorescence, which may provide advantages over current intraoperative imaging modalities.

METHODS
Cadaveric intracranial aneurysm models and turkey wing bypasses were created and tested with white light and micro-Doppler ultrasound, indocyanine green videoangiography (ICG-VA), MFL, and DSA in conditions mimicking surgery. Assessments with these modalities were scored by 7 neurosurgeons.

RESULTS
DSA was significantly better than other modalities in evaluating the vasculature (P < .0001), but was significantly less ergonomic and efficient (P < .0001). MFL and ICG-VA were not significantly different from each other. Both were significantly better than white light/micro-Doppler ultrasound in assessing occlusion and patency (P ≤ .011), and both were better than DSA in ergonomics and efficiency (P < .0001).

CONCLUSION
MFL performs similarly to ICG-VA in a laboratory setting. Further study will be required to determine whether it compares favorably in the operating room. While DSA is the standard for cerebrovascular visualization, MFL and ICG are significantly more ergonomic and efficient.
Implantation of a Thoracic Spinal Cord Stimulator Paddle Electrode and Generator Under General Anesthesia With Intraoperative Neuromonitoring: 2-Dimensional Operative Video
Authors: Stone Lauren E , Falowski Steven M 
Published: October 2018

Abstract
Spinal cord stimulation is a well-established and effective therapy in the treatment of pain. Proper patient selection and accurate lead placement are paramount in its success. Placement is a multifaceted process requiring proper paddle placement, a well thought out generator placement and appropriate means to limit complications and enhance success. Several intraoperative techniques maximize outcomes, including removal of the superior portion of the inferior level's spinous process for paddle access into the epidural space, generator pocket placement in a location that limits patient discomfort, a strain relief loop at the thoracic incision to prevent lead fractures and allow for full spinal flexibility, generator placement parallel to the body and secured in the pocket to prevent unwanted movement, and intraoperative neuromonitoring for patient comfort and more accurate lead placement compared to X-ray alone or awake placement. This case demonstrates these key elements of intraoperative technique in a candidate with the most common indication for spinal cord stimulator placement–postlaminectomy syndrome–underscoring the ease and viability of this procedure in the appropriate patient population in a means that reduces future complications and adverse events while maximizing success.
Full patient consent for video-recording and subsequent use for research purposes was attained. All patient identifiers have been removed for the purpose of patient confidentiality.
Resection of an Embolized Cirsoid Aneurysm With Intracranial Venous Drainage: 2-Dimensional Operative Video
Authors: Heiferman Daniel M , Syed Hasan R , Li Daphne , Rothstein Brian D , Shaibani Ali , Tomita Tadanori 
Published: October 2018

Abstract
Cirsoid aneurysms, also known as scalp arteriovenous malformations (AVM), are rare congenital extracranial vascular anomalies that often present as an enlarging pulsatile scalp mass. A 14-yr-old male presented with a pulsatile scalp lesion that was first noticed 3 yr prior and had progressively enlarged. No history of trauma was reported. MRI demonstrated a 4 cm wide and 2 cm tall nidus and catheter angiography was performed to further define the vascular supply and drainage. The patient underwent transvenous endovascular embolization followed by surgical excision via a bicoronal incision, as shown in this operative video. Care was taken to identify, cauterize, and transect feeding vessels from the superficial temporal, supratrochlear, and supraorbital arteries circumferentially to completely devascularize and resect the galeal nidus from overlying scalp tissue and underlying pericranium. Previously unreported in the literature, transosseous emissary veins partially draining the lesion were noted on angiography and were waxed thoroughly during surgery. Six-month follow-up examination demonstrated a well-healed incision without evidence of AVM recurrence. The unique venous drainage of this cirsoid aneurysm highlights the value of diagnostic angiography to fully characterize these rare and complex vascular lesions prior to pursuing definitive treatment.
IRB approval was obtained from the Ann & Robert H. Lurie Children's Hospital of Chicago Institutional Review Board (IRB #2018-1799). The IRB waives the requirement of obtaining informed consent for this study in accordance with 45 CFR 46.116(d).
Microsurgery of Spinal Dural Arteriovenous Fistula Using Indocyanine Green Video Angiography: 2-Dimensional Operative Video
Authors: Yokoyama Kunio , Okuda Yasuaki , Yamada Makoto , Tanaka Hidekazu , Ito Yutaka , Yamashita Masashi , Sugie Akira , Kawanishi Masahiro 
Published: October 2018

Abstract
Spinal dural arteriovenous fistulas (SDAVF) develop by direct abnormal arteriovenous connection between both sides of the spinal dura matter. In this condition, there is no intervening nidus between a meningeal segmental artery and a radiculomedullary vein. Open microsurgery is one of the choices for patients with SDAVF. When the AVF is on the inner dural surface, we can easily block the radiculomedullary vein in a microscopic view. We herein report a 50-yr-old woman who presented with low back pain, was diagnosed with an SDAVF, and underwent surgical treatment under a microscopic view. The spinal angiography demonstrated abnormal arteriovenous connections between intercostal arteries at the level of Th11 to 12 and the intradural radiculomedullary vein. Operative indocyanine green (ICG) microangiography demonstrated the blood flow in meningeal vessels and their anastomoses between both sides of the dural surface. We easily identified the radiculomedullary vein fed by the surrounding meningeal feeding arteries and block completely under a direct microscopic view. We detected the change in hemodynamic during feeder ligation by Flow 800 (Zeiss Penteto Flow 800 microscope; Zeiss Corporation, Tokyo, Japan). After surgery, the patient's symptoms disappeared and no recurrence of the disease has been noted in the past 23 mo. We have received the informed consent of this patient for the publication of this case report.