bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anesthetic Gases and Vapors
Authors: Reynolds Rhett , Cornett Elyse M. 
Published: May 2024

Abstract
This chapter discusses the inhalation agents commonly used in anesthesia, including nitrous oxide and the volatile agents (desflurane, halothane, isoflurane, sevoflurane). It also reviews the mechanism of action of these agents, although this is not completely understood. In addition, this chapter focuses on the advantages and disadvantages associated with the inhaled gases. The advantages it touches on include bronchodilation, dose-dependent decrease in skeletal and smooth muscle tone, decreased cerebral metabolic rate, and increased cerebral blood flow. Some of the disadvantages considered are as follows: malignant hyperthermia, hepatotoxicity, respiratory depression, myocardial depression, and postoperative nausea. Finally, it discusses the fact that although the volatile anesthetics as a class are similar, each agent is unique.
Minimum Alveolar Concentration (MAC)
Authors: Hua Hao , Cormican Daniel S. 
Published: May 2024

Abstract
Minimum alveolar concentration (MAC) serves as a marker of anesthetic depth while using a volatile anesthetic, and allows for comparison of the potencies between different volatile anesthetic agents. MAC value has a specific definition, and there is clinical significance to varying MAC values, such as MAC-aware and MAC-BAR. Multiple physiological and pharmacological factors affect MAC, which may predispose a patient to inadequate anesthesia or anesthetic overdose. End tidal anesthetic concentration (ETAC) and electroencephalogram-derived bispectral index (BIS) are contemporary means to prevent intraoperative awareness and to target the depth of anesthesia.
Trace Concentrations, Pollution, and Personnel Harzards
Authors: Swanson David E. 
Published: May 2024

Abstract
Operating room personnel hazards include infectious risk from inhalation and contact with bodily fluids, breathing anesthetic gases, toxic fumes from the surgical field, radiation, eye injury from lasers, and psychological stress. Steps need to be taken to minimize these risks. Trace concentrations of anesthetic gas and smoke from the surgical field have raised concerns for over 50 years. Following careful anesthetic technique with a good mask seal and pausing fresh gas flow when the mask is off the patient are steps each anesthesiologist can take to minimize the exposure of personnel to anesthetic gas. The health of the operating room personnel and the environment is impacted by this pollution. Proper preoperative evaluation has been highlighted by the COVID-19 pandemic, as has the availability of adequate supplies of personal protective equipment. The risk of human immunodeficiency virus and hepatitis heightened awareness of the importance of wearing gloves and hand hygiene.
Monoamine Oxidase Inhibitors
Authors: Yates Christopher , Sharma Archit 
Published: May 2024

Abstract
Monoamine oxidase inhibitors (MAOIs) are a separate class from other antidepressants, treating different forms of depression as well as other nervous system disorders such as panic disorder, social phobia, and depression with atypical features. They increase the availability of neurotransmitters such as norepinephrine, serotonin, dopamine, as well as tyramine. The side effect profile of MAOIs can be attributed to alterations in neurotransmitter concentrations as a result of MAO inhibition, the anticholinergic properties of the drugs, and interactions with other medications. The anesthesia provider needs to ensure careful perioperative management of patients on these medications to provide drug-drug interactions and a safe anesthetic.
Anticonvulsants
Authors: Sethi Anish , Trehan Gaurav 
Published: May 2024

Abstract
Anticonvulsants are a broad category of medications that are utilized for the management of epileptic seizures, neuropathic pain syndromes, and psychiatric disorders. Their cellular targets include sodium channels, calcium channels, chloride channels, GABA receptors, and NMDA receptors. Often times, anticonvulsants target multiple receptors to exert their principal effects. When used for epilepsy, these medications are typically continued in the perioperative period. Several drug-drug interactions may occur with anticonvulsant medications due to enzymatic induction, which lead to changes in the metabolism of coadministered drugs. As such, patients on anticonvulsants should be closely monitored for potential adverse effects.
American Society of Anesthesiologists (ASA) Preoperative Testing Guidelines
Authors: Flanagan Timothy F. , Fikry Karim 
Published: May 2024

Abstract
Preoperative assessment is an essential component of safe, adequate and efficient anesthetic care. Preoperative testing guidelines rely on understanding the urgency of the intended procedure and completion of a history and physical exam. Risk stratification can occur after the anesthesiologist reviews the patient’s history with regard to ischemic heart disease, insulin-controlled diabetes, cerebrovascular disease, renal function, congestive heart failure, and the type and/or location of surgery. While testing is commonly not required or available for emergency surgeries, moderate- to high-risk, non-emergency surgeries for patients with poor functional capacity may warrant further testing if such testing would alter decision-making. Subsequent testing is guided by patients’ relevant factors and comorbidities.
Pediatric and Geriatric Doses
Authors: Bess Leah , Chhabada Surendrasingh 
Published: May 2024

Abstract
Pharmacodynamics and pharmacokinetics of drugs are distinctly different in neonates, children, and geriatric patient populations. Differences in the body fluid composition, organ immaturity, and limited reserve, and increased sensitivity to anesthetic agents make them vulnerable to medication-related side effects and toxicity. Thorough understanding of physiology and pharmacologic differences assists with safe dose regimen and optimal perioperative management.
Prophylactic Antibiotics
Authors: Lin Austine , Graber Raymond 
Published: May 2024

Abstract
Perioperative prophylactic antibiotics are administered in order to reduce the risk of surgical site infection (SSI). Multiple studies have demonstrated the efficacy of this practice. However, knowledge about appropriate drug choice, timing, dosing, redosing, and duration has continued to evolve. The practitioner should be aware that there are additional strategies that can be used to reduce the risk of perioperative infections, including maintaining normothermia, preventing hyperglycemia, using appropriate methods to remove hair, reducing the use of bladder catheterization, and using maximal barrier precautions when placing central lines.
Coma and Hyperosmolar Coma
Authors: Gluncic Vicko 
Published: May 2024

Abstract
Loss of consciousness is associated with physiological states (sleeping), anesthesia, and various pathological conditions. There are several terms describing the level to which the consciousness is decreased. Lethargy is the state of slightly reduced alertness and extreme fatigue. The term somnolence describes a drowsy patient who responds to mild stimulus (such as voice), and mumbles incoherently and moves in a disorganized fashion. In contrast, a stuporous patient responds to a vigorous and continuous stimulus only, and upon discontinuation of a stimulus returns to an unresponsive state. Coma is a state of complete unresponsiveness, from which a patient cannot be aroused.
Abdominal Aortic Aneurysm
Authors: Grandhi Ravi K. , Joseph Claire 
Published: May 2024

Abstract
Abdominal aortic aneurysms (AAA) occur due to compromised vascular strength from abnormal elastin activity. The majority of AAA require non-emergent repair via an endovascular approach when they reach over 5.5 cm or begin to grow at a rate of &gt;0.5 cm/year. Patients often have coronary artery disease or respiratory dysfunction associated with smoking. Repair is performed via general or neuraxial anesthesia based on comorbidities and aneurysm morphology. Postoperatively, patients require close monitoring to evaluate renal function and graft-associated complications. If patients don’t receive an early intervention on their AAA, the AAA may rupture, leading to hemodynamic collapse and acute intervention.
Problems of Term and Delivery
Authors: Fayed Mohamed , Younger Joshua 
Published: May 2024

Abstract
Every pregnancy-related death is devastating. About 700 women die each year from complications of pregnancy. About 36% of deaths happened at delivery or in the week after. Heart disease and stroke caused more than 1 in 3 deaths (34%). Other leading causes of death included infections and severe bleeding.1 African American and American Indian were about three times as likely to die from a pregnancy-related cause as white women. Getting regular health care before, during, and after pregnancy can help in identifying these risks and prevent serious health problems. This chapter will summarize several important topics as related to problems of term and delivery.
Enhanced Recovery after Surgery Protocol for Fluid Therapy
Authors: Kassem Hisham , Urits Ivan 
Published: May 2024

Abstract
Enhanced recovery after surgery (ERAS) protocols have emerged to apply to many types of surgeries and provide recommendations to reduce variability and improves patient outcomes. An essential pillar of ERAS protocols is fluid management throughout the entire perioperative period. Preoperatively there is emphasis on limiting prolonged fasting; intraoperatively there is a goal-directed approach to maintain adequate organ perfusion; and postoperatively patients are encouraged to have early oral intake. To provide maximal benefit for the patient there needs to be an understanding among the anesthesiologist, surgeon, and ancillary staff with what directions should be followed. Further investigations are still needed to identify the best goals of fluid management during ERAS surgeries.
Pain Relief
Authors: Cosic Adi , Lawrence Melinda M. 
Published: May 2024

Abstract
Postoperative pain is an unpleasant sequala encountered by patients following almost all surgeries. Although the spectrum for pain is broad, and each patient’s perception of pain different, even mild pain can cause lasting change at the molecular level along pain pathways. Thus, it is imperative for anesthesia providers to have an understanding of the fundamental physiology of pain and its perception, as well as proper treatment.
Other Modalities
Authors: Leonard Ethan R. , Eckmann Maxim S. 
Published: May 2024

Abstract
While opioids and local anesthetics remain the mainstays of perioperative pain management due to their potency and versatility, other pharmacologic and nonpharmacologic treatments are available in the management of postoperative pain. These agents may confer benefits in reducing dependence on opioid therapy through synergism and multimodal pain reduction, thereby possibly improving maintenance of the patient in a more favorable therapeutic window. These agents have unique mechanisms, side effects, and contraindications; therefore patient-centered care requires consideration of how these adjunctive pain treatments can be used appropriately.
Respiratory Consequences of Anesthesia and the Surgical Incision
Authors: Jahromi Behdad , Jani Jai 
Published: May 2024

Abstract
This chapter discusses how anesthesia and surgical incision can impair pulmonary function, leading to hypoxemia. The focus is on the upper airway patency and the patient’s effective respiratory effort, which should be closely monitored. Potential common postoperative pulmonary complications include upper airway obstruction, pulmonary edema, arterial hypoxemia, decreased alveolar ventilation, decreased oxygen pressure, decreased diffusion capacity, ventilation-perfusion mismatch or shunts, and increased venous admixture. Surgical incision is also an important factor in predicting the risk of postoperative respiratory complications. Except in rare cases, all patients receiving general anesthesia should receive supplemental oxygen during postoperative care.
Functional Organization of the Cerebral Cortex
Authors: Latimer Dustin , Kaye Alan D. 
Published: May 2024

Abstract
The central nervous system is composed of neurons within the cerebrum, cerebellum, and brainstem. This review highlights the lobes of the brain and the anatomy of the central nervous system. The cerebral cortex is comprised of four lobes: frontal, parietal, temporal, and occipital. Each of the lobes in the cerebral cortex plays a specific role in function and physiology discussed below. The posterior fossa is discussed as its own region as it houses the most posterior and inferior portions of the cerebral cortex as well as the brainstem and cerebellum. The brainstem functions as the most primitive portion of the human brain. The majority of the cranial nerves are housed within the posterior fossa as well.
Cerebrospinal Fluid
Authors: Nguyen Christina T. , Schulman Nathan 
Published: May 2024

Abstract
This chapter gives an overview of cerebral spinal fluid (CSF) and its implications in anesthetic care. It covers the physiology of CSF formation, including flow through the cerebral ventricular system, electrolyte balance, and mechanisms of absorption. It also briefly discusses abnormalities in CSF pressure caused by imbalances in formation and reabsorption, as well as the effects some anesthetics have on these processes. Included in this chapter is a table comparing the composition of CSF to blood plasma.
Relation to Blood Chemistry and Acid-Base Balance
Authors: DaBreo Evan , Kohan Lynn 
Published: May 2024

Abstract
The physiologic mechanisms of cerebrospinal fluid (CSF) buffering in relation to blood chemistry and acid-base balance are crucial in understanding the ventilatory response to metabolic derangements and induced changes in intracranial pressure (ICP). Hyperventilation is often used in the context of head trauma or neurosurgical procedures to reduce ICP; however, careful use of this technique is critical. Because non-ionized CO2 molecules, and not ionized molecules such as H+, are able to cross the blood-brain barrier, induced changes in cerebrovascular blood flow (CBF) are largely independent of systemic arterial pH. Due to compensatory mechanisms, CBF will return to baseline as both blood and CSF pH return to normal over 6–24 hours, regardless of continued hyperventilation. Preoperative communication with the neurosurgical team prior to procedure is key for planning any potential need for reduction in ICP to improve operative conditions. Postoperatively this return to baseline must be kept in mind as prolonged hyperventilation also results in increased “CO2 reactivity,” making the patient more susceptible to acute rises in ICP.
General Organization of the Spinal Cord
Authors: Ozcan Asli , Conermann Till 
Published: May 2024

Abstract
This chapter on spinal cord general organization serves as a basic overview of the organization of the spinal cord, emphasizing high-yield points for anesthesiology board examination purposes. Gross anatomy of the vertebral column and the spinal cord are discussed. Important details about spinal nerves, gray matter, and white matter are reviewed, including critical portions such as the laminae of Rexed. An illustration of a cross-section of the spinal cord is shown to highlight critical structures of the gray and white matter. The arterial blood supply to the spinal cord is also reviewed.
The Sympathetic Nervous System
Authors: Cosic Adi , Lawrence Melinda M. 
Published: May 2024

Abstract
The autonomic nervous system is an integral part of the body’s hemostasis, maintaining mechanisms through two opposing forces. The autonomic nervous system is split into two subtypes, the sympathetic nervous system (SNS) and parasympathetic nervous system (PSNS). The SNS and PSNS act in response to stimuli, and regulate body functions such as digestion, response to stress, heart and respiratory rate, and many others. The SNS possesses an ability to release large amounts of catecholamines in response to stressful stimuli, earning it the common description of “fight or flight.” In the context of the far-reaching effects of the SNS and its importance in anesthesia, it is crucial for anesthesia providers to have a thorough understanding of its mechanisms.
Afferent and Efferent Pathways
Authors: Singh Simranjit , Waghray-Penmetcha Taruna 
Published: May 2024

Abstract
The autonomic nervous system (ANS) is divided into not only sympathetic and parasympathetic divisions, but afferent and efferent pathways as well. Afferent fibers transmit sensory information from the periphery to higher centers, while efferent fibers transmit modulate responses from the central nervous system back to the periphery in order to maintain homeostasis. Efferent pathways are divided into sympathetic and parasympathetic branches, whereas a single afferent sensory system conducts information for the ANS. Both pathways typically share the same postganglionic nerve fibers. A majority of afferent signals converge at the solitary nucleus in the medulla, before being sent to other areas of the brain. Preganglionic parasympathetic efferent pathways are controlled by cranial nerves III, VII, IX, X, and sacral fibers S2–S4. Postganglionic nerves are located near the effector organ. Meanwhile, preganglionic sympathetic efferents originate from spinal cord levels T1–L2 and synapse with the paraspinal postganglionic sympathetic chain, before axons are sent to the periphery.
Meninges
Authors: Abdallah Rany T. , Villatoro-Lopez Jasmin 
Published: May 2024

Abstract
The meninges are membranous layers surrounding the central nervous system (CNS). The meninges provide protection of the soft neural tissue of the brain and the spinal cord. They are composed of three distinct layers: the outermost dura mater, the middle arachnoid mater, and the innermost pia mater. The meninges contain space via which cerebrospinal fluid (CSF) travels through the CNS. Defects in the meninges are believed to cause two neurodevelopmental disorders in humans: Dandy-Walker malformation, and cobblestone lissencephaly. Both conditions can impair the function of the brain. Both Dandy-Walker malformation and Walker-Warburg syndrome symptoms occur at birth or early infancy.
Carotid and Aortic Bodies and Carotid Sinus
Authors: Vasant Kris , Ahmed Muhammad Fayyaz 
Published: May 2024

Abstract
In this chapter the authors discuss the different types of chemoreceptors, with particular focus on structure, function, and physiologic effects on maintaining homeostasis. The main peripheral chemoreceptors in the body, which include the carotid and aortic bodies, are discussed. The chapter also outlines the structure and function of the carotid sinus. Clinically relevant anesthetic considerations have been mentioned for clinically managing patients.
Ganglia, Rami Communicantes and Sympathetic Chain
Authors: Friedman Eric D. , Subieta-Benito Gunar G. 
Published: May 2024

Abstract
Ganglia, autonomic fibers and plexuses of both the sympathetic and parasympathetic nervous system network with one another to maintain a homeostatic balance in nearly every organ system in the human body. Although its anatomy is well understood, the intrinsic functions of this system remain a challenge for most physicians due to its involvement in life-sustaining functions and pain control. In the latter, dysfunctional sympathetic ganglia could contribute to pain syndromes that are currently beyond the ability to cure. Given the overlap, but also independence from somatic nerves, it is important to understand the sympathetic anatomic relationships in order to maximize therapeutic yield.
Work of Breathing
Authors: Pham Ba Hoang Nguyen , Bang Jason 
Published: May 2024

Abstract
Work of breathing is defined as the energy spent to move air in and out of the lung during inspiration and expiration, respectively. It comprises the elastic work and the resistive work; their relationship can be demonstrated through the Campbell diagram. The increase in work of breathing can be seen in various comorbidities such as obesity, congestive heart failure, and lung diseases. It can be minimized by altering factors that affect the elastic and resistive work. The practical importance of understanding and calculating the work of breathing in the operating room and more so in the field of intensive care is to optimize the ventilator settings according to the needs of the patient.
Distribution of Perfusion
Authors: Rodriguez Gloria , Jamroz Tatiana 
Published: May 2024

Abstract
The pulmonary circulation is a low-pressure system and is characterized by a low vascular resistance compared to the systemic circulation. This lower vascular resistance allows the existence of thinner capillaries and alveolar walls that facilitate diffusion of oxygen and CO2 for gas exchange. The distribution of blood received by the lungs is not uniform, and based on the interactions between alveolar pressure, pulmonary capillary arterial, and venous pressures, as well as interstitial pressures, the lungs have been divided into four different zones called the West lung zones. Several factors regulate blood supply to different areas of the lungs. One of the most important is the phenomenon known as hypoxic pulmonary vasoconstriction, in which blood is diverted away from poorly ventilated alveoli and redirected toward better ventilated ones.
Special Considerations in Pediatric Otolaryngology Surgery
Authors: McDaniel Eric , Fromer Ilana R. 
Published: May 2024

Abstract
Pediatric otolaryngology procedures are the most frequently performed surgeries in children. They are often booked as same-day procedures despite their disproportionately high risk of complications which require a close working partnership between surgeon and anesthesiologist to formulate a clear plan of management to ensure safe patient care and good outcomes. The most common pediatric otolaryngology surgeries include but are not limited to: cleft lip and palate, tonsillectomy and adenoidectomy, common ear procedures, peritonsillar abscess, rigid bronchoscopy and laryngoscopy techniques including jet ventilation and laser surgery, and foreign body aspiration. This chapter will deal with the high-yield preoperative, intraoperative, and postoperative considerations in managing the anesthesia for these surgeries.
Nasal Anatomy and Pathology
Authors: Falgoust Evan , Kaye Alan D. 
Published: May 2024

Abstract
Respiratory anatomy, specifically the nose, is an important anatomical landmark, as well as common source of pathological abnormalities. The cell type, blood supply, and nerve supply all play various roles in the function of the nose, and these critical factors are described regarding individual significance in numerous pathological. Therapeutic considerations are described in the treatment of epistaxis, rhinitis, and nasal polyps, including pharmacological management strategy as well as surgical treatments.
Pharynx
Authors: Penny Kayla , Cornett Elyse M. 
Published: May 2024

Abstract
The pharynx extends from the base of the skull to the inferior border of the cricoid cartilage. It serves as a common channel for both swallowing and respiration. The internal pharynx consists of the nasopharynx, oropharynx, and laryngopharynx, and is innervated by various branches of the external carotid artery. Pharyngeal function is decreased in anesthetized patients. The anesthesiologist should evaluate the anatomy of the airway, including the pharynx, to determine whether the patient is at risk for a difficult intubation.