bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acetylcholinesterase-Inhibitor Toxicity
Authors: Guz David , Johnson Angela 
Published: May 2024

Abstract
The use of acetylcholinesterase-inhibiting agents (AChI) is widespread and particularly relevant to the perioperative physician, who will commonly encounter patients on chronic AChI therapy and also frequently will administer these drugs as a component of typical anesthetic management. The events leading up to the development of AChI medications for therapeutic purposes was fraught with reports of cholinergic toxicity, which is the mechanism behind many commonly used pesticides and chemical nerve agents. As with any medication, therapeutic effects of AChI must be weighed against the potential for toxicity, and it is paramount that the perioperative physician is well equipped to recognize and manage this situation. This chapter will review acetylcholinesterase inhibitors, cholinergic toxicity, and its treatment.
Opioids
Authors: McGinty Lauren 
Published: May 2024

Abstract
Opioids are widely used to treat somatic, visceral, and neuropathic pain associated with a variety of medical conditions. This chapter reviews the indications, mechanisms of action, therapeutic effects, adverse effect profiles, and special precautions associated with different agents. It addresses significant drug interactions and available routes of administration for different opioids. Finally, this chapter highlights unique advantages and disadvantages associated with the agents in this medication class.
Spinal Cord Reflexes
Authors: Woodrow Alex , Sharma Archit 
Published: May 2024

Abstract
Many functions of the spinal cord are controlled by the brain, but certain functions also executed independently, such as spinal reflexes. Spinal reflexes include the stretch reflex, the Golgi tendon reflex, the crossed extensor reflex, and the withdrawal reflex. Pathway for any reflex action is known as reflex arc. These spinal reflexes allow for faster reflex response to occur by activating spinal motor neurons, and also contribute to normal muscle tone. Reflex tests are an important component of a neurological exam, to confirm integrity of the spinal cord or to diagnose the presence and location of spinal cord injury. This chapter reviews the various spinal reflexes and their clinical implications.
Psychological, Social, and Vocational Influences on Pain Perception
Authors: Rushmer Timothy , Abd-Elsayed Alaa 
Published: May 2024

Abstract
The understanding of pain and the factors that influence it has come a long way from the strictly biological perspective of the past. Now, experts agree, pain is best understood with a biobehavioral or biopsychosocial model. These models integrate the physiological, social, and psychological components that influence pain and its perception across the lifetime of the patient. This is a broad and expanding area of study, but this chapter will focus on the highlights of these influences.
Termination of Action
Authors: Stedman Robin B. 
Published: May 2024

Abstract
This chapter discusses the termination of action of the neurotransmitters of the sympathetic and parasympathetic nervous systems. This includes termination of action of norepinephrine, the neurotransmitter of the postganglionic adrenergic fibers, of epinephrine released by chromaffin cells, and of acetylcholine, the neurotransmitter of the postganglionic cholinergic fibers and autonomic ganglia.
Heat Loss Mechanisms
Authors: MacCormick Samuel , Kohan Lynn 
Published: May 2024

Abstract
This chapter covers intraoperative heat loss mechanisms leading to hypothermia. Hypothermia is an important physiologic mechanism with many perioperative risks affecting both morbidity and mortality. Identifying potential sources of heat loss, specifically related to anesthetic techniques and the environment, is integral to the prevention and management of hypothermia. There are three phases associated with heat loss while under general anesthesia. The first phase accounts for the majority of heat loss and encompasses redistribution of body heat as anesthetics induce vasodilation and the core body temperature rapidly drops. The second phase includes environmental losses (radiation, convection, conduction, evaporation), and phase three is the equilibrium phase. Management strategies in the preoperative, intraoperative, and postoperative periods include both passive and active warming techniques. However, prevention of hypothermia remains the most important and effective strategy.
Effect of Drugs/Anesthetic Technique on Temperature Regulation
Authors: Guruswamy Jayakar , Angappan Santhalakshmi 
Published: May 2024

Abstract
This chapter on the effect of drugs/anesthetic technique on temperature regulation gives an overview of the impact of both general anesthetic drugs and neuraxial techniques on thermoregulation. General anesthesia decreases the metabolic rate by 20%–30%. General anesthesia inhibits any behavioral and autonomic responses to temperature fluctuations. The interthreshold range increases up to 10-fold, from 0.2°–0.4°C to 2°–4°C. Volatile anesthetics such as sevoflurane or nitrous oxide and intravenous anesthetics such as propofol and opioids impair thermoregulatory control. Sedatives like midazolam have minimal effects on thermoregulation. Neuraxial anesthesia inhibits central thermoregulatory control. Behavioral responses are impaired by neuraxial anesthesia. The effects of general anesthesia and regional anesthesia on thermoregulation are additive.
Blood Supply
Authors: Abdallah Rany T. , Villatoro-Lopez Jasmin 
Published: May 2024

Abstract
The spinal cord is located in the vertebral cavity and runs from the foramen magnum to the second lumbar vertebra (L2). The blood supply of the spinal cord derives from two sets of branches from the dorsal aorta. The main blood supply of the spinal cord is via the single anterior spinal artery (ASA), providing blood to the anterior two-thirds of the spinal cord, along with the two posterior spinal arteries, which provides blood to the posterior one-third of the spinal cord. Anterior spinal cord syndrome within the region of the lumbar spinal cord and vertebral artery dissection may occur; however, both can be treated.
Regulation of Airway Caliber
Authors: Lapkouski Vadzim , Jamroz Tatiana 
Published: May 2024

Abstract
Neural control of airway diameter is predominantly via the parasympathetic system with afferent and efferent fibers in the vagus nerve. Stimulation by foreign bodies in the airway or inhalation of cold air or irritant pollutants stimulates reflex bronchoconstriction acting via release of acetylcholine and activation of M3 cholinergic receptors. Once stimulated, M3 receptors activate a Gq protein, which in turn activates phospholipase 3 to produce inositol triphosphate, which causes release of calcium from the airway smooth muscle sarcoplasmic reticulum. Humoral control of airway diameter is dominated by the effects of circulating adrenaline acting on the plentiful β-2 adrenoreceptors found on airway smooth muscle. The mechanism of action of the β-2 receptor is clearly elucidated, and involves the agonist binding within the core of the protein, stabilizing the molecule in its activated state. In this state the β-2 receptor stimulates a linked Gs protein to activate adenylate cyclase to produce cyclic adenosine monophosphate (cAMP), which inhibits calcium release from intracellular stores and causes the actin-myosin contractile units to become less calcium sensitive.
Ventilation/Perfusion
Authors: Farela Andrea , Jamroz Tatiana 
Published: May 2024

Abstract
Lung ventilation and pulmonary perfusion are essential components of the normal function of the lung, but it is their ratio (V/Q) that determines adequate gas exchange. This chapter on ventilation/perfusion defines the main concepts about gas exchange in the lungs and different factors involved in its variability throughout the lung. It reviews the concepts of dead space and shunt, and its effects on V/Q, as well as the mechanisms involved in V/Q mismatch. It also mentions the most common pathologies that exemplify dead space and shunt. A typical example of pathology causing V/Q mismatch secondary to increased dead space is pulmonary embolism, while acute lobar atelectasis, extensive acute lung injury, pulmonary edema and pneumonia are pathologic states that increase shunt fraction.
Alveolar Gas Equation
Authors: Teixeira Camila , Jamroz Tatiana 
Published: May 2024

Abstract
The alveolar gas equation (AGE) was created to estimate the partial pressure of oxygen inside the alveoli (PAO2). The equation relates PAO2 to three major variables: inspired oxygen tension (PiO2), alveolar partial pressure of carbon dioxide (PACO2), and respiratory quotient (R). The variation or manipulation of any variable quantity has a significant impact on PAO2 values, eliciting different clinical responses. In the clinical practice, the AGE is used to calculate the alveolar-arterial O2 gradient (A-a gradient). The simplified equation has its application limited to a steady state condition. The elaborated version of the AGE has an extra term within brackets which is given to compensate a larger O2 uptake than O2 elimination over the alveolar capillary membranes.
Carbon Dioxide Response Curves
Authors: Cornwell Drew , Kohan Lynn 
Published: May 2024

Abstract
Building upon earlier discussions of peripheral and central chemoreceptors, this chapter discusses the carbon dioxide and oxygen response curves. Additional discussion is held regarding the changes in alveolar ventilation that occur in response to commonly seen clinical influences and scenarios. A linear relationship exists between PaCO2 and alveolar ventilation. When graphically represented, predictable changes in the slope and position of this relationship can be seen with inhaled anesthetics &gt;1 MAC, opioids, CNS depressants, and hypoxia. A strong understanding of this concept is an effective clinical tool in the administration of an anesthetic.
Perioperative Smoking and Caffeine Use
Authors: Swanson David E. 
Published: May 2024

Abstract
Preoperative smoking can increase the length of hospital stay, infection, pulmonary, neurological and wound complications, as well as the odds of an intensive care admission and mortality. If patients can stop smoking 4 weeks ahead of surgery, this will decrease the reactivity of the airways and lessen the chance for bronchospasm, laryngospasm, hypoxia, and wound-healing complications. The perioperative discussion of smoking cessation is an important window when patients are thinking of their health. Many patients are also addicted to caffeine, and withdrawal headaches may occur. Tobacco smoking and likely vaping nicotine have significant effects on the cardiopulmonary systems at the cellular and subcellular level, putting these patients at higher risk of morbidity and warranting heightened vigilance in their care. Caffeine is an effective adjunct for treating many types of headaches and has long been touted for mild post-dural puncture headaches without solid evidence of significant benefit.
Anticholinergics
Authors: Markatos Sheridan , Manders Larry 
Published: May 2024

Abstract
Anticholinergics block the neurotransmitter acetylcholine in the brain and peripheral tissues. Inhaled anticholinergics, including ipratropium bromide and tiotropium bromide, are important medications in the management of COPD and severe asthma. They have slower onset of action than beta agonists and are therefore used for long-term management rather than acute exacerbations. However, inhaled anticholinergics can be useful in the perioperative setting to mitigate the parasympathetic response to airway instrumentation. This chapter briefly discusses the mechanism of action on anticholinergics and briefly outlines the two major drugs in this class and possible side effects.
Synchronicity of Pressure
Authors: Ahmed Muhammad Fayyaz , Ahmed Furqan 
Published: May 2024

Abstract
The cardiac physiology relies on a synchronized series of events that occur with every heartbeat. They are characterized by electrical and mechanical events. The mechanical events consist of phases of systole (isovolumetric contraction and ejection) and diastole (isovolumetric relaxation and ventricular filling). Associated with these phases are the valvular actions of valve opening or closing. The changes in pressure in the heart chambers create a pressure wave in the central venous system, which can be of diagnostic assistance in certain pathologies.
Impulse Propagation
Authors: Dakhlallah Nadeen , Manders Larry 
Published: May 2024

Abstract
The heart’s pumping capabilities are regulated by an electrical conduction system that coordinates contraction of the chambers of the heart. The main components of the heart’s electrical conduction system are the sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, bundle branches, and Purkinje fibers. This chapter summarizes impulse propagation and discusses the electrophysiology of the heart.
Venous Return
Authors: Nowatzke Ryan , Manders Larry 
Published: May 2024

Abstract
The venous system is a high capacitance system containing ~70% of the total blood volume. Change in central venous pressure (CVP) can dramatically alter the volume of blood return to the heart. A complex regulatory system governs venous capacitance. In times of stress, the volume stored within the venous system can be recruited to increase cardiac output via increase input from the sympathetic nervous system. Further complicating the subject, blood volume in the venous system differs by age, sex, and underlying medical comorbidities. This chapter summarizes venous return to the heart, the factors that govern it, and the various physiological changes commonly experienced in anesthesia.
Heart Conduction System
Authors: Pellicer Robert , Abd-Elsayed Alaa 
Published: May 2024

Abstract
The cardiac conduction system is a specialized collection of cells that generate and propagate action potentials throughout the heart in order to facilitate the synchronized contraction of myocardium. The system consists of the sinoatrial (SA) node, the atrioventricular (AV) node, and the His-Purkinje system. The SA node acts as the heart’s pacemaker, generating action potentials at a rate determined by the “funny current,” a mixed sodium-potassium current that may be modulated by the autonomic nervous system. As impulses are generated along the conduction system, they pass through the AV node, where a brief delay prevents simultaneous atrial and ventricular contraction. As the action potential reaches the ventricles, the His-Purkinje system ensures synchronized ventricular depolarization in order to maximize cardiac output. Action potentials propagated along the conduction system are exquisitely regulated by varying physiologic states and neural mediators.
Vasopressors and Inotropes
Authors: Sohn Jacqueline , Pesa Nicholas 
Published: May 2024

Abstract
Inotropes are pharmacologic agents that increase contractility of the heart. Vasopressors are pharmacologic agents that cause vasoconstriction. Not all adrenergic agents are pure inotropes because some of them have vasopressor effects also. This chapter reviews the basic physiology and pathways of vasopressors and inotropes. It also discusses specific pharmacological agents categorized by either their structure or function: endogenous catecholamines, synthetic catecholamines, sympathomimetics, PDE-inhibitors, vasopressors used in obstetric anesthesia, and others. Each pharmacologic agent’s mechanisms of action, common uses, and side effects are also discussed.
Vasodilators
Authors: Besada Stefan , Nguyen Christina T. 
Published: May 2024

Abstract
This chapter provides an overview of the current and commonly used vasodilators in anesthesia practice today. Nitrovasodilators, adrenergic antagonists, dopamine agonists, and calcium channel blockers are discussed, including the pharmacokinetics and pharmacodynamics of each drug, dosing, and suggested uses. Included in this chapter is a table readily outlining dose, onset, and elimination half-life of each of the vasodilators, which serves as a useful quick reference. It becomes readily apparent that each one of these agents has their own specific clinical indications. This chapter also outlines the heavily tested topics of adverse reactions associated with these agents, such as cyanide toxicity, methemoglobinemia, reflex tachycardia, or rebound hypertension.
Synthetic and Recombinant Hemoglobins
Authors: Tillmans Samuel , Watt Stacey 
Published: May 2024

Abstract
This chapter on synthetic and recombinant hemoglobins discusses hemoglobin-based oxygen carrier blood substitutes that one may encounter during the practice of anesthesiology. It will also discuss the impact these substiutions have on the longevity of storage and potential impact the use of these symthetic and recombinant hemoblobins may have on patient care. Recombinant hemoglobin and synthetic blood are extremely important in light of blood shortages, possible contaminants, limited donor blood shelf life, donor blood storage issues, and ethical issues involving blood donation. This chapter addresses specific advantages, disadvantages, costs, and other aspects of these artificial hemoglobins to our healthcare systems.
Thyroid Gland
Authors: Chamu Jauhleene , Johnson Angela 
Published: May 2024

Abstract
This chapter identifies relevant anatomy and physiology of the thyroid gland while describing thyroid gland disorders and the perioperative considerations necessary to adequately manage patients with thyroid disease. The physiology of iodine utilization to make thyroid hormone and the negative feedback system between the hypothalamus, pituitary, and thyroid gland to control thyroid hormone production are described. Etiologies and treatment for both hypothyroidism and hyperthyroidism can be found. This chapter also provides management strategies for the clinical manifestations of severe hyperthyroidism and hypothyroidism-thyroid storm and myxedema coma, respectively. Furthermore, it explores the preoperative, intraoperative, and postoperative considerations for a patient with thyroid disease undergoing surgery.
Adrenal Cortex Anatomy and Physiology
Authors: McCafferty Brendan , Pesa Nicholas 
Published: May 2024

Abstract
The adrenal gland is a structure that sits on the superior pole of the kidneys bilaterally. It is composed of two distinct glands with unique anatomy and physiology. This chapter will focus on the outer layer of the adrenal gland, the adrenal cortex. This layer produces hormones that are vital to life, such as cortisol and aldosterone. The adrenal cortex can be further separated into three layers: zona fasciculata, zona glomerulosa, and zona reticularis. Each layer is associated with the production of specific hormones. Pancreatic anatomy is discussed briefly at the end of the chapter.
Protein Synthesis, Structure, and Function
Authors: Stuckey Ryan , James Dominika Lipowska 
Published: May 2024

Abstract
Proteins are large and complex biomolecules that play an essential role in structure and regulation of function within an organism. Twenty different amino acids are utilized as building blocks in the creation of polypeptide chains in the process of protein formation. These polypeptide chains undergo conformational changes to create functional proteins. Protein function is highly dependent on its structure; change to the polypeptide chain sequence may alter protein’s function. Absence or dysfunction of proteins can lead to a disease state. Proteins are the most structurally diverse biological molecules and are involved in a vast array of functions within an organism, including structural support to organelles, cells, and tissues; selective transport of molecules and ions across the cellular membrane; cellular communication; and as enzymatic activity–intracellular metabolic catalysts. All proteins except antibodies and clotting factor VIII are formed in the liver.
Cyclic Adenosine Monophosphate (CAMP) and Cyclic Guanosine Monophosphate (CGMP)
Authors: James Dominika Lipowska , Unnithan Ajay S. 
Published: May 2024

Abstract
Human physiology is highly dependent on a well-coordinated system of communication between cells. A multitude of external signals, including hormones, neurotransmitters, and other molecules, interact with cells via specific cell-surface receptors. This signal-receptor interaction can subsequently trigger a cascade of secondary events within the cell, including activation of intracellular second messenger systems that coordinate the cell’s response to the initial stimulus. Two important molecules involved in this second messenger cascade are cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). A wide range of physiological processes utilize these second messenger systems. These intracellular processes are involved in the regulation of a vast number of physiological processes, including metabolism and everything from endocrine, gastrointestinal, and immune function to cardiovascular homeostasis.
Physician Impairment and Disability
Authors: Saad Ramsey , Hanna Joseph Salama 
Published: May 2024

Abstract
Physician impairment is defined as the inability to practice medicine with reasonable skill and safety to patients by the reason of psychiatric or general medical conditions. In order to be a board certified anesthesiologist, a physician would be required to complete medical education followed by residency and possibly fellowship, board certification exams in addition to fulfilling Maintenance of Certification in Anesthesiology (MOCA) requirements. In order to ensure safe anesthesia care as well the anesthesiologist, and possibly his or her coworkers need to be aware of signs and symptoms of physician impairment. This chapter outlines the various methods of detecting this, in addition to the ethical and legal challenges which face the practitioner and institution regarding safe return to work.
Medical Errors
Authors: Hanna Joseph Salama , Saad Ramsey 
Published: May 2024

Abstract
This chapter reviews previously suggested definitions of medical errors and adverse events. It discusses various types of errors, including action-based like accidental placement of a needle in the carotid artery during central venous cannulation or endotracheal tube placement in the esophagus instead of the trachea., decision-based which are mainly secondary to faulty knowledge or judgment, and communication-based errors which occurs commonly in the operating room setting and are the leading root cause of serious adverse events that result in patient harm. It enumerates possible methods of prevention for such medical errors.
LGBTQ
Authors: Goldstein Mark A. , Goldstein Myrna Chandler 
Published: May 2024

Abstract
LGBTQ individuals experience unique health disparities, and each of the LGBTQ populations has their own health concerns that may be further impacted by race, ethnicity, socioeconomic status, age, and other factors. LGBTQ youth are at increased risk for depression and suicidal ideation. Among LGBTQ youth, rates of substance use may be higher than heterosexual youth; homelessness is a significant issue for LGBTQ youth. LGBTQ youth are targets of increased levels of violence, victimization, harassment, and stigmas. Many LGBTQ adolescents use social media as a primary means to interact with other LGBTQ adolescents; social media does provide a communication opportunity, but LGBTQ youth also face online harassment. While schools are a domain where homophobia may exist, there are also strategies that have been shown to promote the safety and well-being of LGBTQ youth in the school setting.