bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spine Anatomy
Authors: Pan Wenyu , Malik Tariq M. 
Published: May 2024

Abstract
Knowledge of the spine anatomy is required for safe performance of spinal and epidural anesthesia. This includes clear understanding of the variability that is prevalent not only in the spinal column, but also the structures around it. The presence of spine anatomy variability is not only due to aging but also it varies with patients’ body habitus, gender, and even race. This chapter reviews the basic bony anatomy of the spine and the variations in the vertebral configuration present at different spinal levels. The importance of this variability as it affects the daily practice of anesthesia is also highlighted at the end of the chapter.
Upper Extremity
Authors: Samba Amit , Nickless Alexandria 
Published: May 2024

Abstract
A proper understanding of anatomy is important for any practicing anesthesiologist in any clinical or perioperative setting. The upper extremity includes structures connecting the shoulder to the fingers and has an increased ability for motor control and sensory innervation when compared to the lower extremity. Identifying the anatomy (osseous, vasculature, and nervous) structures is necessary to provide a safe and effective anesthetic plan. Proper visualization and identification could help in minimizing the risk of injury during patient positioning, performing regional anesthesia, or anesthetic management of a patient’s pathophysiology in the perioperative setting. This chapter will identify the anatomy (osseous, vasculature, and nervous structures) with possible complications associated with these structures.
Pressure Measurement of Gases and Liquids
Authors: Aquino Ben 
Published: May 2024

Abstract
This chapter on the pressure measurement of gases and liquids seeks to aid the anesthesia provider in understanding how and why pressures are measured, and the factors that affect the data obtained. It looks at the manometer as a basic illustration of the principles of pressure measurement, and it also explains the measurement of partial pressures, and their clinical pertinence in anesthesia for the proper delivery of anesthetic gases. The chapter also explains transduction systems used to measure pressures, using the arterial line system as an example to show principles of measurement as well as factors affecting the quality and accuracy of the data obtained therein.
Components
Authors: Jun Charles , Nasr Ned F. 
Published: May 2024

Abstract
The various components in the delivery of anesthesia all play a vital role. Understanding the mechanism of each component helps operators understand the strengths and limitations of each component. This chapter discusses the properties of the main components involved in the delivery of the volatile anesthetic, including their advantages and disadvantages, along with clinical considerations intraoperatively. The components that are dissected in this chapter are the following: unidirectional valve, corrugated breathing tube, connectors, adaptors, facemasks, laryngeal mask airways, endotracheal tubes, reservoir bag, airway pressure relief valve, and the absorber.
Blood Pressure Monitoring Methods
Authors: Hithe Candice C. , Huebsch Jerome B. 
Published: May 2024

Abstract
Understanding the methods of blood pressure monitoring is an essential concept for the anesthesiologist. This chapter reviews the basic blood pressure monitoring methods, such as the palpatory, auscultatory, and Doppler techniques. These methods rely on the use of a sphygmomanometer (inflatable cuff with a pressure gauge). Their accuracy is dependent on the ability of the cuff to compress the artery reliably. The palpatory and Doppler techniques can only estimate systolic blood pressure. Both systolic and diastolic blood pressure can be estimated by listening for Korotkov sounds during the auscultatory approach. This chapter also explains the more advanced techniques, such as oscillometry and intra-arterial methods. With oscillometry, the mean arterial pressure is measured, and the systolic and diastolic blood pressures are less accurately calculated. Intra-arterial cannulation is considered the gold standard and gives the most accurate measurement of systolic, diastolic, and mean arterial pressures. The newer techniques, such as the volume clamp method and applanation tonometry, are also discussed.
Intravascular Pumps
Authors: Hagan Jack , Giordano Chris 
Published: May 2024

Abstract
Intravenous pumps have evolved since the 1600’s into important tools for anesthesia professionals to meet their anesthetic goals. Various pumps are available, including syringe, intravenous line with a manual resistance device or electronic pump, elastomeric, and even simple gravity by counting drops. These also range from powerless to electronically highly complex—with drug databases and electronic medical record connection. Each has its advantages; however, as with any device, there are complexities, and vigilance is needed to prevent patient harm. This chapter reviews types of pumps, factors involved in selection, and clinical examples in which pumps can lead to potential harm.
Pharmacokinetics and Pharmacodynamics
Authors: Parker Nicholas M. , Waqar Syed 
Published: May 2024

Abstract
Pharmacokinetics addresses the many ways drugs are moved into, around, and out of the body, and how drug molecules are changed in the process. Pharmacokinetics includes absorption, distribution, metabolism, and excretion. Pharmacokinetics may be altered by renal or hepatic impairment, body size, genetic polymorphism, or interactions with food or other drugs. Pharmacodymaics is concerned with how drugs cause an effect in the body, having reached the site of action. Drugs may act as a receptor agonist, antagonist, or partial agonist. Each drug’s unique pharmacokinetic and pharmacodynamic properties guide the selection of the right drug, dose, rate or frequency, and route of adminsitration for a given patient.
Comparative Pharmacodynamics of Inhaled Anesthetics
Authors: Parker Nicholas M. 
Published: May 2024

Abstract
A variety of effective inhaled anesthetics is available, including nitrous oxide, sevoflurane, isoflurane, desflurane, enflurane, and halothane. The agents differ in time to onset, hemodynamic effects, pungency, and toxicities. Nitrous oxide has an excellent safety profile but cannot produce complete anesthesia on its own. Sevoflurane may be used for induction and maintenance of anesthesia but can cause hypotension. Isoflurane is potent and inexpensive, which may be of benefit for long operations. Desflurane is useful for rapidly increasing the depth of anesthesia during painful parts of a surgery. Understanding the pharmacologic similarities and differences of each inhaled anesthetic allows for optimal anesthetic selection for a given patient and operation.
Substance Use Disorder
Authors: Yu Raymond C. , Conermann Till 
Published: May 2024

Abstract
This chapter reviews key concepts and definitions pertaining to substance abuse, addiction, and dependence, as well as important preoperative, intraoperative, and postoperative considerations when managing these patients. Abused and addictive substances exert their reinforcing effects through the activation of the mesolimbic dopamine system in the central nervous system (CNS). Genetic and epigenetic variations account for variable responses to addictive substances. Preoperatively, patients may present with altered mental status, and identification of ingested substance is helpful for intraoperative management. In addition to physiologic derangements, acute intoxication of addictive substances will lower minimum alveolar concentration (MAC), with exceptions such as cocaine and CNS stimulants, which do the contrary. Chronic substance abuse will typically increase MAC requirements. Postoperatively, patients might require intensive care monitoring for withdrawal symptoms and stabilization. Different medications (e.g., naltrexone, buprenorphine, methadone) are being utilized by physicians to help treat substance use disorder (SUD), and these medications may complicate anesthetic management in these patients. This chapter discusses important anesthetic considerations in patients abusing several common drugs of abuse: alcohol, opioids, cocaine, LSD, barbiturates, amphetamine, PCP, and marijuana.
Epidural and Intrathecal Anesthetics
Authors: Medina Wilson Alfredo , Gershon Laura Liss 
Published: May 2024

Abstract
This chapter explores the clinical implications of neuraxial anesthesia in review. Neuraxial content discussed includes epidural, spinal, and caudal anesthesia. Specific focus on indications, contraindications, sites of pharmacologic action, as well as factors affecting onset, duration, termination of action, and level of blockade, are addressed. The physiologic impact of neuraxial anesthesia, in addition to complications such as local anesthetic systemic toxicity, is also discussed. The intent of this chapter is to provide a resource for clear and concise rapid board review preparation.
Barbiturates
Authors: Ferguson Kris , Soin Amol 
Published: May 2024

Abstract
Thiopental is the prototypical barbiturate intravenous induction agent. It has a rapid onset of action and quick termination of action. Termination of action is due to redistribution. It lacks analgesic properties, therefore airway manipulation can precipitate laryngospasm. Barbiturates have minimal impact on blood pressure and cardiac output; however, in patients with hypovolemia or shock, barbiturates can precipitate significant hypotension due to a decrease in sympathetic outflow. Barbiturates are contraindicated in patients with acute intermittent porphyria.
Benzodiazepines
Authors: Ferguson Kris , Papapetrou Peter 
Published: May 2024

Abstract
Benzodiazepines are a class of drugs often used for anxiolysis and sedation. Benzodiazepines are also used in an outpatient setting for anxiety, panic disorder, alcohol withdrawl, insomnia, seizures and it also has muscle relaxant properties. The benzodiazepine binds to the gama-aminobutyric acid receptor A (GABA A) prolonging the opening of the chloride channel thereby hyperpolarizing the cell. Benzodiazepines quickly cross the blood brain barrier producing sedation. There is minimal impact on the cardiovascular system. When used in isolation, there is a modest respiratory depression. When benzodiazepines are combined with opioids there is a synergistic effect which can significantly depress respiratory drive. Higher doses of benzodiazepines may also cause anterograde amnesia. Flumazenil is the benzodiazepine reversal agent.
Local Anesthetics
Authors: Papapetrou Peter , Ferguson Kris 
Published: May 2024

Abstract
Local anesthetics are especially useful agents used in the perioperative setting to prevent and control acute pain. They act by binding to voltage-gated sodium channels and terminate propagation of nerve action potentials. They are categorized as either ester or amides based on their chemical structure, which are also metabolized differently and carry different allergic potential. Ester local anesthetics carry higher allergic potential due to their metabolite PABA. Potency of local anesthetics is related to their lipid solubility, and onset is determined by pKa. Side effects from local anesthetics can occur, which include transient neurologic symptoms (TNS), cauda equina syndrome, and methemoglobinemia. Local anesthetic toxicity can be manifested as minor changes such as tinnitus or restlessness but can progress to seizures and circulatory collapse. Local anesthetic toxicity is treated with supportive measures as well as 20% lipid emulsion.
Malignancy
Authors: Gluncic Vicko 
Published: May 2024

Abstract
Approximately 40% of people have a chance to develop cancer during their lifetime, and two-thirds of these patients will undergo anesthesia and surgery. In perioperative care, special consideration should be paid to the patients receiving chemotherapy and/or radiation and/or immunotherapy due to side effects affecting different organ systems. In addition, paraneoplastic syndromes may accompany cancers and cause pathophysiologic disturbances. Anesthesia, surgery, and perioperative analgesia also have immunomodulatory effects and cause stress reaction—both of which can possibly contribute to metastatic dissemination of malignant cells and subsequent cancer progression. Studies showed that anesthetic techniques could affect many of these pathophysiological processes—influencing risk of cancer recurrence in either a beneficial or harmful way. Currently there are insufficient clinical data to support that specific anesthetic interventions have more favorable outcomes. However, retrospective clinical studies have indicated an association between regional anesthetic techniques for primary cancer surgery and reduced incidence of metastatic disease. Nevertheless, the emphasis should be adequate pain control, as there is significant evidence that pain-related stress reaction mediated via β-adrenergic activation promotes neoplastic propagation and metastasis, thus decreasing survival rates. Optimal perioperative patient care requires individual assessment of the impact of cancer and its treatment on the functional reserve of all major organ systems. While further research of the anesthetic techniques and drugs that could minimize the perioperative inflammation and pain is important, close cooperation of anesthesiologists with oncologists and surgeons ensures optimal treatment.
Endobronchial Intubation
Authors: Kassem Hisham , Viswanath Omar 
Published: May 2024

Abstract
Endobronchial intubation (EI) is the placement of an endotracheal tube in either the right or left mainstem bronchus. This can be done both intentionally and inadvertently. In the perioperative period, EI is typically used to assist in surgical exposure during certain thoracic and cardiac surgery. EI can be achieved with multiple devices, such as double-lumen tubes and bronchial blockers, providing lung isolation. The understanding of the physiological changes associated with EI and the management of hypoxia is essential to the anesthesiologist. The familiarity with all the devices that can be used to secure EI is necessary to provide a safe perioperative environment for the patient to ensure the best outcomes.
Intravenous Fluid Therapy During Anesthesia
Authors: Guz David , McNamara Connor 
Published: May 2024

Abstract
Intravenous fluid therapy has been an essential element in the realms of medicine, particularly anesthesia and critical care, since its introduction in the early 1800s as a treatment for dehydration associated with cholera. Intravenous (IV) fluids serve to directly restore intravascular volume and subsequently, depending on the solution administered, variably redistribute throughout the body’s intra- and extra-cellular compartments. Intravenous fluid solutions have been listed as essential drugs by the World Health Organization and, like any other drug, improper use can be associated with adverse patient outcomes, including volume overload, acid/base disturbances, and surgical morbidity. Despite having been used for over 150 years, there remains no set strategy to dictate the appropriate volume and composition of IV fluids to be administered for a given clinical situation. While traditionally rigid weight-based formulae were used to approximate fluid deficits, the development of ERAS and sepsis protocols seek to individualize administration of fluids to a patients’ specific needs, utilizing modern methods including ultrasound and cardiac output monitoring. As part of the American Board of Anesthesiology BASIC exam curriculum, trainees are expected to have familiarity with the physiology of free water and electrolyte balance, the various classes and types of solutions commonly available, and commonly used paradigms for fluid administration.
Indications and Contraindications
Authors: Kremen Elizabeth , Keshavarzi Sahel 
Published: May 2024

Abstract
Increasing volumes of pediatric surgeries are being performed in outpatient ambulatory surgery settings. However, for the procedure to be appropriate in an outpatient setting, the patient must be reasonably healthy, the surgery must be straightforward and have minimal expected complications. The facility needs to be equipped to handle the high volume of patients, including screening patients and following up with patients and families postoperatively. The site needs to have a plan in place for emergencies and for unexpected need for escalation of care. Special considerations for case rescheduling include the acutely ill child, new onset upper respiratory infections, or children with obstructive sleep apnea.
Neurological Complications
Authors: Youssef Yasser M. A. , Ragheb-Mueller Nawal E. 
Published: May 2024

Abstract
This chapter reviews the neurological complications that may arise in anesthesia practice. Peripheral nerve injuries are rare but devastating complications that may occur in any patient undergoing surgical procedures. Most of these injuries are related to malpositioning of patients under general anesthesia; a significant proportion, however, are reported to occur following monitored anesthesia care (MAC) and regional anesthesia. The natural course of the perioperative neuropathy is variable and differs according to the mechanism of injury. Axonal degeneration and discontinuity carry the worst prognosis, with subsequent long-term disability. Given the potential for significant long-term complications for patients who sustain these injuries, anesthetists should maintain a high degree of vigilance to reduce risk and ensure proper positioning and adequate padding of surgical patients. Ultrasound-guided regional anesthesia has proven to be a superior tool to increase the success rate of nerve blocks; the literature, however, lacks any strong clinical evidence that it reduces the incidence of peripheral neuropathy.
Hypothermia
Authors: Sarrafpour Syena 
Published: May 2024

Abstract
Hypothermia, defined by a core temperature less than 35°C, is commonly seen during anesthesia. General anesthesia results in redistribution of warmer core blood (2°–4°C warmer) to the periphery, resulting in the majority of heat loss through radiation. The next common modes of heat loss are evaporation, followed by conduction and convection. As time under anesthesia continues for several hours, equilibrium is achieved with heat lost being equivalent to heat produced. Common anesthetics, such as volatile anesthetics and propofol, also hinder the body’s response to thermoregulation. Regional anesthesia also results in hypothermia, despite the warmer sensation of the skin anesthetized. Preoperative warming of a patient for approximately 30 minutes with forced air systems is the most effective way to prevent heat loss. Even mild hypothermia can result in increased oxygen requirements due to shivering, increased catecholamines, and increased myocardial adverse events. Furthermore, there are increased rates of immune dysfunction, coagulopathy, perioperative blood loss and transfusion needs, post-anesthesia care unit (PACU) stays, and costs.
Aspiration of Gastric Contents
Authors: Sarwary Mariam , Schulman Nathan 
Published: May 2024

Abstract
The administration of anesthesia places patients at risk for aspiration of gastric contents for several reasons, including decreased protective airway reflexes and relaxation of the lower esophageal sphincter. This chapter discusses preoperative and intraoperative measures to reduce the risk of aspiration, and gives a brief overview of the range of presentations, including transient pneumonitis and pneumonia. It also discusses treatment for witnessed or suspected aspiration, which is dependent on content and quality of material aspirated, with recent studies showing little benefit in prophylactic antibiotics or steroids.
Tricyclic Antidepressants
Authors: Munoz-Acuna Ronny , Munoz-Acuna Ricardo 
Published: May 2024

Abstract
Antidepressants are commonly prescribed medications generally used to treat depression, chronic pain, and some forms of acute pain. Tricyclic antidepressants (TCAs) block the reuptake of noradrenaline and serotonin in presynaptic terminals, which leads to increased concentration of these neurotransmitters in the synaptic cleft. TCAs also block muscarinic, histaminergic, and alpha adrenoceptors, potentially causing a broad spectrum of adverse effects. They can interact with other medications given in the perioperative period. The most common side effects involve the cardiovascular and central nervous systems. The anesthesiologist needs to be aware of the mechanism of action, potential side effects, and perioperative considerations to avoid potentially harmful complications. Early and accurate detection of harmful events is necessary. And supportive treatment is usually the treatment of choice.
Pathophysiology of Ischemia/Hypoxia
Authors: Latimer Dustin , Kaye Alan D. 
Published: May 2024

Abstract
Brain physiology can be compromised by a variety of mechanisms. This chapter describes physiologic and pathophysiologic states, including ischemic injury mechanisms and manifestations. Appropriate assessment, drugs, and techniques which optimize cerebral flow can maximize outcomes of patients with cerebral pathophysiology or limited reserve. This chapter will discuss the basic physiology of cerebral blood flow as well as hypoxia, ischemia, and the pathophysiologic consequence of abnormal substrate. Abnormalities of neurologic function are difficult to assess when a patient in undergoing surgery requiring general anesthesia, but we will also discuss monitoring parameters to potentially prevent neurologic complications associated with surgery.
Neuromuscular Transmission
Authors: Mundi Gurpreet , Roberman Dmitry 
Published: May 2024

Abstract
The simplest neuromuscular transmission involves motor neurons in the spinal cord that synapse with muscle fibers at the motor end plate. Transmission across the length of a neuron involves the use of an action potential, which can be defined as the sudden rise and subsequent fall in membrane potential that propagates down the length of a neuronal axon. The transmission of a signal across a synapse is chemical in nature, involving a neurotransmitter and receptors. Many anesthetic drugs interact with these components; thus understanding the physiology of neuromuscular transmission is critical to the practice of anesthesiology.
Ganglionic Transmission
Authors: Strand Natalie H. , Maloney Jillian A. 
Published: May 2024

Abstract
The autonomic nervous system is divided into the sympathetic and parasympathetic nervous systems. The preganglionic and postganglionic neurons synapse in the autonomic ganglia. All preganglionic neurons release acetylcholine, and the action of acetylcholine is terminated by reuptake or degradation by acetylcholinesterase. Presynaptic voltage gated calcium channels are involved in the release of acetylcholine into the synaptic cleft. Postsynaptic ligand gated sodium channels are involved in the propagation of neuronal signals in response to acetylcholine binding. Norepinephrine is released by most postganglionic neurons of the sympathetic nervous system, and the action of norepinephrine is terminated by reuptake or degradation by degradation catechol-o-methyl transferase (COMT). Patients with autonomic neuropathy have several important clinical implications for the anesthesiologist.