bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medication-Assisted Opioid Withdrawal
Authors: Peng Huanhuan , Conermann Till 
Published: May 2024

Abstract
This chapter on medication-assisted opioid withdrawal, also called detoxification, discusses that the goal of treatment is not to achieve total abstinence from opioids, but rather to safely transition a patient with opioid use disorder to an alternative, safer medication-assisted treatment, as well as to reduce the severity of withdrawal symptoms and successfully switch a patient to a maintenance medication regimen in order to prevent relapse. It reviews maintenance pharmacotherapy for opioid use disorder, using an approved opioid agonist methadone, a partial agonist/antagonist buprenorphine, and an antagonist naltrexone. It also discusses how naltrexone as a full agonist can be used for full detoxication, whereas methadone and buprenorphine, relying on full and partial opioid agonism, respectively, result in a state of continued physiological dependence. Also reviewed are alpha-2 adrenergic agonists such as clonidine and lofexidine, often used to mitigate the severity of withdrawal symptoms. The efficacy of buprenorphine and methadone are comparable, and both are superior to clonidine and lofexidine in supervised withdrawal. This chapter includes DSM-5 criteria for opioid use disorder and withdrawal including the clinical opioid withdrawal scale.
Agents and Techniques in Pediatric Anesthesiology
Authors: Dooley F. Cole , Streetzel Charlotte 
Published: May 2024

Abstract
The safe practice of pediatric anesthesiology requires a thorough understanding of the physiologic and pharmacologic mechanisms involved with common medications and scenarios. From the operative environment to the physiologic responses, to the metabolism and clearance of medications, there are significant differences one should expect when treating a pediatric patient compared to an adult. Furthermore, within the pediatric population, patients can be subdivided further into neonates, infants, children, and adolescents, each with varying metabolic and physiologic parameters that need to be accounted for. In this chapter, common induction techniques and agents will be discussed, focusing on key details that distinguish this population and are crucial to understand in order to provide safe care. The chapter will review agents that are preferentially toxic to children, as well as those agents which have varying sensitivities, metabolism, and contraindications when compared to their use in adults.
Intraocular Pressure
Authors: Teixeira Camila , Minear Steven 
Published: May 2024

Abstract
Subtle intraocular pressure (IOP) elevation during surgery plays a significant role in the pathogenesis of perioperative ocular morbidity, particularly in patients with preexisting eye disease. The balance between the aqueous humor production and outflow rate is the main predictor of IOP. Resistance to the aqueous humor outflow, as presented in glaucomatous patients, can rapidly increase IOP and impair blood flow to retina and nerve optic. Perioperative visual loss (POVL) is an uncommon but catastrophic complication. Surgical or anesthetic features that combine either to decrease the arterial pressure or to elevate the IOP can reduce intraocular perfusion pressure (IOPP). Vigilance in controlling IOP and safeguarding IOPP is therefore of critical importance when planning the anesthesia management of patients with glaucoma disease.
Depression
Authors: Schwartz Ruben , Viswanath Omar 
Published: May 2024

Abstract
Depression is a highly researched topic due to its increased prevalence throughout the patient population. Disruption in neurochemical substrates such as serotonin, dopamine, epinephrine, and others have all been implicated as decreased in depressed individuals. Many of these patients have been started on antidepressant medications as a result. Anesthesiologists must know the potential interactions these medications might have with the anesthetic regimen. Some of the common antidepressants prescribed include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Understanding the pharmacology of these medications is vital to provide a safe environment for patients.
Chronic Obstructive Pulmonary Disease
Authors: Hussain Shahrose , Fikry Karim 
Published: May 2024

Abstract
Chronic obstructive pulmonary disease (COPD) is chronic, irreversible airflow limitation due to airway and/or alveolar abnormalities caused by noxious particles and/or developmental abnormalities associated with significant morbidity and mortality. COPD commonly presents with dyspnea and a chronic, productive cough. A COPD exacerbation is an acute worsening in respiratory symptoms from baseline, necessitating additional therapy. Diagnosis of stable COPD is confirmed by spirometry, whereas an acute exacerbation is diagnosed clinically. Treatment involves smoking cessation, inhaled treatments, appropriate oxygenation, and pulmonary physiotherapy. Anesthetic management includes a thorough preoperative evaluation ensuring optimal pulmonary function, utilizing regional techniques if possible, preventing bronchoconstriction, and optimizing air flow.
Minimally Invasive Cardiac Surgery
Authors: Gray Ellyn , Sharma Archit 
Published: May 2024

Abstract
Minimally invasive cardiac surgery has been rapidly evolving over the past few decades, and it is important for anesthesiologists to be aware of the range of approaches and special considerations for each surgery. A minimally invasive approach has numerous advantages, including less inflammation, less pain, avoiding bypass, and avoiding a complete sternotomy. Anesthesiologists facilitate this approach by providing optimal surgical settings beginning with lung isolation, confirming cannula placement, and cardioplegia delivery. However, the concern remains and is related to patient safety, prolonged surgical times, and reduced surgical exposure, leading to possibility of suboptimal treatment. It is critical to be prepared for the possibility of an emergent sternotomy and crashing onto cardiac bypass being necessary at any point during the procedure.
Anesthetic Choice in Reduced Renal Function
Authors: Tian Ling , Nguyen Christina T. 
Published: May 2024

Abstract
This chapter focuses on overall perioperative concerns for a patient with reduced renal function about to undergo anesthesia. It briefly discusses the pathophysiology of renal disease and risk factors to help identify patients who may need special consideration. It contains a comprehensive table discussing the renal considerations for commonly used anesthetics, as well as explanations for the mechanisms by which reduced renal function affects anesthetics. It concludes with a brief overview for prevention, management, and treatment of perioperative renal failure, as well as perioperative considerations for at-risk patients.
Fluid-Replacement Strategies and Controversies
Authors: Conhaim Jay I. , Lemmink Gretchen A. 
Published: May 2024

Abstract
One’s perspective on intraoperative fluid management is stereotypically determined by one’s location in relation to the surgical drapes. However, just as stereotypes can be wildly misleading, so can the perspective that there is one type of resuscitation that will apply to all surgical patients. Perioperative fluid replacement strategies must be patient centered and must account for a variety of factors, including patient comorbidities, type of surgery, duration of surgery, type of anesthesia, and presence or absence of intraoperative complications. The ultimate goal of intravenous (IV) fluid administration is to optimize a patient’s preload, thus maximizing their cardiac output, tissue perfusion, and oxygen delivery. Methods of determining the optimal fluid volume needed to achieve these goals have changed dramatically in the past decade. Static mathematical calculations have given way to real-time, continuous physiologic assessment. Preoperative fasting guidelines are now evolving into preoperative hydration guidelines. Even the optimal type and composition of resuscitative fluids are now better understood. Despite the numerous recent changes in perioperative fluid strategies, a new and evidence-based path toward perioperative IV fluid resuscitation is emerging and is illustrated in this chapter.
Intravenous Regional Anesthesia
Authors: Scholzen Elizabeth , Klesius Lisa 
Published: May 2024

Abstract
Intravenous regional anesthesia (IVRA), also known as a Bier block, provides anesthesia of the entire extremity and can be used as the primary anesthetic for surgeries involving the upper extremity. Dilute local anesthetic (typically 0.5% lidocaine) is administered intravenously after a tourniquet is placed on the extremity. Currently, this technique is most commonly performed as a modified forearm technique that uses less local anesthetic. Contraindications include patient refusal as well as abnormalities of the extremity that is to be anesthetized including crush injury, scleroderma, or infection. Local anesthetic toxicity is the feared complication of IVRA but, fortunately, is rare.
The Surgical Airway
Authors: Kendrick Julia , Kaye Alan D. 
Published: May 2024

Abstract
Orotracheal and nasotracheal intubation is performed thousands of times daily for a variety of reasons. However, related to a number of factors, such as difficult patient anatomy, excessive blood in the mouth or nose, massive facial trauma, or airway obstruction, surgical airways may be required to secure an airway. A tracheostomy tube or endotracheal tube placed during a cricothyroidotomy performed under emergency circumstances can be temporarily placed but should be converted to tracheostomy for long-term airway management. Needle cricothyrotomy with transtracheal jet ventilation is the surgical airway technique of choice in the pediatric population. Tracheostomy requires a higher level of skill, is commonly preferred for long-term management, and is usually performed by a surgeon in a controlled setting.
Supraglottic Secretion Suctioning and LASER Safety Protocols
Authors: Connolly Matthew T. 
Published: May 2024

Abstract
Supraglottic secretion and LASER safety protocols both deal with airway safety management and are essential parts of anesthesia care. The former is used in daily prior to extubation and consists of use of either a hard plastic Yankhauer or flexible suction catheter. Avoidance of oropharyngeal soft tissues and proper timing of suction are necessary to prevent trauma or any agitation that could lead to premature extubation, laryngospasm, or a sympathetic response that could be detrimental to the surgery. Intraoperative use of LASERs (light amplification by stimulated emission of radiation) is becoming more common in the operating room, and knowledge of the types of procedures that use LASERs, as well as the risks and anesthetic implications of the various types of LASERs, is necessary to provide safe anesthesia. Anesthesia for these procedures can be employed through moderate sedation techniques or with LASER-safe endotracheal tubes.
Acute Postoperative and Posttraumatic Pain
Authors: Johnson Savion D. , Starr Brian M. 
Published: May 2024

Abstract
Treatment of acute postoperative and posttraumatic pain is an integral piece in the care of the surgical patient, as inadequate pain control can result in increased morbidity and mortality. In contrast, effective postoperative pain management not only improves patient satisfaction, but also leads to earlier mobilization, decreased cardiopulmonary complications, improved recovery, and shorter length of hospital stay. In addition to systemic opioids, a variety of modalities are used for acute postoperative analgesia, which include epidural analgesia, neuraxial opioids, peripheral nerve blocks, patient-controlled analgesia, and the use of oral medications and infusions as part of multimodal analgesia regimens.
Vascular Injuries
Authors: Youssef Yasser M. A. , Ragheb-Mueller Nawal E. 
Published: May 2024

Abstract
Anesthesia-related vascular access injuries range from arterial/venous thrombosis, thrombophlebitis, sheared catheters, and inadvertent intra-arterial injections to air emboli, cardiac/vascular perforations, and pulmonary artery rupture. This chapter addresses the most significant injuries associated with these procedures. Although peripheral venous and arterial cannulation is relatively safe, significant complications may lead to iatrogenic injury and liability for anesthetists. Claims for peripheral vascular catheter complications comprise 2% of all those in the ASA Closed Claims database; 91% of these are related to intravenous (IV) and 9% to arterial catheters. Anesthesia providers should recognize any early signs of peripheral intravenous extravasation, as delayed management may lead to compartment syndrome. Invasive arterial monitoring is associated with risks of bleeding, hematoma, pseudo-aneurysm, infection, nerve damage, and distal limb ischemia. Early recognition of distal ischemia and proper management can prevent surgical exploration or devastating loss of extremity. Vascular injuries from central venous catheterization range from minor complications, such as local hematoma, to serious consequences, including cardiac perforation or thromboembolism. Pulmonary artery rupture during pulmonary arterial catheterization is a rare but life-threatening complication with a mortality rate of 50%. Preoperative identification of patients at risk and proper intraoperative catheter management can reduce the associated morbidity and mortality.
Non-Malignant Hyperthermia
Authors: Ferguson Kyle , Johnson Angela 
Published: May 2024

Abstract
Perioperative hyperthermia can have numerous etiologies which can prove detrimental to patient outcomes. Many causes of hyperthermia are secondary to iatrogenic administration of medications that lead to chemical imbalance of the thermoregulatory centers in the brain. Medications and pathologic states that affect the serotonergic, dopaminergic, adrenergic, and cholinergic systems can alter the thermoregulatory actions of the hypothalamus, resulting in systemic temperature dysregulation. Many of these disorders present in very similar manners. Hyperthermic states can be difficult to diagnose; however, they carry a high risk of morbidity and mortality, and quick recognition and treatment are crucial.
Laryngospasm
Authors: Beebe David S. , Belani Kumar G. 
Published: May 2024

Abstract
Laryngospasm is a complication that can happen to all patients undergoing anesthesia, but it is more common in infants and small children, patients with upper airway infections and those undergoing surgery in the mouth or larynx, and patients who are obese. Stimulation of the larynx can cause the vocal cords to close and prevent ventilation. This can occur both during induction of general anesthesia and upon emerging from anesthesia. Anesthesiologists must therefore always be prepared to open the airway, including using skeletal muscle relaxants if necessary to provide oxygenation, ventilation, and prevent the serious complications that may result from untreated laryngospasm.
Postobstructive Pulmonary Edema
Authors: Kloesel Benjamin , Horvath Balazs 
Published: May 2024

Abstract
Postobstructive pulmonary edema (POPE) can occur in the perioperative period. A variety of causes, including upper airway obstruction due to oropharyngeal anatomical and functional variations, oversedation, laryngospasm, and occlusion of the endotracheal tube, may result in supraglottic or glottic obstruction. Respiratory efforts against an obstructed airway can generate negative pleural pressures significantly below the physiological level. The large pressure gradient increases venous return to the heart and facilitates fluid movement from the alveolar capillary network into the alveoli. The ensuing pulmonary edema causes dyspnea, hypoxemia, and cough. POPE is frequently self-limited with good prognosis but, depending on the severity, may require treatment ranging from supplemental oxygen to mechanical ventilation and potentially even extracorporeal life support.
Agonist-Antagonists
Authors: Trehan Gaurav , Sethi Anish 
Published: May 2024

Abstract
The agonist-antagonist analgesics, unlike pure opioid agonists (e.g., morphine), were originally created to retain the potency of morphine without the respiratory side effects. The mechanism of action is primarily as an agonist at the kappa receptors and an antagonistic or partial agonist at the mu opioid receptors. These drugs exhibit a characteristic “ceiling effect” to respiratory depression as well as analgesia. This class of medications include nalorphine, pentazocine, butorphanol, nalbuphine, buprenorphine, bremazocine, dezocine, and meptazinol, among others. In recent years, buprenorphine has gained widespread acceptance for the treatment of chronic pain and opioid use disorder (OUD). The medical provider should be well acquainted with this unique and popular drug so as to appropriately manage patients in emergent as well as elective situations.
Postoperative Nausea and Vomiting
Authors: Swanson David E. 
Published: May 2024

Abstract
Postoperative nausea and vomiting (PONV) continue to be significant problems after surgery. Major advances in minimizing the related morbidity occurred with the realization that preoperative risk assessment, combined with multimodal management of both prophylaxis and analgesia, is key. Timely preoperative ordering of a scopolamine patch in high-risk patients and without contraindications, along with oral acetaminophen or other analgesics, is helpful. Intraoperative avoidance of nitrous oxide and volatile anesthetics by using a total intravenous anesthetic will also reduce PONV. Utilizing medications with different mechanisms of action will maximize efficacy while minimizing adverse effects for optimum patient satisfaction. This is true for both prophylaxis and treatment. In the recovery room, choosing a different class of medication for treatment than has already been used intraoperatively for prophylaxis is more likely to be effective.
Neurologic Consequences of Anesthesia
Authors: Latimer Dustin , Kaye Alan D. 
Published: May 2024

Abstract
Postoperative complications are multifactorial, with a significant percentage related to neurologic related pathophysiologic states. This chapter outlines a variety of neurologic-related conditions, including seizure, postoperative delirium, delayed emergence, serotonin syndrome, neuroleptic malignant syndrome, and malignant hyperthermia. This purpose of this chapter is to prevent premature consultations to neurology and prompt action for postoperative complications reversed by appropriate identification of pathology. As with most medical care, a thorough history and physical can minimize preventable complications, but rapid and accurate assessment of reversible pathology can lead to appropriate action and improved outcomes while minimizing excessive consultations and optimizing healthcare spending.
Subcortical Areas
Authors: Latimer Dustin , Kaye Alan D. 
Published: May 2024

Abstract
The subcortical region of the brain includes important structures such as the basal ganglia, hippocampus, internal capsule, cerebellum, brainstem, and reticular activating system. These structures are important in a variety of important functions related to human cognition and affective and social function between the periphery and the cerebral cortex. Disruption of the basal ganglia has been known to be responsible for movement disorders. Alzheimer’s has been associated with atrophied hippocampal region. The internal capsule functions to transmit information to and from the cerebral cortex. This chapter describes the function of subcortical regions of the brain in further detail.
Effects of Brain Trauma and Tumors
Authors: Latimer Dustin , Kaye Alan D. 
Published: May 2024

Abstract
Brain trauma and brain tumors often lead to surgical interventions. These interventions require capable anesthesia providers who appreciate anesthesia-related effects on neurophysiology. Delays in treatment of reversible pathology can have devastating consequences. This review highlights important features of brain trauma and brain tumors related to anesthesia considerations in perioperative management. Preventing traumatic brain injury reigns as the most crucial aspect of maintaining healthy brain substrate but being knowledgeable about the consequences of perioperative complications can spare millions of neurons and brain functionality. Blood pressure, intracranial pressure, and cerebral perfusion pressures are objective measures that will be discussed in this chapter.
Blood-Brain Barrier
Authors: Spence Allyson L. , Cornett Elyse M. 
Published: May 2024

Abstract
The blood-brain barrier is crucial for CNS regulation, neuronal functioning, and preventing harmful substances from entering the brain. Likewise, the transport of drugs into the brain is prevented by the blood-brain barrier, which has prompted the development of drugs that more readily cross the blood-brain barrier. General anesthetic agents can alter the function of the blood-brain barrier, which is important to consider in patients with neurological disorders. Blood-brain barrier disruption can be assessed and diagnosed using a cerebrospinal fluid/plasma albumin ratio. More studies are warranted to assess the effects of anesthetic agents on the blood-brain barrier, but there is evidence to suggest that isoflurane, fentanyl, ketamine, and pentobarbital can increase blood-brain barrier permeability.
Spinal Cord Morphology
Authors: Woodrow Alex , Sharma Archit 
Published: May 2024

Abstract
The spinal cord is a cylindrical extension of the central nervous system that is contained within the bony spinal canal. White matter contains the axons of the ascending (sensory) and descending (motor) pathways, while the gray matter consists of the dorsal (sensory) and ventral (motor) horn and contains the cell bodies that synapse with sensory and motor neurons. Vascular supply is largely provided by branches of the aorta, subclavian artery, and internal iliac arteries. Understanding the morphology and intraoperative monitoring using evoked potentials is paramount to reduce complications after major spinal and neurological procedures. This chapter reviews the spinal cord anatomy, blood supply, and course of these tracts, and describes the various associated syndromes.
Sex, Gender, and Age Differences in Pain and Pain Perception
Authors: Rushmer Timothy , Abd-Elsayed Alaa 
Published: May 2024

Abstract
The International Association for the Study of Pain (IASP) defines pain as “[a]n unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” This definition intentionally leaves space for pain and pain perception to be influenced by a variety of objective and subjective inputs. As this chapter discusses, sex, gender, and age certainly have biological as well as psychosocial impacts on pain and pain perception.
Parasympathetic Nervous System
Authors: Lucas Tanya 
Published: May 2024

Abstract
The parasympathetic nervous system (PSNS) and the sympathetic nervous system (SNS) make up the motor system for the viscera. These systems modulate the activity of the organs, and together they are known as the autonomic nervous system. The PSNS dominates during periods of energy conservation (rest and digest). The PSNS has a more specific effect on individual organs than the SNS, as the ganglia of the two-neuron system are found near or within the organs controlled. Acetylcholine is the neurotransmitter found in both the preganglionic and postganglionic nerve of the PSNS.