bluuebunny/crossref_metadata_2025_split huggingface dataset:
Larynx
Authors: Iqbal Fatima , Cornett Elyse M. 
Published: May 2024

Abstract
The larynx is a segment of the respiratory tract that connects the pharynx to the trachea and serves to maintain a patent airway, prevent aspiration of food into the trachea, and provide vocalization. These functions are achieved by its cartilaginous framework, interconnected with ligaments and joints, that support its various muscles innervated by branches of the vagus nerve (CN X). An appreciation of its anatomy is necessary for anesthesiologists to provide proper airway management and for appropriate care to the pediatric population, who possess significant anatomical differences in their larynx from the adult population.
Innervation
Authors: Lauve Sarah , Cornett Elyse M. 
Published: May 2024

Abstract
Efferent innervation of the respiratory tract and respiratory muscles originates in the medulla and pons and is supplied through the phrenic, vagus (X), and glossopharyngeal nerves (IX). Sensory afferent information is provided to the respiratory control centers in the medulla and pons via efferent neurons from the lungs and chemoreceptors, regulated by pH, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), and arterial perfusion pressure.
Differences between Infant and Adult Airway
Authors: Jeffers Susan , Kaye Alan D. 
Published: May 2024

Abstract
Neonates and infants differ from adults in many ways, and it is imperative that the anesthesiologist be familiar with these differences in order to provide safe airway management and carry out appropriate treatment plans. Infants vary from adults in both anatomical and physiological characteristics. The unique anatomy of neonates and infants influences the approach the provider should take during airway and ventilator management. Important anatomical considerations include the larger head and tongue of infants, their shorter and more compliant airway, as well as the differences in position of the glottis between infants and adults.
Structures and Relationships in the Neck and Chest
Authors: Saunders Alpaugh E. , Kaye Alan D. 
Published: May 2024

Abstract
The anesthesiologist’s role during surgical and procedural interventions requires expertise in the anatomy, physiology, and management of the structures in the neck and chest. The anesthesiologist can perform a variety of procedures to obtain physiologic measurements and maintain respiratory and cardiovascular homeostasis, along with providing pain control. It is vital to have a thorough understanding of the relevant anatomy and landmarks in order to perform these procedures safely. This chapter outlines the anatomic structures and their relationships in the neck and chest and includes pertinent considerations for the anesthesiologist.
Leukotriene Modifier Drugs
Authors: Cruz Adam , Manders Larry 
Published: May 2024

Abstract
The leukotriene modifiers include montelukast, zafirlukast, and zileuton. These medications mitigate the effects and production of leukotrienes, proinflammatory mediators produced during inflammatory responses via arachidonic acid breakdown. As anti-inflammatory agents, the leukotriene modifiers are indicated for use in prophylaxis of asthma exacerbations and chronic asthma treatment. This chapter highlights leukotriene synthesis and their effects on the pulmonary system. Furthermore, the current pharmacological agents are highlighted, as well as their anesthetic considerations.
Pre- and Post-Capillary Sphincter Control in Shock
Authors: Cook Rollin , Sharma Archit 
Published: May 2024

Abstract
The microcirculation is a complex and integrated system that supplies and distributes oxygen throughout the tissues. In normal states, the delivery of oxygen and electrolytes to peripheral organs is controlled by neurohumoral mechanisms which act through specific control mechanisms in the circulatory system, such as the pre-capillary sphincters. Shock states causes abnormal microvascular oxygen transport as significant numbers of capillaries stop flowing and the microcirculation fails to compensate for decreased functional capillary density. This chapter discusses both the normal functioning of the microvasculature, as well as the changes that are introduced in a shock state, as the body tries to maintain homeostasis.
Regulation of Circulation and Blood Volume
Authors: Dressen Kirk , Sharma Archit 
Published: May 2024

Abstract
Circulation is regulated by neural, endocrine, and autoregulatory systems via control of systemic arterial pressure and heart function. Vasomotor fibers reach small arteries, arterioles, venules, and veins from sympathetic nerve origins in the medulla and pons known as the vasomotor center. Both increased and decreased blood volumes can have clinical complications and hence the maintenance of blood volume is crucial to normal perfusion of body tissues. Blood volume, normally proportioned with extracellular fluid in the body, is closely controlled through a combination of factors. This chapter reviews how these mechanisms work in conjunction to protect the body during periods of instability.
Digoxin
Authors: Perez-Ruiz Carlos M. , Abdullah Ali 
Published: May 2024

Abstract
Cardiac glycosides have important effects on cardiac contractility and conduction activity. The main clinical importance is its use in two situations: heart failure due to systolic dysfunction, and in certain supraventricular tachyarrhythmias (e.g., atrial fibrillation or flutter). The drug originates from the foxglove plant, also known as the Digitalis plant, and has been studied since the 1780s. The term “digitalis” has also been used to describe the whole group of cardiac glycosides (digoxin and digitoxin). Digitoxin has not been widely available since the 1980s. Consequently, digoxin has become the only cardiac glycoside available in most countries.
Phosphodiesterase III Inhibitors (Inotropic Dilators)
Authors: Haswah Muin , Kolesnikov Igor 
Published: May 2024

Abstract
Phosphodiesterase (PDE) III inhibitors are pharmacologic agents that have been used in a variety of cardiovascular settings. They are known for their inotropic, vasodilator, afterload-reducing properties. PDE inhibitors are most commonly used in patients with congestive heart failure. Milrinone (the most common drug from the class) is a bipyridine derivative of amrinone (an older drug), inhibiting the enzyme phosphodiesterase III ordinarily found in cardiac myocytes. PDEs are responsible for the breakdown of c-AMP. Therefore, PDE inhibitors lead to increased c-AMP which in turn creates improved uptake, storage and uptake of calcium from sarcoplasmic reticulum during excitation-contraction coupling. These drugs also have separate direct vasodilatory properties (milrinone ˃ amrinone). Despite milrinone’s clear vasodilatory clinical benefit, its significance to treat congestive heart failure as a single agent remains controversial in comparison to conventional therapy. Milrinone is currently only available in intravenous form. Arrhythmias and hypotension are among its most frequent adverse side effects. Milrinone dosing should be reduced or avoided in patients with renal disease, as the medication is renally excreted.
Electrolytes
Authors: Cieslinski Lindsey 
Published: May 2024

Abstract
Physiologic responses to surgical stress have significant implications for perioperative fluids. Electrolyte homeostasis is essential to proper organ function. Potassium (K+) and sodium (Na+) are the predominant cations in the intracellular fluid (ICF) and extracellular fluid (ECF). While chloride is the main anion in the ECF, changes in Cl– are mainly secondary to changes in Na+. Sodium balance is related to ECF volume and water balance. The charged lipid nature of the cell membrane does not allow cations to cross; this makes the composition of ions on either side of the membrane different. Na+, K, Cl– ions have an ATP-dependent process to maintain a gradient across the membrane, while calcium (Ca2+) and magnesium (Mg2+) are important for vascular tone; Ca2+ is needed for inotropy and peripheral vasoconstriction. Mg2+ antagonizes the effect of Ca2+ on the vasculature, and plays a vital role in ATP production and as a cofactor for DNA production. This chapter discusses the fundamental electrolytes Na+, K+, Ca2+, and Cl– and Mg2+ with a focus on basic science content with perspective of clinical practice and application.
Diuretics
Authors: Brown J. , Ramirez Maria F. 
Published: May 2024

Abstract
Diuretics are commonly prescribed medications that are designed to increase urine output by decreasing the reabsorption of water and sodium. They are categorized by their primary site of action along the renal nephron. Diuretics are commonly used to treat condition associated with volume overload such as heart failure, pulmonary edema and cerebral edema. Side effects of diuretics such as electrolyte imbalances and hypovolemia vary by class and are important to consider, as they can lead to increased perioperative morbidity and mortality. Proper preoperative evaluation and perioperative management, as well as a thorough understanding of each class of diuretics, are required when patients utilizing these medications undergo anesthesia. This abstract will highlights the mechanism of action, clinical indications, adverse effects and other key factors relevant to the anesthesia management.
Blood Transfusions
Authors: Boydston Elaine A. 
Published: May 2024

Abstract
Anesthesiologists are major users of blood products due to the large number of transfusions that occur in the operating room and perioperative setting; thus it is important to be well versed in the practice of blood transfusion, including the indications, risks, and complications. Treatment of symptomatic anemia and bleeding frequently includes transfusion of packed red blood cells (PRBCs) in order to replace lost intravascular volume and maintain cardiac output, and to maintain hemoglobin levels adequate to preserve oxygen delivery to vital organs and other tissues. Transfusion of plasma containing blood products and platelets is performed in order to avoid or correct coagulopathies due to either qualitative or quantitative defects in coagulation enzymes or platelets. The risks and complications of blood transfusion include the possibility of transmission of blood-borne pathogens, immunologic reactions including hemolytic and febrile (non-hemolytic) transfusion reactions, pulmonary edema and respiratory failure due to either transfusion-related acute lung injury (TRALI) or transfusion-associated circulatory overload (TACO), and other derangements due to the transfusion of a large number of blood products such as hypothermia, hyperkalemia, citrate toxicity and acidosis. In the setting of massive hemorrhage or trauma, fixed ratios of blood products are typically administered as part of a “massive transfusion protocol” in order to reduce blood loss, decrease transfusion requirements, and improve mortality. In the absence of suitable donor blood product availability or patient consent to transfusion, several alternatives exist, including pre-deposit autologous blood donation (PABT), cell salvage, and acute normovolemic hemodilution (ANH).
Immunosuppressive and Anti-Rejection Drugs
Authors: Syed Madiha , Palm Nicole 
Published: May 2024

Abstract
Rates of organ transplantation have increased every year in the United States; in 2019, 39 718 organs were transplanted. Patients who receive organs from a genetically different donor require immunosuppressive medications to prevent and treat rejection of the transplanted organ. Due to the increased number of organs being transplanted, these patients will frequently present to the operating room for non-transplant or emergency surgery. Anesthesiologists involved in the perioperative care of these patients need to understand the immunosuppressive regimens that patients are prescribed, possible side effects, and drug interaction with medications used in the perioperative period. This chapter provides a concise review of current immunosuppressive regimens, drug interactions in the perioperative period, preoperative evaluation, and management of transplant recipients.
Massive Transfusion Protocol
Authors: Genis Alina 
Published: May 2024

Abstract
Massive transfusion protocols (MTP) are incorporated at various institutions to facilitate the replacement of large blood volume in a short period of time in responsive to uncontrolled hemorrhage. The presence of an MTP has been shown to decrease the amount of each blood component transfused, turnaround times, and hospital expenses. Traumatic injury and massive acute blood loss often are associated with trauma-induced coagulopathy. Trauma-induced coagulopathy can be attenuated by the avoidance of hypothermia, acidosis, and dilution by administration of a large amount of crystalloid fluids. Significant data support the replacement of blood products in equal ratios. Recent studies have also explored the potential benefits of incorporating adjunct therapies as part of an MTP. Antifibrinolytics, finrinogen concentrate, cryoprecipitate, and factor VIIa are occasionally utilized as part of the transfusion protocol. Although transfusing large amounts of blood products to an exsanguinating patient can be life-saving, risks such as hypocalemia, hyperkalemia, citrate toxicity, and hypothermia should be anticipated and addressed if necessary.
Pituitary Gland
Authors: Jenkins Thomas Keith , Giordano Chris 
Published: May 2024

Abstract
The pituitary gland is an endocrine gland resting in a small cavity of the ethmoid bone at the base of the brain. It produces eight major systemically acting hormones. Hyper- or hyposecretion of these hormones can result in disease processes, which may have a significant impact on anesthetic management. Acromegaly, caused by overproduction of growth hormone, can lead to difficult airways due to macroglossia and obstructive sleep apnea. Diabetes insipidus ensues from a low antidiuretic hormone level, leading to increased urine output and electrolyte derangements that may require fluid or hormone replacement. The syndrome of inappropriate antidiuretic hormone secretion is caused by antidiuretic hormone-secreting tumors and results in a hypo-osmotic state that often requires gentle electrolyte replacement. Finally, the removal of the pituitary gland (hypophysectomy) is a treatment for pituitary adenoma and causes iatrogenic panhypopituitarism. These patients require lifelong hormone replacement and stress-dose steroids because the hypothalamic-pituitary-adrenal axis does not function.
Relationship to Hormones
Authors: Costa Santos Lucas , Rossi Raquel Montagner 
Published: May 2024

Abstract
Metabolic adjustments are necessary for adaptation to ever changing environmental and biological conditions. The main agents responsible for this process are hormones, which act to maintain a balance between anabolic and catabolic states. Insulin and growth hormone are major anabolic hormones and act in one side of this interaction promoting molecular synthesis. Insulin also promotes glycogenesis, glucose uptake, and fatty acid uptake. On the other hand, cortisol, catecholamines, and glucagon exert catabolic effects and are responsible for maintaining available energy sources in situations where a higher demand is presented, mainly by inducing opposing processes such as glycogenolysis, gluconeogenesis, and lipolysis.
Prejunctional Components and Events
Authors: Roche Shaun , Moncayo Ruth E. 
Published: May 2024

Abstract
The prejunctional portion of the neuromuscular junction is responsible for the synthesis, storage, and release of the neurotransmitter acetylcholine (ACh) across the synaptic cleft, as well as the reuptake of choline after hydrolysis. This process is facilitated by voltage-gated channels that control the flow of ions across the nerve terminal membrane. Basic understanding of the anatomy and physiology of the prejunctional component of the neuromuscular junction will guide an understanding of the mechanism of action of neuromuscular blocking agents and their side effects, as well as providing anesthetic clinical correlation to prejunctional membrane disorders such as in Eaton-Lambert syndrome. This chapter covers the prejunctional events and components of the neuromuscular junction, the synthesis and release of ACh, prejunctional nicotinic and muscarinic receptors, and anesthetic clinical considerations associated with presynaptic neuromuscular junction abnormalities.
Depression
Authors: Goldstein Mark A. , Goldstein Myrna Chandler 
Published: May 2024

Abstract
Prior to the COVID-19 pandemic, there had been a growing mental health crisis for adolescents. In 2019, the prevalence of depression in the adolescent age groups ran from 10 to 20 percent. After the pandemic, the rates are even higher. Factors that may predispose adolescents to depression include early life stressors, genetic makeup, and being a child of a depressed parent. Depression can lead some adolescents to use substances, and substance use may induce depression. And, of course, depression is a major factor in the cause of suicidal behavior in adolescents. But the problematic use of social media may also be linked to depression in the adolescent age group. Racism is associated with poorer mental health outcomes including depression; this is more likely to occur in female adolescents. Adolescents should be screened periodically for depression since there are effective treatments that include therapies and medications.
Cyberbullying
Authors: Goldstein Mark A. , Goldstein Myrna Chandler 
Published: May 2024

Abstract
Adolescents have a significant risk of being harmed by cyberbullying since their brains are still developing emotion control, judgment, and executive functions. Social media sites are known settings for cyberbullying behaviors. The symptoms of cyberbullying may be nonspecific, including changes in sleep and eating patterns, increased anxiety and school absenteeism, and increasing self-harm behaviors. Victims of cyberbullying may experience negative physical and mental outcomes including an increased risk to abuse substances as well as an increased likelihood to have suicidal behaviors. Cyberbully perpetration is associated with problematic internet use as well substance use, depression, and low self-esteem. Cyberbullying prevention efforts should include families, schools, health care providers, and governments.
Divorce
Authors: Goldstein Mark A. , Goldstein Myrna Chandler 
Published: May 2024

Abstract
Parental divorce may affect adolescents in their biological, psychological, and social domains with problems continuing into adulthood. A parental divorce is considered an adverse childhood experience that could have an impact on an early adolescent’s brain circuitry, leading to lifelong issues. Understandably, parental divorce is a very stressful event. Children of divorced parents have a higher risk for depression and suicidality compared to those with married parents. Adolescents in divorced families may use substances earlier than those in intact families, and there are some studies that suggest an association between parental divorce and anger, aggression, and hostility in adolescents. Early referral to individual or group therapy for those adolescents experiencing divorce may be helpful.
Model of Pain in Vulnerable Populations and the Role of Social Determinants of Health
Authors: Meghani Salimah H. , Janevic Mary R. 
Published: May 2024

Abstract
This chapter explores the mechanisms behind inequities in pain prevalence, experience, and outcomes among subgroups, including minoritized and racialized populations. The chapter emphasizes the need for an anti-racist framework to confront racism in pain care and support cultural humility and critical self-reflection in clinical practice and research. Policy interventions, such as improving access to non-opioid and nonpharmacological pain interventions, expanding insurance access, and promoting patient-centered outcomes in pain research, are also highlighted as potential avenues for reducing pain care disparities. The chapter cautions against making biological or behavioral attributions and invoking easy misconceptions about the mechanisms behind disparities, instead urging readers to carefully examine these disparities and address the social risks and epigenetic risks underlying them. Ultimately, the chapter calls for continued efforts to create equitable models of pain care to reduce the burden of pain and improve the well-being of all individuals and communities.
Insight and Responsibility
Authors: Gallagher Rollin M. 
Published: May 2024

Abstract
Millennia-old philosophical considerations of morality and values in the practice of medicine have led to the development of the field of bioethics encompassing the domains of clinical care, education and training, clinical and basic research, health administration, and public policy. As “keyholders” to solutions to the universal human problem of pain, the pain field must not only provide good care to patients but also steward needed progress in education, science, and health system policy that will improve pain care across populations. This challenge requires both insight and responsibility. Practitioners must understand human nature—humans’ vulnerabilities and strengths—and how these attributes interact with management of the complexity of pain throughout the continuum of care. Core ethical principles (beneficence, nonmaleficence, respect for autonomy, justice, and double effect) help guide daily clinical work, but practice conditions dictated by a commercialized health care system challenge these principles. Data science algorithms based on medical variables help standardize care in clinical practice guidelines, but they must include psychosocial variables to remediate care disparities in providing effective biopsychosocial stepped care. Sociocultural factors, such as mental illness, racism, and poverty, interact with institutionalized barriers such as inadequate training, interspecialty economic disparities, and specialty tribalism to perpetuate poor care. Stewardship teamwork, involving all sectors of the health system and policymakers, is needed to improve pain care for vulnerable populations.
The Vulnerable Patient
Authors: Mossey Jana M. 
Published: May 2024

Abstract
This chapter addresses the occurrence, risk factors for, and consequences of pain across the life span with a focus on identification of groups vulnerable to chronic pain conditions in six age-specific groups: newborns, preschool children, preadolescent and adolescent youth, young adults, middle-aged adults, and elderly individuals. Despite the absence of a common chronic pain assessment tool used across studies, several findings regarding chronic pain vulnerability and impact have emerged from review of the relevant pain literature. First, due to frequent receipt of medically indicated, painful neonatal intensive care unit procedures, lifelong chronic pain vulnerability begins at birth for preterm infants. Second, most chronic pain risk factors are relevant for all age-specific groups. Excluding age, sex, and genetic makeup, most chronic pain risk factors—including persistent exposure to racial discrimination and/or poverty, personal maltreatment, physical inactivity, obesity, nonrestorative sleep, multiple comorbid medical conditions, anxiety and/or depression, and behaviors such as smoking—are preventable or modifiable. Third, experienced chronic pain increases the likelihood of future chronic pain episodes. Fourth, the negative impacts of risk factors that become persistent (e.g., racial discrimination, physical inactivity, and obesity) accumulate over time. Finally, with aging, most risk factors increase in strength. Falling and fear of falling emerge as additional chronic pain risk factors. These findings emphasize the potential benefits of aggressive primary prevention efforts and the importance of monitoring those whose chronic pain occurs early in life. Recommendations to achieve these aims are provided.