bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autonomic Reflexes
Authors: Strand Natalie H. , Maloney Jillian A. 
Published: May 2024

Abstract
The autonomic nervous system is divided into the parasympathetic and sympathetic nervous system. The autonomic nervous system targets smooth muscle to exert its effect on heart rate, respiratory rate, gastrointestinal function, urination, and gland activity. Autonomic reflexes are involuntary and are a result of an autonomic reflex arc which consists of a receptor, sensory neuron, integrating center, and both a preganglionic and postganglionic motor neuron. Disease states that disrupt the autonomic nervous system have several anesthetic implications to consider. Preoperative bowel care and voiding prior to surgery reduces the risk of bladder or bowel distension intraoperatively. Aggressive blood pressure management intraoperatively and removing the noxious stimuli is recommended.
Cerebellum and Basal Ganglia
Authors: Kaye Alan D. , Possoit Harlee 
Published: May 2024

Abstract
The cerebellum and basal ganglia are key structures of the central nervous system. These structures are important in a variety of functions, such as human cognition and coordination, which relay information to and from the cerebral cortex and periphery. Dysfunction of the cerebellum and basal ganglia can lead to dysfunction of balance and smooth coordinated movements. This chapter summarizes the anatomy, function, pathways, and key pathologies of the cerebellum and basal ganglia.
Reticular Activating System
Authors: Shah Rutvij 
Published: May 2024

Abstract
The reticular formation is made up of a loose group of neurons extended from the cervical cord caudally to the thalamus rostrally. The ascending pathway of reticular formation, also known as ascending reticular activating system (RAS), is responsible for arousal of a person and modulation of nociception. RAS constitutes several nuclei that has serotonergic, noradrenergic, cholinergic, glutaminergic, and histaminergic neurotransmitters. Disturbance to RAS results in sleep disturbances, schizophrenia, altered pain perception, post-traumatic stress disorder, and Parkinson’s disease. The synthetic opioid fentanyl controls the pain and reduces arousals by decreasing acetylcholine in the medial pontine reticular formation. The rapid atonia by a bolus dose of propofol is due to the drug’s effects on these reticular nuclei and GABAergic neurons of the spinal cord.
Sacral Nerves
Authors: Topfer Jacob , Abdallah Rany T. 
Published: May 2024

Abstract
The sacrum is a large structure that is made up of 5 sacral vertebrae. The 5 sacral nerves run within the sacrum and are part of the lumbosacral plexus. These sacral nerves exit the sacrum through their intervertebral foramina and provide sensory and motor function to portions of the lower extremity and perineum. The sacral plexus is formed with the union of the lumbosacral trunk from L4 to S4 and gives rise to 12 peripheral nerves, including the sciatic nerve, pudendal nerve, and posterior femoral cutaneous nerves of the thigh. Additionally, there is parasympathetic nervous system output from S2 to S4 nerves that supply the colon, rectum, uterus, and bladder. The sacral nerves and lumbosacral plexus are extremely important for lower extremity function, but also as an etiology and source of pain in that area. Peripheral nerve blocks and spinal cord stimulation techniques are utilized to help control pain coming from the sacral nerves.
Cranial Nerves
Authors: George Arun , Rajan Shobana 
Published: May 2024

Abstract
Cranial nerves transmit information including senses of vision, smell, hearing, and taste. There are 12 cranial nerves; the olfactory and optic nerves arise from the cerebrum, while the other 10 arise from the brainstem. Cranial nerves are generally named according to their structure or function. They are numbered based on their position from front to back (rostral to caudal) of their position on the brainstem. The 12 cranial nerves were characterized by some of history’s most famous anatomists from Galen to Von Sommering. Understanding cranial nerve anatomy and function is important for anesthesiologists as there are many physiological and perioperative considerations.
Ascending Pathways and Descending Inhibition
Authors: Lennertz Richard 
Published: May 2024

Abstract
Most nociceptors carry pain signals from the body and synapse in the dorsal horn of the spinal cord. Pain signals from the body cross midline in the spinal cord and ascend along tracts in the contralateral spinal cord. The spinothalamic tract is the dominant pathway for discriminatory pain and projects to the somatosensory cortex. The spinobulbar tract is the dominant pathway for affective pain and projects to multiple cortical areas. Nociceptors from the face and vagal afferents project to sensory nuclei in the brainstem. Descending output from the rostral ventromedial medulla and locus coeruleus modulate nociceptive processing in the dorsal horn.
Lung Volumes and Capacity
Authors: Ahmed Muhammad Fayyaz , Ahmed Furqan 
Published: May 2024

Abstract
Lung volumes are vital parameters in clinical medicine, and changes in lung volumes can give useful information about lung function. Lung volumes are measured with a spirometer. Lung capacities are a sum of two or more lung volumes. Furthermore, lung volumes are classified into dynamic and static lung volumes, depending on how the breaths are measured in a spirometer. Slow breaths measure static lung volumes, whereas fast breaths measure dynamic lung volumes . Static lung volumes are residual volume, expiratory reserve volume, inspiratory reserve volume, inspiratory capacity, tidal volume, vital capacity, forced residual capacity, and total lung capacity. Dynamic lung volumes are forced expiratory volume in one second and forced vital capacity.
Apneic Oxygenation and Diffusion Hypoxia
Authors: Parniani Ahmad Reza , White Peggy 
Published: May 2024

Abstract
Apneic oxygenation is the process of oxygenation with no spontaneous breathing or mechanical ventilation. It can be used in a number of clinical settings, including as a means of delaying hypoxemia during airway management. The addition of high-flow nasal cannula has introduced another effective method for apneic oxygenation. Diffusion hypoxia is a consequence of rapid outgassing from the tissues of patients who receive nitrous oxide. This chapter summarizes the current methods used to perform apneic oxygenation, in addition to the benefits, applications, and potential complications of this technique. Lastly, it presents a detailed description of diffusion hypoxia.
Systemic Effects of Hyperoxia and Hypoxemia
Authors: Smith Sarah C. 
Published: May 2024

Abstract
Oxygen is required for ongoing cellular metabolism, with prolonged periods of ischemia resulting in cell death. Therefore, oxygen homeostasis is a tightly regulated process throughout the body such that systemic adaptations to hypoxia manifest almost immediately so that oxygen delivery is maintained to the most sensitive end-organs, namely the brain and the heart. Patients who experience chronic hypoxia due to lung disease, intracardiac shunts, or simply living at high altitude, will manifest systemic adaptations that should be considered when developing a plan for anesthetic management. Despite the critical importance of adequate oxygen delivery to maintain life, iatrogenic hyperoxia can also be deleterious due to the formation of oxygen free radicals that overwhelm the body’s normal antioxidant defense mechanisms. Therefore, prolonged periods of high FiO2 (greater than 70%) should generally be avoided in the perioperative period when possible.
Muscles of Respiration
Authors: Eng Lauren K. , Kaye Alan D. 
Published: May 2024

Abstract
Primary and accessory muscles of respiration provide for both inspiration and expiration. Primary muscles include the diaphragm, external, and internal intercostal muscles. The accessory muscles of inspiration include the scalenes, sternocleidomastoid, levator scapulae, trapezius, iliocostalis thoracis, subclavius, and omohyoid. The accessory muscles of expiration include the interosseous intercostals, abdominal muscles, transversus thoracis, subcostalis, quadratus lumborum, iliocostalis lumborum, latissimus dorsi, and serratus posterior.
Mast Cell Stabilizers
Authors: Reilly Eric , Manders Larry 
Published: May 2024

Abstract
Mast cells are key mediators in allergic diseases and can be activated through both immunoglobulin E (IgE) dependent and independent mechanisms. When an allergen comes into contact with the IgE complex on a sensitized mast cell, it starts a tyrosine kinase signaling cascade, which leads to a calcium influx and ultimately the release of chemical mediators such as histamine, prostaglandins, leukotrienes, cytokines, and chemokines. These mediators are responsible for the symptoms seen in primary, secondary, and idiopathic mast cell disorders which cause bronchoconstriction and increase airway resistance. Medications such as sodium cromoglycate stabilize mast cells to inhibit the release of allergic mediators, thus providing symptomatic relief. This outlines the physiology of mast cells, medications, and anesthetic considerations.
Immunoglobulin E (IgE) Blockers (Anti-IgE Therapy)
Authors: Reilly Eric , Manders Larry 
Published: May 2024

Abstract
Immunoglobulin E (IgE), composed of two light chains and two identical heavy chains, is a key component of many allergic diseases such as asthma. It is produced via communication between B and T cells after exposure to foreign allergens. Once produced and released, IgE can remain free in the plasma, or it can bind to membrane-bound receptors on mast cells, basophils, and other effector cells. Once bound with IgE, cells are considered sensitized. When an allergen binds to a membrane-bound IgE, the sensitized cell undergoes an activation signaling cascade which results in the release of preformed mediators and the production of inflammatory cytokines. These mediators and cytokines are what cause allergic responses in diseases such as asthma. Anti-IgE therapies have been created in an effort to prevent these allergic responses. These therapies have shown strong evidence for clinical benefits in allergic asthma and chronic urticaria.
The Cardiac Cycle
Authors: Pellicer Robert , Abd-Elsayed Alaa 
Published: May 2024

Abstract
The cardiac cycle is a series of physiological events in which blood moves through the chambers of the heart in alternating phases of systole and diastole. Movement of blood throughout the cardiac chambers is dependent on pressure changes and gradients, generated by alternating contraction and relaxation of myocardium. The cardiac cycle is generally described as having four phases: filling phase, isovolumetric contraction, ejection phase, and isovolumetric relaxation. Each of these phases is regulated by the cardiac conduction system, a complex network of specialized myocytes that ensures synchronized contraction and relaxation of myocardium.
Control of Heart Rate
Authors: Chuba Emuejevoke , Ahmed Muhammad Fayyaz 
Published: May 2024

Abstract
In this chapter the authors review heart rate and factors responsible for controlling it. Factors controlling the heart rate are the autonomic system, reflexes, and hormonal and local factors. A stepwise approach of managing tachycardia and bradycardia in the operating room is described, including the management of bradycardia in a heart-transplant recipient.
The Frank-Starling Law
Authors: Daklallah Youssef , Manders Larry 
Published: May 2024

Abstract
The Frank-Starling law is the observation that under normal limits, cardiac output increases as preload increases. There is a link between the force generated by a myocardial contraction and the initial length of myocardial fibers. The greater the diastolic volume in the left ventricle, the more myocardial fibers are stretched before contraction and the more tension in these fibers. This chapter describes the Frank-Starling Law and outlines major anesthetic considerations related to it.
Intracardiac, Pulmonary, and Venous Pressures
Authors: Martin Adriana , Chhabada Surendrasingh 
Published: May 2024

Abstract
Intravascular and intracardiac pressure measurements are routinely performed in intensive care units, operating rooms, and catheterization laboratories. Throughout the cardiac cycle there are pressure changes in all the heart chambers. It is important to know the normal values and pressure waveforms, so one can easily identify pathological processes where these values are abnormally increased or decreased. Central venous access can provide right-sided filling pressure values, and pulmonary artery catheter (PAC) can help estimate left-sided filling pressures via pulmonary capillary wedge pressure (PCWP). The central venous pressure (CVP) waveform consists of three peaks and two descends. Each of these components represents an event in the cardiac cycle and will be affected by numerous pathologies. The clinical use of CVP to estimate preload and fluid responsiveness has been a topic of debate and should not be used alone when making clinical decisions. Pulmonary artery catheters can indirectly provide estimation of left-sided pressures and left ventricle preload. The use of PAC has been questioned due to risk of severe complications like pulmonary artery rupture, pulmonary infarct, and arrhythmias. Because of that, this type of monitoring is only indicated in patients with severe pathologies where the data provided by the catheter can aid in making important clinical decisions.
Coronary Circulation
Authors: Andrews Keith A. , Helou Mada 
Published: May 2024

Abstract
This chapter reviews the arterial and venous anatomy of the heart. Regarding coronary arterial supply, special attention is paid to the difference between right versus left dominant circulation, clinical manifestations of the arterial occlusion in various territories, and clinical correlation to ischemic changes seen on ECG tracing. Venous return is also reviewed, and both systems are detailed in an illustration that can be easily reproduced under exam conditions.
Antiarrhythmics
Authors: Nemergut Greta 
Published: May 2024

Abstract
Antiarrhythmics are divided into four main Vaughan-Williams classifications based on their primary actions on the myocardial cell action potential (AP). The different classes of drugs exert their action on different phastes of the cardiac AP. New drugs and actions have become available or are being researched, including class 0, the pacemaker channel HCN4 modulators that affect the pacemaker current If. However, the original four overarching classes (class 1–4) remain the primary mechanisms for antiarrhythmic therapy: sodium channel blockade, beta receptor blockade, potassium channel blockade, and calcium channel blockade. This chapter reviews the classes of antiarrhythmic agents, drugs that are in each class, and their primary modes of action.
Non-Adrenergic Vasoconstrictors
Authors: Lee Albert , Schulman Nathan 
Published: May 2024

Abstract
Non-adrenergic vasoconstrictors, including vasopressin, methylene blue, and angiotensin II, are used for their vasoconstriction effects in states such as septic shock and other forms of vasoplegia. Methylene blue acts to inhibit an endogenous vasodilatory pathway by decreasing nitric oxide and cyclic guanosine monophosphate (cGMP) production. Though its use has repeatedly been shown to increase mean arterial pressure, data have yet to demonstrate robust benefits in mortality or oxygen delivery. Vasopressin produces intense peripheral vasoconstriction through its action on smooth-muscle V1 receptors. The Surviving Sepsis campaign currently recommends consideration of vasopressin as a second-line agent in septic shock refractory to a single vasopressor. As an end-product of the renin-angiotensin pathway, angiotensin II is responsible for triggering multiple downstream pathways resulting in vasopressin release and vasoconstriction. Recently, it has garnered much attention as an incredibly potent non-adrenergic vasopressor in septic shock due to its ability to effectively increase mean arterial pressures in otherwise refractory patients. Though it failed to demonstrate a mortality benefit, its novelty has led to continued interest and studies exploring its use.
Anatomy of the Kidney
Authors: El-Sabbahy Marwa , Fikry Karim 
Published: May 2024

Abstract
Understanding the anatomy of the kidney is critical to understanding its physiology and multiple roles in blood pressure control, fluid and electrolyte balance, as well as other hormonal functions. The kidneys consist of glomeruli and tubules. The glomerulus consists of a network of capillaries that branch from the afferent arteriole. Each tubule consists of proximal tubule, loop of Henle, distal convoluted tubule, collecting tubule, and ends with the papilla. Each part of the tubule has a distinct function. In addition, the kidney is a very vascular organ. The complex vasculature of the kidney is also discussed in this chapter.
Specific Organ Metabolism
Authors: Hallman Matthew J. , James Dominika Lipowska 
Published: May 2024

Abstract
Metabolism is a broad topic that describes the complex biochemical reactions required to sustain life. The liver serves as a center of multiple complex metabolic processes and is capable of converting glucose for storage into glycogen (in liver) or triglycerides (also occurs in peripheral tissues). Conversely, the liver is also capable of extracting glucose from glycogen when energy is required. In times of glucose and fatty acid scarcity, the liver has a capacity of using protein as an energy source by converting it into ketone bodies. Only cells containing mitochondria are capable of obtaining energy from fatty acids; thus human red blood cells must rely on energy formulated from glucose metabolism.
Postjunctional Components and Events
Authors: Roche Shaun , Moncayo Ruth E. 
Published: May 2024

Abstract
Neuromuscular transmission and skeletal muscle contraction occur when acetylcholine released from the nerve ending binds to the endplate nicotinic acetylcholine receptors (AChRs) on the postjunctional muscle membrane. The postsynaptic apparatus of the skeletal neuromuscular junction contains acetylcholine receptors that are densely packed at the motor end plate and organized by signals from the presynaptic nerve terminal. These postjunctional receptors change in shape and molecular architecture as they mature, and have the capacity for remodeling in response to altered input or pathologic states such as burns, denervation, immobilization, and inflammation. This chapter covers the postjunctional components, the acetylcholine receptor, and the postjunctional events that occur in the neuromuscular junction, as well as anesthetic considerations for patients suffering from disorders that impact the postjunctional receptors.
Perijunctional Channels
Authors: Roche Shaun , Moncayo Ruth E. 
Published: May 2024

Abstract
The area of muscle in close proximity to the motor end plate is known as the perijunctional zone. It is here where the membrane potential developed at the end plate is converted to an action potential, which propagates through the muscle to initiate muscle contraction. A basic understanding of the mechanism behind the opening and closing of these perijunctional sodium channels will assist in the understanding of different blocks seen within the practice of anesthesia. This chapter will cover the perijunctional zone, and perijunctional channels associated with the neuromuscular junction, as well as the mechanism of action and clinical presentation behind phase I, phase II, desensitization, and channel blocks.
Physician Wellness
Authors: Hanna Joseph Salama , Saad Ramsey 
Published: May 2024

Abstract
The World Health Organization (WHO) defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” One in four people worldwide are affected by mental health concerns. Physicians are particularly vulnerable to experiencing mental illness due to the nature of their work, which is often stressful and characterized by shift work, irregular work hours, and a high-pressure environment. This chapter reviews the definition of burnout, components of wellness, and keys to boost physicians’ well-being.
Professionalism and Licensure
Authors: Hanna Joseph Salama , Saad Ramsey 
Published: May 2024

Abstract
This chapter reviews the concept of medical professionalism with focus on its core components including ethical value system, medical knowledge and technical skills required for a good effective medical practice as well as interpersonal skills for the healthcare provider necessary to work with patients which can be referred to collectively as “Art” of medicine. It also discusses the requirements of licensure and certification in the field of Anesthesiology by reviewing important information obtained from the 2021 ABA policy book. It also sheds light on the updated MOCA-2 components including medical licensure, continued medical education CME, Moca Minute and quality improvement.
Informed Consent
Authors: Hanna Joseph Salama , Saad Ramsey 
Published: May 2024

Abstract
Physicians have a legal and ethical responsibility to provide sufficient information to the patient so that he or she can make appropriate decisions. An educated patient also benefits the physician, both in terms of cooperation in the planned intervention and in reducing frustrations and possibility of litigation in case of complications. The physician is expected to carefully bring the patient into the medical decision-making process, addressing the patient’s concerns, and creating reasonable expectations regarding outcomes. This chapter reviews the principles and components of the informed consent with focus on informed decision making, communication as well as documentation of the obtained consent.
Disclosure of Errors to Patients
Authors: Hanna Joseph Salama , Saad Ramsey 
Published: May 2024

Abstract
Physicians have a duty to communicate and disclose complications that result from interventional procedures to the patient; however, this may place the provider in a difficult position. On one hand, the provider is encouraged to disclose adverse outcomes, and his/her human instinct is to empathize with the patient and their families. On the other hand, providers are warned that apologies and disclosures can be seen as inviting lawsuits and lessening the ability to defend oneself if sued. In conclusion, what constitutes a protected apology in the medical setting should be carefully considered and composed; this will often need the help of malpractice insurer personnel, hospital counsel, and, perhaps, the provider’s own legal counsel. Care must be taken that the resulting dialogue does not lose the intended moral and social benefits.
Bullying, Impact on Health, and Beyond
Authors: Srabstein Jorge C. 
Published: May 2024

Abstract
This book is intended to promote awareness of the evolving understanding of the multifaceted and toxic nature of bullying, a psychosocial stressor that is associated with morbidity and mortality and that is globally prevalent across social settings and the life span. The recognition that bullying is a type of maltreatment that may be associated with other forms of victimization prompts us to go beyond the notion of bullying and to examine the spectrum of maltreatment. Reviewing at least 2,000 peer-reviewed articles published in the last two decades, this book examines what is known, so far, about the nature, prevalence, and health/psychosocial risks of bullying and other forms of victimization, how they occur across different social environments, and the strategies developed for their prevention, detection, and treatment.