bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malignant Hyperthermia
Authors: Patel Priyanka H. , Matteson David 
Published: May 2024

Abstract
This review chapter on malignant hyperthermia (MH) examines the epidemiology, genetic basis, and pathophysiology of this rare autosomal-dominant disorder. The role of ryanodine receptor 1 and the diagnostic options for MH are discussed, including genetic testing and the caffeine-halothane contracture test. The pathophysiology is examined in detail using an organ system-based approach including neurologic and neuromuscular, cardiovascular, respiratory, renal, gastrointestinal, hepatobiliary, and hematologic manifestations. As early identification of the disease is crucial, the common signs and symptoms are detailed, in particular tachycardia, hypercarbia, and a hypermetabolic state. Finally, anesthetic considerations are discussed, emphasizing proper treatment with dantrolene and associated supportive care.
Alpha-2 Agonists
Authors: Horvath Balazs , Kloesel Benjamin 
Published: May 2024

Abstract
The alpha-2 adrenoreceptor agonists clonidine and dexmedetomidine possess sedative and analgesic properties without significant cardiovascular or respiratory depression as side effects. That, along with the versatile routes of administration, has made them integral elements of sedation for various procedures and in the intensive care unit. They are effective adjuvants to general and regional anesthesia, as well as to multimodal acute and chronic pain control. This chapter reviews the key pharmacological and clinical information that guides the safe and effective utilization of clonidine and dexmedetomidine for the anesthesiologist.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Authors: Reilly Austin , Elmofty Dalia 
Published: May 2024

Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for analgesia in the perioperative time frame. NSAIDs are classified as non-selective or selective cyclooxygenase 2 (COX-2) inhibitors. Some are available over the counter, while other formulations require a physician’s prescription. It is important for the anesthesiologist to be familiar with the physiologic and pathologic effects of NSAIDs to effectively manage their use in the perioperative setting. This chapter reviews NSAIDs classifications, mechanism of action, pharmacology, side effects, and anesthetic considerations. Various factors such as age and comorbidities should be considered when administering NSAIDs to avoid perioperative complications.
N-Methyl-D-Aspartate (NMDA) Receptor Antagonists
Authors: Leonard Ethan R. , Eckmann Maxim S. 
Published: May 2024

Abstract
N-methyl-D-aspartate (NMDA) receptor antagonists are a group of drugs used widely in medicine as anesthetics. These agents work by inhibiting the NMDA receptor, a glutamate and ion channel protein receptor, thereby providing analgesia, sedation, and amnesia. There are several NMDA receptor antagonist agents available with varied routes of administration, including intravenous, oral, and intramuscular preparations. These agents include ketamine, methadone, memantine, and dextromethorphan. These drugs have sympathomimetic effects, with ketamine being the most potent. Ketamine is the NMDA antagonist drug of choice for procedures that require conscious sedation or general anesthesia. It is also often used for acute pain management. NMDA receptor antagonist use for chronic pain management is a topic of interest for many researchers, but preliminary results are inconclusive and further research needs to be conducted.
Neuromuscular Complications of Anesthesia
Authors: Anand Suwarna , Prem Anand 
Published: May 2024

Abstract
Over the last several decades, with reduction in anesthesia-related perioperative mortality, the need to further optimize patient care by reducing morbidity has taken precedence. Recognition of the role of anesthetic agents and techniques on airway reflexes and airway protection can reduce the risk of pulmonary complications and aspiration. Postoperative myalgia has long been attributed to succinylcholine use, and techniques to reduce this mild though distressing complication has improved the perioperative patient experience. Over the past decade, there has been renewed interest in the role of residual neuromuscular blockade and its significant impact on postoperative morbidity and mortality. Recognition of optimal train-of-four monitoring sites, quantitative neuromuscular blockade monitoring, optimal timing of reversal agents, and newer reversal agents such as sugammadex have reduced the incidence of residual paralysis in the postoperative period, improving patient safety.
Temperature-Regulating Centers
Authors: Dwarki Karthik , McConnell Matthew 
Published: May 2024

Abstract
Temperature regulation is essential for maintaining cellular function within the body. Core body temperature is generally kept around 37°C, with small daily variations due to circadian rhythm and monthly changes in fertile women. Thermoregulation occurs in three phases: afferent thermal sensing, central regulation, and efferent response. Multiple neurotransmitters determine the overall temperature threshold. Maintenance of homeostasis is regulated through the hypothalamic-pituitary-adrenal axis, specifically within the preoptic area of the anterior hypothalamus. With respect to anesthesiology, it is this axis and its response to temperature changes that are downregulated, including in the settings of general anesthesia, monitored anesthesia care, and regional anesthesia (especially with neuraxial techniques).
Variations in Vertebral Configuration
Authors: Rausch Douglas K. , Abdallah Rany T. 
Published: May 2024

Abstract
Cervical, thoracic, and lumbar vertebrae differ in both shape and size, allowing for region-specific functions. There are characteristics that are considered typical for each section of vertebrae, and atypical vertebrae also exist among them. The cervical vertebrae allow for ample range of motion, and C1 serves as a study seat for the occiput. The thoracic vertebrae contain extra attachment sites for the ribs and are important for rotation of the spine. Lumbar vertebrae are large and link in a way that allows for flexion and extension. Knowing the key differences between the vertebrae is also important because they serve as anatomic landmarks for many regional anesthesia procedures.
Carbon Dioxide Transport
Authors: Sidagam Vasu 
Published: May 2024

Abstract
This chapter discusses the physiology of carbon dioxide transport in blood, emphasizing that its main form of transport is in the HCO3– (bicarbonate) form. The critical role of the RBC is pointed out. Differences in the arterial, venous, measured and calculated bicarbonate levels, and its reasons are highlighted. The role of the serum HCO3––H2CO3 buffer system is discussed. The chapter ends with perioperative implications of abnormal serum HCO3 values.
Non-Respiratory Function of Lungs
Authors: Cornwell Drew , Kohan Lynn 
Published: May 2024

Abstract
This chapter discusses the multiple functions of the lung beyond that of gas exchange. Physical barriers provide a first line of defense against inhaled particles and pathogens from the outside world. These materials are trapped and filtered within the lungs, along with endogenous particles such as circulating emboli. Defense mechanisms also include filtration of both endogenous and exogenous materials. Metabolic activity of the lungs can modify drugs as well as circulating hormones. The cytochrome P450 system in the lungs aids in this process. Additionally, the highly compliant pulmonary microvasculature can serve as a reservoir of blood that is adaptable to varied demands.
The Tracheobronchial Tree
Authors: Alpaugh E. Saunders , Kaye Alan D. 
Published: May 2024

Abstract
The tracheobronchial tree contains important airway structures that the clinical anesthesiologist should be able to identify and to manage. Endotracheal intubation and single lobe ventilation are just a few of the many airway techniques the anesthesia provider can use to keep the patient physiologically stable during surgical interventions. Proper endotracheal tube placement requires an extensive knowledge of the distal trachea, its surrounding structures, and their physiologic roles. Once these procedures are performed safely, the anesthesia provider can obtain accurate respiratory measurements and respond with appropriate actions. This chapter outlines relevant anatomical structures within the tracheobronchial tree and considerations for the anesthesiologist.
Normal ECG and Electrophysiology
Authors: Dakhlallah Nadeen , Manders Larry 
Published: May 2024

Abstract
The heart can be divided into a right and left pump, each consisting of an atrium and ventricle. The heart fills to eject blood to the rest of the body in a synchronized fashion. A series of electrical signals are generated that stimulate the muscle fibers of the heart to contract and relax, ensuring appropriate time for synchronous movement. An electrical potential (voltage) results in a directional flow (current) that can be quantified. This flow of current is large enough to be detected on the surface of the body as an electrocardiogram (ECG). This chapter summarizes electrical physiology of the heart and assessment/interpretation via transcutaneous monitoring by electrocardiogram.
Myocardial Contractility
Authors: Tobes Daniel , Manders Larry 
Published: May 2024

Abstract
Myocardial contractility represents the ventricles’ ability to contract and eject blood. There are two ways in which to modify contractility: in a length-dependent (increased preload) or length-independent fashion (inotropy). These processes are made up of a dynamic interaction of myosin to actin and well as intracellular Ca2+ concentration. This chapter summarizes myocardial contractility as it relates to the intrinsic electrical conductance of the heart, which facilitates its ability to pump blood and transport oxygen to the rest of the body.
Blood Pressure
Authors: Zanath Erica , Helou Mada 
Published: May 2024

Abstract
Blood pressure monitoring is essential in every anesthetic. ASA Standard II requires that blood pressure be measured at least every five minutes. Blood pressure is the pressure generated in the arterial system from cardiac contraction. It determines the perfusion to all vital organs. According to the American College of Cardiology and the American Heart Association, normal blood pressure is defined as systolic &lt;120 mmHg and diastolic &lt;80 mmHg. Both hypotension and hypertension can lead to end organ damage, making careful monitoring and control imperative. Blood pressure can be monitored using both noninvasive and invasive methods. Noninvasive blood pressure monitoring can be accomplished via palpation, Doppler, auscultation, oscillometry, and arterial tonometry. Of these methods, oscillometry is the most common perioperatively. Invasive monitoring is accomplished using an arterial line with pressure transduction. Measurement of blood pressure using an arterial line is considered the gold standard.
Baroreceptor Function
Authors: Vasant Kris , Fayyaz Ahmed Muhammad 
Published: May 2024

Abstract
In this chapter the authors discuss the various arterial and venous baroreceptors in the body. They describe the structure, function, and effects on the regulation of cardiopulmonary homeostasis, including heart rate, contractility, preload, and afterload. Anesthetic considerations have been mentioned in the clinical context of patient care, including carotid sinus massage.
Capillary Diffusion, Osmotic Pressure, and Starling’s Law
Authors: Hayden Andrew , Sharma Archit 
Published: May 2024

Abstract
In order to function, cells are required to move materials in and out of their cytoplasm via their cell membranes. Diffusion is the movement of particles from an area of higher concentration to lower concentration, whereas osmosis is movement of fluid across a semi-permeable membrane. The exchange of gases between the alveoli and the blood occurs by simple diffusion, i.e., oxygen diffusing from the alveoli into the blood and carbon dioxide from the blood. Starling forces (hydrostatic pressure and osmotic pressure) govern the passive exchange of water between the capillary microcirculation and the interstitial fluid. This chapter describes the various degrees of interaction of these forces that govern the movement of fluid and gases in the human body.
Enhanced Recovery after Colorectal Surgery
Authors: Torres Patrick , Ghabra Hussam 
Published: May 2024

Abstract
Enhanced Recovery after Surgery (ERAS) refers to a set of evidenced-based protocols that are intended to optimize the perioperative surgical experience by attempting to minimize surgical stress and hasten time to return to baseline health status postoperatively. This perioperative technique necessarily requires a multidisciplinary team approach, including surgeons, anesthesiologists, nurses, physical therapy, occupational therapy, and social workers to be implemented successfully. It covers most aspects of the preoperative, intraoperative, and postoperative care, with the goals of standardizing care while improving outcomes and potentially lowering medical costs. The results of these evidenced-based protocols include a reduction in surgical complications and postoperative pain, improved surgical outcomes, and decreased hospital length of stay. While this strategy is utilized across many different surgical subspecialties, it has been long implemented and studied with respect to colorectal surgery. This chapter will cover the different elements of ERAS protocols with emphasis on anesthesia-related interventions.
Renin-Angiotensin-Aldosterone System
Authors: El-Sabbahy Marwa , Fikry Karim 
Published: May 2024

Abstract
Renin-angiotensin-aldosterone systems exist in various tissues throughout the body, including the kidneys, adrenal gland, cardiovascular system, and nervous system, where it may be involved in local regulation of vascular tone. Renin causes angiotensin to be cleaved into angiotensin I, which is then converted to angiotensin II via angiotensin converting enzyme. In addition to its potent vasoconstrictor effect, angiotensin II has other important hormonal and electrolyte effects that significantly alter fluid balance. Angiotensin II leads to a direct increase in Na reabsorption via the proximal tubules, as well as the release of aldosterone from the zona glomerulosa of the adrenal cortex. Renin-angiotensin system can be interrupted by angiotensin converting enzyme inhibitors as well as angiotensin receptor blocker, both of which can lead to prolonged hypotension if not withheld in the perioperative period, especially if large fluid and blood shifts occur.
Transfusion Indications
Authors: Scott Courtney L. , Boydston Elaine A. 
Published: May 2024

Abstract
Transfusion medicine is an evolving practice, and today the tendency is toward more restrictive strategies, including goal-directed transfusion. Red blood cell transfusions are administered to treat symptomatic anemia in order to increase oxygen-carrying capacity of the blood and oxygen delivery to vital organs. Red blood cells are generally indicated when the hemoglobin level is less than 7 gm/dL, but not when it is greater than 10 gm/dL. Patients with hemoglobin levels between 7 and 10 mg/dL may benefit from transfusion depending on their underlying medical comorbidities, or in the setting of signs of end organ ischemia or active bleeding. Fresh frozen plasma contains all the factors necessary for coagulation and is indicated to correct hypocoagulable states due to either quantitative or qualitative deficiencies of these factors. Pooled units of platelets from multiple donors or apheresis units obtained from a single donor are administered to treat thrombocytopenia or to correct qualitative platelet deficiencies. Lastly, cryoprecipitate contains an abundant amount of fibrinogen, as well as Von Willebrand factor and factors VII and XII, and is administered to correct hypofibringenemia and other specific factor deficiencies.
Blood Preservation and Storage
Authors: Watt Stacey , Bonsu Prince 
Published: May 2024

Abstract
The collection of blood from donors undergoes a rigorous screening process before storage. Prior to storage, anticoagulants and preservatives such as citrate phosphate dextrose (CPD) or CPDA-1 are added; the additive adenine is used in order to provide nutrients, prevent clotting, and help maintain the overall viability of the red blood cell during storage. Blood is often stored at a temperature of 4°C but can be stored at much colder temperatures with variable storage time that ranges anywhere from 21 days to 10 years from the time of collection, unlike platelets, which have a limited storage time of 5 days at 22°C.
Effects of Cooling and Heating
Authors: Syed Madiha , Chen Pinxia 
Published: May 2024

Abstract
Body temperature is tightly regulated within a few tenths of a degree Celsius by the hypothalamus; deviations of a few degrees can have a profound impact on cellular metabolism. The human body maintains an average core temperature of 36.5–37.5°C via signals to the hypothalamus. Patients can experience variations in temperature under both general and neuraxial anesthesia. Intraoperative hypothermia is more common than hyperthermia. The major mechanism of hypothermia in both general and neuraxial anesthesia is the redistribution of body heat from the core to the periphery. This chapter aims to explain the physiologic effects of cooling and heating, common causes, and management strategies in the perioperative period.
Preparation for Transfusion
Authors: Cheng Paul K. , Malik Tariq M. 
Published: May 2024

Abstract
This chapter reviews key concepts related to preparation for transfusion of blood products. In addition to discussing ABO typing, blood screening, and cross-matching of allogeneic blood products, it also describes unique situations which arise in clinical practice including use of uncross-matched blood for emergent situations of anemia/hemorrhage or coagulopathy, use of designated or directed donor blood products, and a comparison of the different types of autologous blood transfusion options, such as pre-deposited autologous donation, intraoperative and postoperative blood salvage, and acute normovolemic hemodilution. These salient topics are relevant to daily anesthetic practice and often tested on the American Board of Anesthesiology board examinations.
Hypothalamus
Authors: Powers Zack , Giordano Chris 
Published: May 2024

Abstract
In a normal physiologic state, the hypothalamus plays a role in coordinating endocrine function, regulating autonomics, consolidating environmental input, and managing temperature and appetite. Pathology involving the hypothalamus may lead to conditions requiring expertise for a safe anesthetic. Specifically, endocrine dysregulation, autonomic instability, autonomic dysregulation, and neurosurgical technique may require consideration of the hypothalamus in the differential diagnosis. Pathology regarding the hypothalamus may require preoperative optimization/anesthetic consideration due to hormone imbalance from prior radiation, infiltrative disease, or a tumor. Hypothalamus dysfunction may also manifest intraoperatively or postoperatively due to surgical manipulation, infection, trauma, or stroke.
Glucagon and Catecholamines
Authors: Torres Felipe Vasconcelos , Santos Lucas Costa 
Published: May 2024

Abstract
This chapter discusses the role of glucagon and epinephrine in the metabolic regulation of the human body with a focus on carbohydrate metabolism. Glucagon is secreted by the pancreas, while epinephrine is secreted by the adrenal medulla. Both are catabolic hormones that are able to promote glycogenolysis, gluconeogenesis, and ketogenesis, and reduce glucose uptake in order to make energy sources available to vital tissues and organs, which may be needed during fasting or when a stress response is induced. They also exert hemodynamic effects by interacting with β-adrenergic receptors in order to sustain perfusion of vital organs. Their actions are critical in the metabolic response to stress in order to maintain energy availability and homeostasis.
Shared Decision-Making
Authors: Hanna Joseph Salama , Saad Ramsey 
Published: May 2024

Abstract
Shared decision-making is a key component of patient-centered healthcare. It is a process in which clinicians and patients work together to achieve multiple goals that includes making decisions, selecting tests, treatments, and care plans. These selections are based on clinical evidence that balances the risks of such test or treatments and the most likely expected outcomes with patient preferences and values. Shared decision-making relies basically on both patient autonomy and informed consent. The chapter reviews few steps that can help providers with shared decision-making which can eventually lead to both providers and patients agree on a healthcare plan. They are adapted from the Informed Medical Decisions Foundation.
Eating Disorders
Authors: Goldstein Mark A. , Goldstein Myrna Chandler 
Published: May 2024

Abstract
Eating disorders in adolescents are psychiatric issues that also impair biopsychosocial functioning. The four principal eating disorders seen during adolescence are anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant-restrictive food intake disorder. The risk factors for an eating disorder include genetic, psychosocial, and environmental factors; bullying; weight-based teasing; obesity; stress; anxiety; social media; and the female gender. Individuals with gender dysphoria as well as those who may have endured abusive experiences during dating relationships may also present with disordered eating. During the COVID-19 pandemic, there were increasing numbers of adolescents presenting with restricting eating disorders. The treatment for an eating disorder is complex, lengthy, and best done with a team approach. Anorexia nervosa has the highest fatality rate for any psychiatric disease.
Substance Use
Authors: Goldstein Mark A. , Goldstein Myrna Chandler 
Published: May 2024

Abstract
Adolescence is a high-risk period for the use of substances; the vast majority of youth try alcohol during this time, and about half experiment with an illicit drug. A number of factors place adolescents at risk for substance use including depression, attention-deficit disorder, peer relationships, and a history of child abuse and neglect. The example set by parents is even more powerful than any genetic influences. Social media influences may also increase the risk for an adolescent to use substances. Research has demonstrated an association between adolescents who abuse substances and suicidal behaviors. The treatment for adolescents with substance use issues begins with screening, and this may be done at a routine medical visit. Individual and/or group therapy, especially with family involvement, are the first steps in treatment.
Problematic Internet Use
Authors: Goldstein Mark A. , Goldstein Myrna Chandler 
Published: May 2024

Abstract
As a result of new technology, problematic internet use (PIU) is a problem for a significant number of adolescents. Most adolescents spend more than 7 hours a day using media, but a subset of adolescents who suffer from PIU spent more than that online. There appear to be associations between PIU in adolescents and mental health issues including anxiety and depression. In addition, there is evidence that adolescents with PIU have an increased risk for self-injurious behaviors, suicidal ideation, and suicidal attempts. Parents need to set boundaries with their adolescents on the amount of daily screen time. In addition, parents should model the appropriate use of the internet and smartphones. Parents should also advise and monitor the areas that adolescents are allowed to visit online, especially gaming and social media sites.