bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse Reactions to Premedication
Authors: Yao Caylynn , Peterson Elisha 
Published: May 2024

Abstract
Adverse reactions to premedication include delirium, postoperative cognitive dysfunction, cardiac and respiratory aberrations, paradoxical reactions, and extrapyramidal symptoms. These adverse reactions to medications can be due in part to intrinsic properties of the medication itself and patient variability. Intrinsic properties of premedications and commonly studied side effects are discussed. Patient variability includes both biological and social factors ranging from genetic predisposition, gender, race and ethnicity, to more modifiable factors including tobacco and alcohol intake. Patient-related factors also comprise polypharmacy, CYP450 hepatic enzyme activity, age, creatinine clearance, body weight and fat distribution, and accompanying disease processes. Each factor influences dose responses and efficacy of premedication.
Drug Abuse
Authors: Sam Sabrina S. , Torres Maria 
Published: May 2024

Abstract
This chapter discusses drug abuse, also known as substance use disorder, which is becoming increasingly prevalent. This requires anesthesia providers to become familiar with perioperative considerations in this patient population. Drug abuse comprises three stages that occur in a cycle: intoxication, withdrawal, and preoccupation. Signs and symptoms of acute intoxication and withdrawal vary depending on the specific substances used in a population with coexisting psychiatric illness. Both behavioral and pharmacological treatments are available for substance use disorders. Treatment goals are immediate and long-term abstinence and recovery. It is important to provide adequate depths of anesthesia and analgesia and also to consider the risk of relapse after re-exposure to these medications. Multimodal analgesia with opioid-sparing techniques and responsible prescribing on discharge are important aspects of perioperative care.
Chronic Steroid Ingestion
Authors: Li Hewenfei , Nguyen Christina T. 
Published: May 2024

Abstract
This chapter discusses the effects of chronic steroid ingestion on the patient and perioperative management. It examines the pathophysiology of steroid use in patients including hypothalamic-pituitary-adrenal axis suppression and the resulting secondary adrenal insufficiency, as well as effects on other organ systems. It focuses on steroid replacement therapy recommendations for the perioperative period, based on differing risk levels for HPAA suppression and proper dosing of glucocorticoids.
Alteration of Gastric Fluid Volume, pH, and Sphincter Tone
Authors: Beplate Sean , Toth Kenneth 
Published: May 2024

Abstract
Understanding aspiration risk is crucial for any anesthesia provider, as pulmonary aspiration is a significant potential source of morbidity and mortality. Thus, efforts must be made to minimize both the chance and severity of an aspiration event. Anesthetic plans for patients at risk for aspiration should include methods of increasing gastric emptying and therefore minimizing gastric volume as well as increasing the pH of gastric contents.
Continuation vs. Discontinuation of Chronic Medications
Authors: Schroell Robert P. , Harter Ronald 
Published: May 2024

Abstract
A large number of patients undergoing surgery take at least one chronic medication, so it is essential for the safe practice of anesthesiology to have a thorough understanding of patients’ medical history and current medications. Some medications are recommended to be continued during surgery due to their protective effects or the risk of withdrawal with discontinuation, while others are recommended to be held. Most cardiac, pulmonary, psychotropic, and chronic pain medications are recommended to be continued in the perioperative period. Agents that impair hemostasis have differing recommendations for their discontinuation. Overall, for the safety of patients, knowing whether to continue or discontinue chronic medications in the perioperative period is imperative.
Nonobstetric Surgery during Pregnancy
Authors: Al Jindi Piotr 
Published: May 2024

Abstract
The pregnant patient should not be denied necessary surgery because delaying such surgery will result in increased morbidity and mortality. Elective surgery should be postponed until after delivery. Anesthetic management of pregnant patients necessitates maternal and fetal considerations. Physiologic and anatomic changes related to pregnancy may require adaptations of surgical and anesthetic techniques. No anesthetic agent has been shown to be teratogenic at clinical concentrations and doses; however, it is prudent to minimize fetal drug exposure. Each case warrants a multidisciplinary approach. It is prudent to maintain oxygenation, hemostasis, and normothermia and avoid hypoxemia to assure the best fetal outcome.
Spinal, Epidural, Caudal, and Combined Spinal/Epidural Anesthesia
Authors: Fadumiye Christopher O. , Cacioppo Brian J. 
Published: May 2024

Abstract
This chapter highlights three different kinds of regional anesthesia—spinal, epidural, and caudal. Specific focus is on how each works, their individual indications and contraindications, and the physiological effects and complications to watch out for. The chapter also explores onset, duration, and action termination for spinal, epidural and caudal anesthesia. The dose, concentration, and volume of local anesthetic administered for spinal, epidural, and caudal have different effects on different individuals, and this chapter examines how possible prior complication plays an important role in the kind and dosage of anesthesia to be administered. The target audience is anesthesia residents in the United States and around the world. The chapter’s overall intention is to provide a quick broad overview of spinal, epidural, and caudal anesthesia, making it a handy and quick review for board exam prep.
Assessment/Identification of Difficult Airway
Authors: Chiong Katya H. 
Published: May 2024

Abstract
Proper airway assessment is essential if one is to properly identify a difficult airway. A full history and physical exam should be performed, taking particular note of anatomic components from the airway examination. While there is no one particular anatomic correlate that completely predicts a difficult airway, the collected data can be a useful tool for the anesthesiologist in unmasking potential difficultly and enable proper preparation. The key is proper preparation when a difficult airway is anticipated. This may involve additional airway preparation, including medications and equipment, as well as additional support staff and colleagues for an extra set of skilled hands.
Chronic Environmental Exposure
Authors: Smith Sarah C. 
Published: May 2024

Abstract
Chronic exposure to waste anesthetic gases (WAGs) is an important occupational safety issue for anesthesia practitioners and others working in anesthetizing locations and post-anesthesia recovery units. While the results of epidemiological studies investigating the impact of WAG exposure on perioperative workers are conflicting, chronic exposure to low levels of inhalational anesthetic agents may be associated with oxidative damage, genotoxicity, teratogenicity, and fertility problems. Although completely eliminating the presence of WAGs from perioperative environments is not possible, exposure can be successfully minimized through workplace engineering, appropriate anesthetic management, and other modifications to the work environment.
Bronchospasm
Authors: Eapen Jeffery James , Bang Jason 
Published: May 2024

Abstract
Bronchospasm is a respiratory complication encountered with anesthesia practice. This chapter will provide a review of the condition in terms of pathophysiology and its management in the perioperative period. Bronchospasm is a manifestation of a complication from reactive airway disease (asthma), COPD, anaphylaxis, release of vasoactive substances, or interventions by an anesthesiologist. It is caused by increased activity of smooth muscles surrounding the bronchioles, resulting in airflow obstruction impacting primarily the expiratory phase of the respiratory cycle. Diagnosis is confirmed by physical examinations revealing end expiratory wheezes and increased peak airway pressures during mechanical ventilation. Management includes administering 100% oxygen, use of beta 2 agonists such as albuterol, increasing inspired concentration of bronchodilating inhaled anesthetics, and use of bronchodilating IV agents such as ketamine.
Latex Allergy
Authors: Lacourrege Kelsey E. , Kaye Alan D. 
Published: May 2024

Abstract
Allergy to natural rubber latex can result in morbidity and mortality. This chapter focuses on the etiology, diagnosis, and management of latex allergy. Exposure to latex allergens through skin contact, such as gloves, has been shown to lead to localized allergic reactions. Powdered latex gloves associated with aerosolization of latex allergens can trigger allergic asthma, rhinitis, ocular symptoms, and anaphylaxis. Patients with spina bifida have heightened susceptibility to latex allergy. At the height of the latex allergy epidemic in 1991, 1 of every 8 patients with spina bifida experienced anaphylaxis perioperatively, with allergy rates as high as 17% among healthcare workers and 70% among spina bifida patients. At present, the rate of allergy development has declined to 1% for the entire population. Patients with a clinical history consistent with latex allergy should be considered high risk even in the absence of serologic confirmation. The use of latex-containing products in healthcare has dwindled significantly in the United States and has led to a decline in incidence of new latex allergies. Prompt recognition and management are critical. Anaphylaxis can occur immediately upon exposure but may take up to 60 minutes to present. Immediate resuscitation with intravenous epinephrine and intravascular fluid should be initiated, with immediate removal of the latex product and replacement with a latex-free alternative.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Authors: Rosenblum David , Elias Hila 
Published: May 2024

Abstract
Selective serotonin reuptake inhibitors (SSRI) and selective noradrenaline reuptake inhibitors (SNRI) are commonly used medications in the treatment of depression, anxiety, and other psychiatric disorders. These drugs are becoming increasingly common and therefore the perioperative clinician needs to know how to recognize, prevent, and treat reactions associated with these medications. Serotonin syndrome is one of the most feared and infamous complications when treating patients who are taking SSRIs. Symptoms can range from mild to life-threatening. They are related to the overactivation of both the central and peripheral serotonin receptors by high serotonin levels, resulting in the serotonin syndrome and its various symptoms. A history of chronic pain or psychiatric comorbidities may alert to the possibility of serotonin syndrome. Other considerations when taking care of patients on these medications include bleeding and sensitivity to epinephrine-containing local anesthetics.
Acupuncture and Hypnosis
Authors: Mazmanyan Hovik , Alexander Bozana 
Published: May 2024

Abstract
Acupuncture and hypnosis are playing an increasingly prominent role in the field of pain management. This chapter discusses and highlights the current understanding of hypnosis and acupuncture in the field of anesthesia and their potential as a useful adjuvant in the current anesthesia toolbox. In the case of acupuncture, memorizing all acupuncture points on the body is not necessary. However, one must understand the full potential of this interconnected system in order to incorporate a few simple and useful techniques in anesthesiology training and to apply them during the perioperative period for patient outcome optimization.
Cardiovascular Consequences of General and Regional Anesthesia
Authors: Herman Jared , Viswanath Omar 
Published: May 2024

Abstract
General anesthesia leads to a reduction in systemic vascular resistance, arterial blood pressure, and cardiac output. Success and failures in the perioperative period rely on a thorough understanding of the cardiovascular physiologic changes associated with administering general and regional anesthesia. Unanticipated spread of local anesthetic during a spinal anesthetic or local anesthetic systemic toxicity can have a devastating impact on the cardiovascular system. Cardiac complications account for 25%–50% of mortality after noncardiac surgery. Understanding cardiac risk and anticipating physiologic changes can allow for successful treatment in the perioperative period and allow for less major cardiac complications following procedures.
Cerebral Blood Flow
Authors: Sharma Surangama , Arora Lovkesh 
Published: May 2024

Abstract
Cerebral blood flow (CBF) is coupled to cerebral metabolism, i.e., when cerebral metabolism (or oxygen consumption) increases, blood flow to that region increases as well. Intracranial pathology may uncouple the relationship, and CBF and cerebral metabolism may become independent of each other. CBF is autoregulated and remains constant over a mean arterial pressure (MAP) range of 65 to 150 mmHg. CBF is also affected by factors like arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2), body temperature, and medications, including anesthetics. Understanding the factors affecting CBF, autoregulation, and metabolism is important for safe perioperative patient care.
Increased Intracranial Pressure
Authors: Alkhalili Kenan , Nasr Ned F. 
Published: May 2024

Abstract
Elevated intracranial pressure (ICP) is a potentially devastating complication of neurologic injury. ICP can be elevated in traumatic brain injury, large acute ischemic stroke, intracranial hemorrhage, intracranial neoplasms, and diffuse cerebral disorders such as encephalitis and acute hepatic failure. Management of elevated ICP is, in part, dependent on the underlying cause, and should focus on optimizing perfusion, by minimizing ICP and maximizing cerebral perfusion pressure (CPP). ICP monitoring allows for the judicious use of interventions with a defined target point, thereby avoiding potentially harmful aggressive treatment. Medical management of increased ICP should include sedation, drainage of cerebrospinal fluid (CSF), and osmotherapy with either mannitol or hypertonic saline. This chapter discusses the pathophysiology, monitoring, and treatment modalities of increased ICP.
Spinal Cord Tracts
Authors: Altenhofen Brannon Y. , Schulman Nathan 
Published: May 2024

Abstract
The spinal cord tracts are the ascending and descending neuronal fiber pathways that transmit information to and from the body and the brain. This chapter discusses the ascending pathways, including the spinothalamic tract (pain and temperature), the posterior columns (light touch, vibration, and proprioception), and the spinocerebellar tract (unconscious proprioception). It also discusses the corticospinal tract, which is the major descending motor pathway. The chapter then addresses different spinal cord lesions and explains the reasons for contralateral or ipsilateral deficits (depending on the tracts involved and whether the fibers have crossed over), including disruption of the artery of Adamkiewicz, Brown-Sequard syndrome, posterior cord syndrome, conus medullaris syndrome, and cauda equina syndrome. Finally, it addresses intraoperative neuromonitoring and its role in assessing the functional integrity of the nervous system during surgeries in which these structures are at risk.
Body Temperature Measurement
Authors: Guruswamy Jayakar , Epelman Matthew 
Published: May 2024

Abstract
Intraoperative temperature measurement represents an important but underappreciated aspect of patient care under the purview of the anesthesiologist. Deviations from normal body temperature can have important consequences. Hypothermia is most commonly encountered and is usually caused by loss of heat via radiation within the operating theater. Convection, conduction, and evaporation represent other causes of heat loss. Hyperthermia is less common, but the etiology must be investigated, as it may be a sign of malignant hyperthermia or sepsis, among other causes. Methods to prevent heat loss include application of warm blankets, forced air warming blanket, and adjusting operating room temperature. The patient may shiver in response to cold to increase body temperature, consequently resulting in increased oxygen consumption. Complications of unrecognized and prolonged temperature derangements include decreased wound healing, decreased platelet function, coagulopathy, prolonged action of neuromuscular blockade and anesthetic agent, arrhythmias, hemodynamic instability, significant morbidity, and mortality. A variety of devices exist to aid the anesthesia provider in monitoring temperature, each with its own applications and pitfalls.
Brainstem
Authors: deBoisblanc Charles , Kaye Alan D. 
Published: May 2024

Abstract
The brainstem, responsible for many primitive reflexes, is composed of the midbrain, the pons, and the medulla, each of which performs critical roles in homeostasis. This chapter examines the anatomy and function of each region, as well as reviewing the brainstem’s role in postoperative nausea and emesis. Postoperative nausea and vomiting are, in part, related to the chemoreceptor trigger zone, located within the medullary area postrema; this area and the nucleus tractus solitarius of the medulla constitute the most significant components of the vomiting center. Emetogenic substances activate receptors within the chemoreceptor trigger zone, and this signal is conducted to the nucleus tractus solitarius, which activates the vomiting reflex.
Cerebral Circulation
Authors: Shah Rutvij 
Published: May 2024

Abstract
The brain is supplied by the branches of two internal carotid arteries (ICA) and two vertebral arteries. The terminal branches of ICAs and vertebral arteries form the circle of Willis to provide uninterrupted circulation. Branches of ICAs are the ophthalmic, posterior communicating, anterior choroidal, anterior cerebra,l and middle cerebral arteries. Branches of vertebral arteries are the anterior and posterior spinal arteries, and posterior inferior cerebellar arteries. Both the vertebral arteries merge to make the basilar artery. Acute occlusion of these arteries causes various type of stroke syndromes. Venous drainage of the brain is through superficial and deep cerebral veins. Both superficial and deep cerebral veins drain into various dural venous sinuses to eventually drain to brachiocephalic veins to the right atrium.
Spinal Nerves
Authors: Abdallah Rany T. , Villatoro-Lopez Jasmin 
Published: May 2024

Abstract
The human body contains 12 cranial nerves and 31 pairs of spinal nerves. Spinal nerves carry motor, sensory, and autonomic signals between the spinal cord and the body. They correspond to a segment of the vertebral column: 8 cervical pairs (C1–C8), 12 thoracic pairs (T1–T12), 5 lumbar pairs (L1–L5), 5 sacral pairs (S1–S5), and 1 coccygeal pair. The majority of the upper half of the cervical nerves construct the cervical plexus, specifically from the anterior rami of C1 to C5. The ventral roots C5–T1 form what is known as the brachial plexus, a complex network of nerves that innervate the upper extremities. The thoracic nerves are composed of 12 pairs of spinal nerves in the thoracic spine, each corresponding to a spinal segment. The lumbosacral plexus is simply the lumbar and sacral plexuses that share nerve root overlap. Spinal nerve compression is a condition caused by gradual wear and tear on the joints and discs of the spine, largely known as degenerative arthritis. Other causes may be sudden traumatic blows to the spine that fracture, dislocate, crush, or compress one or more of the vertebrae. However, these conditions may be treated with medications, physical therapy, injections, and in extreme cases with surgery.
Peripheral Nociceptors
Authors: Lennertz Richard 
Published: May 2024

Abstract
Nociceptors are specialized nerve fibers that respond to intense, noxious stimuli. They are classified by their degree of myelination and responses to mechanical, heat, and cold stimuli. The expression of various ion channels determines their sensitivity to mechanical, thermal and chemical stimuli. Nociceptors respond to stimuli when these ion channels depolarize the plasma membrane and initiate an action potential. Some subtypes of voltage-gated sodium channels are highly expressed by nociceptors. In particular, mutations in NaV1.7 have been linked to human diseases such as erythomelalgia and congenital insensitivity to pain. Inflammatory mediators sensitize nociceptors, and nociceptors themselves release neurohumoral peptides that modulate inflammation. These changes may increase the response elicited by painful stimuli or lead to spontaneous activity. These inflammatory changes contribute to acute postoperative pain.
Static, Dynamic Compliance and Airway Resistance
Authors: Shapiro Ezra , Crimi Ettore 
Published: May 2024

Abstract
Physiologic work of breathing includes the inspiratory work to overcome both elastic and frictional forces. Elastic recoil is the natural tendency of the lungs to collapse and can be expressed in terms of elastance. Compliance, the reciprocal of elastance, is defined as the change in volume per unit change in pressure. The total compliance of the respiratory system is the sum of lung and chest wall compliance. Static compliance is the compliance measured under static (zero flow) condition, while dynamic compliance is measured with air flow. Atelectasis, pulmonary edema, acute respiratory distress syndrome, and pleural effusions decrease lung compliance, while pulmonary emphysema is associated with increased lung compliance. Frictional forces, also defined as non-elastic resistance, include the resistance to air flow of the conductive airways and the viscous tissue resistance of the lung and chest wall. Bronchospasm, mucus plugging, and airway foreign bodies increase airway resistance.
Pleural Pressure Gradient, Laplace’s Law, Surfactant, Hysteresis, and Flow-Volume Loops
Authors: Pham Ba Hoang Nguyen , Bang Jason 
Published: May 2024

Abstract
Normal respiration is dependent on the main 3 pressure gradients: transrespiratory pressure, transpulmonary pressure, and transthoracic pressure. While they are the driving forces for inspiration and expiration, and play an important role in keeping the lungs and the alveoli inflated, without surfactant, the alveoli would collapse from the surface tension forces as depicted by Laplace’s law. It states that pressure is directly proportional to the surface tension and inversely proportional to the radius of the alveolus. Surface tension is also main the reason for the presence of hysteresis in the lung compliance curves. In order to help with the diagnosis of certain airway obstruction, as well as lung restrictive diseases that affect the lung compliance, the flow-volume loop can be employed.
Distribution of Ventilation
Authors: Morales Monnica , Jamroz Tatiana 
Published: May 2024

Abstract
This chapter reviews pressure differentials in the respiratory cycle, providing information on how this relates to compliance of the lung and the distribution of inspired gases in the alveoli. Pleural pressure gradients, distribution of ventilation, compliance, and functional residual capacity (FRC) are reviewed. There is also a brief discussion on how this relates to both the spontaneously breathing awake patient and positioning in the anesthetized patient. Pleural pressure differences, termed pleural pressure gradients, exist in the lung due to a variety of reasons. These include gravity, density of the lung tissue, compression from surrounding structures and the shape of the lung in the thorax favoring compression of tissues at the base; therefore, ventilation is also distributed differently.