bluuebunny/crossref_metadata_2025_split huggingface dataset:
Valvular Heart Disease
Authors: Morkos Michael , McConnell Matthew 
Published: March 2023

Abstract
Valvular pathology is a growing concern for the practicing anesthesiologist given the increasing longevity of the patient population. Many patients will present for noncardiac surgery with comorbidities involving stenosis and/or regurgitation in one or more of the four heart valves (aortic, mitral, tricuspid, and pulmonary). These valves are involved throughout the process of blood flow, functioning to preserve pressure gradients and allow for continual forward flow. Awareness of the physiological alterations associated with each valvular pathology and how to optimize the intraoperative hemodynamics is crucial to provide appropriate anesthetic care. Subacute bacterial endocarditis has also been a growing concern impacting which procedures require antibiotic prophylaxis.
Pacemakers and Automated Implantable Cardioverter/Defibrillator (AICD) Implantation
Authors: Guruswamy Jayakar , Parikh Snigdha 
Published: March 2023

Abstract
Cardiovascular diseases are the leading cause of death worldwide, contributing to an estimated 17.9 million deaths annually. Advances in cardiac implantable electrical devices (CIEDs) have resulted in increased life expectancy for these patients, and, as a result, there is a growing proportion of the population who are getting these devices. Approximately 3 million people in the United States have a pacemaker and close to 300,000 people have an implantable cardioverter-defibrillator (ICD), making patients with CIEDs a growing population in the perioperative arena. As these demographics shift, more patients with implanted devices present to the operating room for noncardiac surgeries, and they provide unique challenges. This makes understanding of these devices critical for anesthesiologists.
Perioperative Implications of Pacemakers and AICDs
Authors: Guruswamy Jayakar , Parikh Snigdha 
Published: March 2023

Abstract
The estimated prevalence of cardiac arrhythmias in the United States is approximately 14.4 million, which accounts for approximately 40,000 deaths annually. Advances in cardiac implantable devices combined with an increase in indications for their placement has led to increased implantation of these devices. The presence of these devices poses unique perioperative challenges, especially in the setting of electromagnetic interference, thereby making it important for anesthesia providers to have a complete understanding of these devices. The goal of the perioperative evaluation of a patient with a cardiac implantable electronic device (CIED) consists of determining type of CIED, manufacturer, primary indication for placement, the current setting of the device, if the patient is device dependent, and the possibility of electromagnetic interference.
Ventricular Synchronization
Authors: Guruswamy Jayakar , Parikh Snigdha 
Published: March 2023

Abstract
Approximately 6.5 million adults in the United States have heart failure, which contributed to approximately one in eight deaths in the year 2017 per the Centers for Disease Control and Prevention. Despite advancements in pharmacological therapy available for heart failure and improvements in outcomes, there is still a significant proportion of patients hospitalized with systolic heart failure. Device-based therapies are the latest development in the field of heart failure management. These devices are commonly encountered by anesthesiologists because of the large prevalence of heart failure in the United States. They aim to target patients with systolic dysfunction with dyssynchronous ventricular contraction.
Cardiac Tamponade
Authors: Grandhi Ravi K. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Cardiac tamponade is a medical emergency that requires close attention. It can be acute, subacute, occult, or regional. Etiologies of pericardial tamponade vary based on whether they are inflammatory or noninflammatory (1). The pericardium is composed of two layers of tissue, the serous visceral and fibrous parietal layers, which have less than 50 mL of serous fluid. Presentation will depend on the amount and rate of accumulation of fluid. Diagnosis can be made by history, physical examination, and imaging studies. Treatment will typically require evacuation of the fluid to reduce the pressure around the heart. Treatment goals include maintaining preload, afterload, and contractility.
Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB)
Authors: Kim John K. , Sofjan Iwan 
Published: March 2023

Abstract
Minimally invasive direct coronary artery bypass (MIDCAB) is an approach to surgical coronary revascularization that offers an alternative strategy to traditional techniques involving sternotomy and cardiopulmonary bypass for patients who are suitable candidates. During MIDCAB procedures, a smaller incision is made in the intercostal spaces lateral to the sternum, and the graft vessel is carefully harvested and anastomosed onto a beating heart. Although further studies are required to confirm any long-term advantages, MIDCAB may offer several benefits compared to traditional surgical techniques, such as decreased duration of mechanical ventilation, intensive care unit stay, and hospitalization, as well as the need for fewer blood transfusions. However, MIDCAB also presents unique challenges to both the surgical and anesthesiology teams. This chapter discusses the procedural aspects of MIDCAB as well as considerations for anesthetic management.
Carotid Endarterectomy
Authors: Grandhi Ravi K. , Joseph Claire 
Published: March 2023

Abstract
Carotid endarterectomy is an important procedure to remove plaques in the carotid artery to assist with revascularization after an ischemic stroke. Plaque is most commonly removed from the location of maximum turbulence where the common carotid artery divides into the internal and external carotid artery. Many patients requiring carotid endarterectomy have other comorbidities, including coronary artery disease, that require preoperative assessment and optimization. Intraoperatively, patients require invasive blood pressure monitoring and either general or regional anesthesia. If general anesthesia is used, then neurophysiological monitoring is required. Further, some of these patients may require a carotid shunt to transiently provide perfusion to the brain. Postoperatively, these patients require close monitoring of their vitals and neuromuscular status.
Anesthesia for Upper and Lower GI Endoscopy
Authors: Leer Ethan H. 
Published: March 2023

Abstract
With advancement of minimally invasive techniques, an increasing number of gastrointestinal (GI) endoscopic procedures are performed in the United States. These procedures are typically performed under minimal or moderate sedation. However, individual responses to sedatives can be different, and the depth of sedation might need to be changed throughout a single procedure. The intended level of sedation has to be determined based on patient medical comorbidities, procedure, and duration. It is then critical that anesthesia personnel are trained and proficient in providing all levels of sedation and managing the airway in emergent situations to ensure patient safety while providing optimal procedural conditions.
Management in Renal Failure and Arteriovenous (AV) Shunts
Authors: Haugen Lacey , Jani Jai 
Published: March 2023

Abstract
Anesthetic management of patients with end-stage renal disease (ESRD) and arteriovenous (AV) shunts is complicated due to the physiologic changes of ESRD and the kidneys’ role in metabolism and excretion of medications. This chapter discusses renal physiology and the pathophysiology of ESRD, including renal blood flow (RBF) and glomerular filtration rate (GFR), intravascular volume, hypertension, cardiac disease, electrolyte and acid base anomalies, as well as platelet dysfunction, bleeding, diathesis, and anemia. The focus is on the effects ESRD has on pharmacokinetics, and commonly used anesthetic drugs are discussed, including intravenous and volatile anesthetics, neuromuscular blockers (NMBs), opioids, benzodiazepines, and vasoactive medications. Anesthetic techniques, including regional anesthesia (RA), general anesthesia (GA), and local anesthesia (LA) infiltration, used for AV shunt insertion are covered. Last, preoperative, intraoperative, and postoperative considerations are reviewed.
Anesthesia for Extracorporeal Shock Wave Lithotripsy
Authors: Harb Alain , Geara Elie 
Published: March 2023

Abstract
Urolithiasis is a common condition in the United States. It is more common in men than women and most often presents in the third to fourth decade. Most urinary stones can pass spontaneously; however, 20% require urologic intervention. Extracorporeal shock wave lithotripsy (ESWL) has gradually replaced open and percutaneous surgical techniques as the treatment of choice for most urinary stones in the kidney or upper ureter. Pain experienced during ESWL has several origins: cutaneous, somatic, and visceral. It is proportional to the energy density of the shock wave at the skin entry site and the size of the focal zone. Modern lithotripters generally deliver shock waves of lower energy, resulting in less patient discomfort. A wide variety of anesthetic techniques have been employed alone and in combination for ESWL, including general, epidural, and spinal anesthesia; flank infiltration; nerve blocks; and topical application of EMLA (eutectic mixture of local anesthetic) cream. First-generation lithotripters generally required general or neuraxial anesthesia, whereas procedures using modern lithotripters may be completed with conscious sedation or monitored anesthesia care. When neuraxial blockade is utilized, a sensory level of T6 is necessary. Shock waves can cause arrhythmias and injury to the lungs. Pregnancy and untreated bleeding disorders are contraindications to ESWL.
Pharmacologic Prevention and Treatment of Renal Failure
Authors: Walia Anureet , Sharma Archit 
Published: March 2023

Abstract
Acute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity. AKI affects up to 50% of critically ill patients. The cause of AKI is often multifactorial, with preexisting comorbidities further increasing the risk. The most common and generalized forms of acute renal failure are prerenal conditions and intrarenal acute tubular necrosis (ATN). There are various fluid resuscitation strategies that are employed in treatment of AKI, including colloids, crystalloids, and bicarbonate, and this chapter evaluate the evidence in that regard. The chapter also discusses the current evidence related to the role of volume expansion, nephrotoxic medications, and use of N-acetylcysteine in AKI.
Fluid Therapy and Homeostasis
Authors: Rovira Miguel , Giordano Christopher 
Published: March 2023

Abstract
This chapter covers the basics of fluid homeostasis and fluids that are employed to maintain homeostasis in the perioperative setting. It begins with a basic review of human physiology in relation to fluids, age, and gender. Historical background is also provided on the 4–2–1 rule, the method of choice for determining fluid rate administration that has been passed on from generation to generation of physicians. Then it transitions into how the homeostasis is maintained in the perioperative setting. Particular emphasis is given to the most commonly administered fluids, such as PlasmaLyte, lactated Ringer’s, normal saline (crystalloids), and albumin (colloids). The reader will learn what these fluids are made of, what makes them different, as well as how and why certain fluids should be given and when they could be potentially dangerous.
Disseminated Intravascular Coagulation
Authors: Lemmink Gretchen A. , Conhaim Jay 
Published: March 2023

Abstract
Disseminated intravascular coagulation (DIC) is a life-threatening complication that arises due to the progression of an underlying systemic disorder. Trauma, sepsis, malignancy, and obstetrical emergencies are only some of the myriad conditions that can precipitate DIC. With the onset of DIC, the normal hemostatic response to procoagulants, such as tissue factor, becomes pathologic. Inappropriate activation of the extrinsic clotting cascade ensues, resulting in systemic microvascular thrombosis, a consumptive coagulopathy, hemorrhage, end-organ ischemia, and even death. Prompt diagnosis of DIC relies on both clinical suspicion and laboratory evaluation of coagulopathy using prothrombin time (PT), activated partial thromboplastin time (aPTT), serum fibrinogen, platelet count, and serum fibrin degradation markers. Scoring systems exist to aid in the diagnosis. A patient presenting to the operating room with DIC will require serial evaluation of coagulopathy and ongoing blood component therapy as well as prompt treatment of the inciting underlying disorder.
Use of Uncrossmatched Products
Authors: Stachur Christina 
Published: March 2023

Abstract
Certain clinical situations, such as massive hemorrhage, necessitate transfusion of blood products before crossmatched blood is available. This chapter describes why uncrossmatched blood products are used and what type of uncrossmatched products are commonly used. Uncrossmatched products are used in situations where a patient’s ABO blood group is unknown, and the patient requires a life-saving transfusion that cannot wait for crossmatched blood to be prepared. The risks and benefits of using uncrossmatched packed red blood cells (pRCBs), plasma, and whole blood are covered, as well as how Rhesus status affects selection and transfusion of products. Finally, it describes the clinical markers anesthesia providers should be wary of in cases of transfusion reaction.
Anatomy of the Endocrine System
Authors: Nalbandyan Ruzanna , Ragheb-Mueller Nawal E. 
Published: March 2023

Abstract
The endocrine system consists of a collection of glands that secrete a variety of hormones. These hormones travel to specific target organs via the bloodstream and regulate many vital functions of the body, including metabolism, reproduction, growth and development, response to injury, stress, and mood. The integral parts of the endocrine system are the hypothalamus, pituitary gland, thyroid gland, parathyroids, pineal gland, endocrine pancreas (islets of Langerhans), adrenal glands, and gonads (ovaries and testes). Hormonal regulation of the glands is via neural regulation or by feedback mechanisms from the endocrine glands and other circulating factors. This chapter discusses these integral parts and their functions.
Diabetes Mellitus
Authors: Mori Benjamin B. G. , Al-Jindi Piotr 
Published: March 2023

Abstract
Diabetes mellitus (DM) is a common chronic disorder associated with cardiovascular disease and microvascular complications, often necessitating surgical intervention. These patients are at an increased risk of perioperative infection and postoperative morbidity and mortality. The complex interplay of stress from surgery, anesthesia, and fasting, along with additional postoperative factors such as infection, altered nutritional intake, hyperalimentation, and emesis, can lead to labile blood glucose levels. There is a clear association between perioperative hyperglycemia and adverse clinical outcomes, although the exact mechanism(s) underlying this remains unclear. Perioperative DM management focuses on glycemic control. Substantial evidence indicates that the correction of hyperglycemia with insulin administration reduces complication rates and decreases mortality in cardiac and general surgery patients.
Painful Disease States
Authors: Rushmer Timothy , Abd-Elsayed Alaa 
Published: March 2023

Abstract
This chapter serves as an outline of the different types of pain and pain syndromes, while subsequent chapters go into greater detail on each of these pain states. Pain sensation serves as a physiologic protective system to warn and prevent contact with noxious or damaging stimuli. The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” With such an open definition, it is best to further classify different types of pain and pain states. Frequently, this is done pathophysiologically, etiologically, anatomically, and in terms of duration.
Premedications
Authors: Barnett Natalie R. , Fromer Ilana R. 
Published: March 2023

Abstract
Perioperative stress and anxiety related to surgery and anesthesia in the pediatric population can have long-term sequelae with negative effects on both patients and caregivers. Reducing perioperative anxiety is an essential element of pediatric anesthetic care that must be clearly understood by those involved in the perioperative care of children. There are various methods involved in minimizing perioperative anxiety; these range from utilizing different forms of topical anesthetics in an effort to eliminate or minimize pain associated with peripheral intravenous placement to pharmacological premedications, most often including midazolam, ketamine, and dexmedetomidine; caregiver and child preparation; as well as distraction techniques. These different tools can be used in conjunction with one another for the ultimate goal of safe and effective care of the pediatric patient while generating the least amount of psychological trauma possible.
Opioid Dosing and Sensitivity—Pediatrics
Authors: Hanna Rewais B. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Perioperative pediatric pain management is an exceedingly difficult proposition due to the unique challenges children provide in regard to pain assessment. The incidence of pain in hospitalized children is estimated to be between 33% and 82%, yet clinicians will attest to the fact pediatric pain is often more difficult to treat than that of adults. Moreover, dosing opioids for children is another distinct challenge due to immature metabolism and clearance pathways. With the advent of a multitude of pain management modalities in children, including nonopioid analgesics, oral opioids, patient-controlled anesthesia (PCA), and nerve blocks, it is imperative clinicians understand opioid dosing and sensitivity in this vulnerable population.
NPO Guidelines for Pediatric Patients
Authors: Klein Jonathan W. 
Published: March 2023

Abstract
A patient’s fasting status is a vital aspect of the preoperative evaluation. The American Society of Anesthesiologists has well-established fasting guidelines to ensure a patient’s safety when undergoing elective procedures. These practice guidelines are evidence based and are considered to be best practice. These standards protect the patient from potential aspiration during the anesthetic, which could lead to severe morbidity and mortality. This information is imparted to the patient prior to their elective procedure requiring general anesthesia, regional anesthesia, or procedural sedation and analgesia and should be adhered to; if not this will result in case delay or cancellation as long as the case remains elective.
Acyanotic Defects
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Acyanotic cardiac defects include largely septal defects such as atrial septal defects (ASDs), ventricular septal defects, and complete atrioventricular canal defects (including atrioventricular valvular [AVV] disease associated with complete atrioventricular septal defects), obstructive lesions, and cardiomyopathy. Acyanotic cardiac defects also involve left-to-right shunting lesions, and obstructive lesions. Obstructive lesions discussed in this review are William syndrome and Shone complex. As dilated cardiomyopathy is the most common type in pediatrics, it is the focus of the cardiomyopathy section. Patent ductus arteriosus (PDA) is discussed elsewhere, and valvular heart disease such as the Ebstein anomaly are rare enough to preclude mention here.
Cardiac Surgery
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Just as there are major physiologic differences between children and adults, so too are there differences in cardiac surgery and cardiopulmonary bypass (CPB). Monitoring of children undergoing cardiac surgery requires knowledge of anatomy and communication with the surgeon in deciding location of placement of invasive lines. Children undergo significant physiologic trespass during CPB, such as colder temperatures, greater hemodilution, and greater blood product exposure. Enhanced cardiopulmonary interdependence and shunt physiology make this heterogenous group of surgeries noteworthy. Pediatric cardiac surgery has evolved to include transparent reporting of outcomes, and survival has become commonplace. For that reason, neurodevelopmental outcomes, early extubation, and hospital length of stay have become targets for improvement.
Meconium Aspiration Syndrome
Authors: Nathani Harsh , Gwam Chike 
Published: March 2023

Abstract
Meconium aspiration syndrome (MAS) is respiratory distress in a newborn caused by the presence of meconium in the tracheobronchial airway. The syndrome can vary from mild respiratory distress to life-threatening respiratory failure. The development of MAS is related to the aspiration of MSAF during the antepartum or intrapartum periods and is related to fetal hypoxia and postmature delivery. The pathophysiology of MAS is secondary to airway obstruction, impaired gas exchange, chemical pneumonitis, and surfactant dysfunction and can be exacerbated by the development of persistent pulmonary hypertension. The management of MAS is primarily supportive, and there remains controversy regarding the use of suctioning, corticosteroids, and amnioinfusion.
General and Urologic Surgery
Authors: Valliani Arif , Patel Nimesh 
Published: March 2023

Abstract
In pediatric surgeries, general abdominal and urologic procedures are frequent interventions. Most of the underlying principles are similar to those of the adult population. Enhanced perioperative care depends on thorough patient history and physical examination supported by laboratory investigation. Many surgeries are currently performed with minimally invasive techniques. Commonly, laparoscopic-assisted procedures require general anesthesia with a secure airway device to avoid the risk of aspiration and laryngospasm. Children coming with bowel obstruction or trauma for abdominal exploration are considered to have a full stomach, and rapid sequence induction is recommended. With some exceptions, like acute urinary obstruction or testicular torsion, many pediatric urologic procedures are elective, and most of them are done in an ambulatory setting. Preoperative anxiolysis is important to consider in the wide pediatric age group population. A regional anesthesia technique can be used as an adjuvant or as a sole anesthetic technique and has been shown to enhance the recovery in children undergoing both minor and major surgeries.
Regional Techniques
Authors: Lazar Alina 
Published: March 2023

Abstract
Regional anesthesia is increasingly being used in the perioperative management of children as a result of advancements in technology, such as better ultrasound and appropriate size equipment, and in an attempt to provide excellent analgesia while minimizing opioid-induced side effects. The most common techniques used are caudal and epidural anesthesia. Trunk blocks such as paravertebral, transversus abdominis plane, rectus sheath, and ilioinguinal/iliohypogastric are becoming a popular means of providing analgesia for thoracic and abdominal procedures. Recently described quadratus lumborum and erector spinae plane blocks are also being incorporated in pediatric practice and provide good alternatives to neuraxial blocks. Peripheral nerve blocks of the lower and upper extremity are used particularly in older children, both as single shot and increasingly as continuous infusion techniques. Regional anesthesia has a long record of safety and is usually performed under general anesthesia or heavy sedation.