bluuebunny/crossref_metadata_2025_split huggingface dataset:
Placenta
Authors: McLendon Roneisha 
Published: March 2023

Abstract
The placenta is a very important organ integral to fetal development and primarily responsible for providing oxygen and nutrition. The placenta allows for transfer of deoxygenated blood and fetal waste elimination through the maternal circulation. Deficiencies in placental development and alterations to uteroplacental blood flow can have acute implications impacting fetal viability. Placental development creates a low-resistance uterine blood flow system to increase blood flow to the placenta. In relation to neuraxial analgesia, in the absence of hypotension, epidural analgesia either increases or does not change uteroplacental blood flow. The effect of general anesthesia on uteroplacental drug flow is highly drug dependent and requires consideration of other contributing factors.
Drugs and Adjuvants
Authors: Anthony Cometa M. , Thompson Jordan 
Published: March 2023

Abstract
Physiologic changes in pregnancy alter the maternal volume of distribution, plasma protein concentrations, and the elimination half-life of intravenous medications. Providing the parturient with analgesia and anesthesia during labor and delivery requires the anesthesiology provider to have a thorough understanding of the drugs and adjuvants available to ensure the comfort and safety of the mother, fetus, and neonate. These medications can be provided to the parturient systemically via intravenous or inhalational routes; however, the more common and superior analgesic delivery method occurs by neuraxial administration. General anesthesia may also be used for cesarean delivery, but it is typically avoided due to the increased aspiration risk and potentially difficult airway management in the parturient.
Tocolytic Drugs
Authors: Al-Jindi Piotr , Potere Bethany 
Published: March 2023

Abstract
Tocolytic agents are agents that inhibit uterine contraction and allow enough time for corticosteroids to help with lung maturation. They are administered in cases of premature labor between the 22nd and 34th weeks of gestational age. They are divided into betamimetics, calcium channel blockers, cyclooxygenase inhibitors, and magnesium sulfate. Betamimetics can be used for a short period of time; their prolonged use is not recommended due to extensive side effects, including maternal death. They are associated with pulmonary edema, tachycardia, arrhythmias, hyperglycemia, and hypokalemia. Calcium channel blockers are more beneficial than β-adrenergic agents for prolongation of pregnancy, neonatal morbidity, and maternal side effects. Magnesium sulfate is not effective in delaying labor, and it does not have an advantage over other tocolytic agents when it comes to neonatal and maternal outcomes, as it shown in a Cochrane review. However, evidence suggests that magnesium sulfate reduces the severity of cerebral palsy in surviving infants if administered when the birth is anticipated before 32 weeks of gestation. It does prolong the action of depolarizing and nondepolarizing muscle relaxant and can have serious side effects if overdosed.
Drug Effects on the Newborn
Authors: Aquino Ben 
Published: March 2023

Abstract
Important factors in maternal-fetal drug transmission are the mode of transmission, fetal physiology affecting drug effects, and salient points of a few commonly used peripartum maternal drugs. Drug Effects on the Newborn looks specifically at peripartum maternal administration of drugs and their subsequent effect of those drugs on the fetus and neonate. Maternally self-ingested drugs are among that list, but the focus here is on medications administered by obstetricians and, most importantly, the anesthesia provider. This chapter looks briefly at mechanisms of maternal-fetal drug transmission, factors affecting this transmission, fetal physiology affecting drug actions, and effects of a few specific, noteworthy, and commonly used drugs in obstetric anesthesia.
Preeclampsia and Eclampsia
Authors: Genis Alina 
Published: March 2023

Abstract
Pre-eclampsia is a multisystem disorder of pregnancy occurring after 20 weeks of gestation that continues to contribute significantly to maternal and fetal morbidity and mortality. Mortality occurs most frequently secondary to hemorrhagic stroke and the complications of seizures. Diagnosis involves criteria that include hypertension along with other signs of end-organ impairment, such as renal insufficiency, thrombocytopenia, impaired hepatic function, pulmonary edema, or new-onset neurological symptoms. Management of preeclampsia includes aggressive blood pressure control, seizure prophylaxis, and optimizing the timing of delivery. The only curative treatment is delivery of the fetus and placenta, often leading to preterm delivery. Anesthetic goals include early neuraxial analgesia, avoidance of general anesthesia if possible, management of drastic hemodynamic changes, and fluid optimization.
Supine Hypotensive Syndrome
Authors: Ahmed Muhammad Fayyaz , Kamel Ihab 
Published: March 2023

Abstract
The supine hypotension syndrome (SHS) is a reduction in maternal systolic blood pressure of 15 and 30 mm Hg or an increase in heart rate of 20 beats/min, with or without symptoms, when the patient is in the supine position. SHS is caused by aortocaval compression and can lead to decreased uteroplacental perfusion and nonreassuring fetal heart rate patterns. It begins around 18–20 weeks and typically manifests as pallor, hypotension, dizziness, nausea, tachycardia and sweating during the third trimester. Vasodilation imposed by systemic anesthetics and neuraxial blockade may amplify the reduction in maternal blood pressure caused by SHS. Proper left uterine displacement is a pivotal preventive and therapeutic intervention in managing parturients beyond 20 weeks gestation.
Postpartum Hemorrhage
Authors: Im Mary J. , Kamel Ihab 
Published: March 2023

Abstract
Postpartum hemorrhage (PPH) is a significant and life-threatening obstetric complication. It is defined as blood loss greater than or equal to 1000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours of birth. The increase in uterine blood flow and the role of placental implantation, separation, and uterine contractility renders the management of PPH critical and multifaceted. Common causes of PPH include uterine atony, genital trauma, retained placenta, uterine inversion, and placenta accreta. Measures to minimize PPH should be implemented when appropriate. Proper assessment and prompt management of obstetric hemorrhage is critical for maternal well-being and survival.
Apgar Scoring
Authors: Ahmed Muhammad Fayyaz , Kamel Ihab 
Published: March 2023

Abstract
The Apgar scoring system was developed in 1953 by Virginia Apgar to differentiate between infants who require resuscitation efforts and those for whom routine care is sufficient. Apgar scoring is performed while care is being delivered. The Apgar system has since become a standard neonatal assessment tool, comprising 1- and 5-minute assessments of appearance, pulse, grimace, activity, and respiration. A score of 8 to 10 is normal, while a score of 0 to 3 is a sign of fetal distress requiring immediate resuscitation. The low score is considered a nonspecific sign of illness, which may be one of the first indications of encephalopathy. The score is used in conjunction with routine neonatal assessment.
Anesthetic Considerations in Breastfeeding
Authors: Levin Lora B. , Cannon Jeffrey W. 
Published: March 2023

Abstract
Breastfeeding provides several health benefits to both infant and mother, and there should be little to no disruption in breastfeeding after the administration of anesthesia to a breastfeeding mother. All anesthetic drugs transfer to breast milk in small but relatively safe amounts. The amount of drug that transfers is called the relative infant dose (RID). Some mothers will be under the impression that they should “pump and dump” after undergoing anesthesia while breastfeeding. However, the current American Society of Anesthesiologists guidelines state that breastfeeding is safe to resume after anesthesia as soon as the mother is awake, alert, and stable. A reasonable anesthetic plan for a breastfeeding mother will consider using short-acting agents; minimizing the use of benzodiazepines and narcotics by employing multimodal analgesia, peripheral nerve blocks, and considering neuraxial anesthesia; and avoiding agents with higher RID, such as morphine and agents with active metabolites such as codeine and tramadol. A useful resource to consult for updated information on drugs and breastfeeding is the Drugs and Lactation Database (LactMed) from the National Library of Medicine.
Management of Traumatic Brain Injury
Authors: Vasudevan Bharathram , Nasr Ned F. 
Published: March 2023

Abstract
Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. Primary brain injury occurs at the time of trauma due to external mechanical forces, while secondary brain injury occurs for hours to days after the trauma. The cornerstone of perioperative management lies in prevention of secondary brain injury by preventing elevated intracranial pressure (ICP), hypotension, hypoxia, hypo- or hypercarbia, hypo- or hyperglycemia, hyperthermia, seizures, and coagulopathy. The clinical severity of TBI is assessed by calculating the Glasgow Coma Scale score. Airway management can be challenging, and rapid sequence intubation is performed with manual inline stabilization. Cerebral autoregulation is disrupted, and anesthetic management should ensure adequate cerebral perfusion pressures of 60–70 mm Hg. ICP monitoring is frequently performed, and elevated ICP above 22 mm Hg is treated with head elevation, adequate analgesia and sedation, decreasing intrathoracic pressure, temporary hyperventilation, cerebrospinal fluid drainage, and osmotherapy. Postoperative mechanical ventilation and neuro–intensive care management are often required.
Geriatrics
Authors: Mechlin Maggie W. , Jones Courtney R. 
Published: March 2023

Abstract
Elderly (generally defined as &gt; 65 years old) and medically complex patients represent an increasing proportion of people requiring anesthetic care both inside and outside of the operating room. As patients live longer, they are requiring and qualifying for more invasive procedures and operations than ever before. These difficulties can range from the need to plan a safe, balanced anesthetic and minimize the risk of complications to the need to prepare for the expected risk of morbidity and mortality. The physiologic changes that occur with aging and the issues with multiple comorbidities and polypharmacy complicate both anesthetic planning and execution. In addition, as patients progressively deteriorate, it may be necessary to explore their end-of-life wishes to ensure that care is consistent with the patient’s personal values.
Prescription Medication Overdose
Authors: Huynh Peter , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Data collected by the National Center for Health Statistics and Centers for Disease Control and Prevention have illustrated the ongoing trend of prescription medication overdose. It is very common to encounter patients in the perioperative period who use prescription medications to manage their comorbidities. Despite the best efforts at prescribing drugs, physicians often encounter patients who do not understand the frequency, dose, or name of their medications. Therefore, it is important for anesthesiologists to understand the signs, symptoms, and treatment options for prescription medication overdose. This chapter discusses some common classes involved in medication overdose: opioids, benzodiazepines, and cardiac medications, such as β-blockers.
Needle-Stick Injury
Authors: Saad Ramsey , Hanna Joseph Salama 
Published: March 2023

Abstract
Needle-stick injury is an unfortunate but not uncommon occupational risk. Risk factors for unintentional needle-stick injuries include long work hours, fatigue, and the emergent nature of interventions. Both attending and resident physicians are at risk, although the risk may be slightly higher among trainees. Given the risk to healthcare providers in general and anesthesiologists in particular, anesthesiologists should be familiar with the protocols of prevention and early intervention in the event of this occurrence. Using universal precautions for prevention of blood-borne infections is of paramount importance. This chapter outlines the various methods of prevention and early intervention in the event of exposure.
Intravascular Catheter and Urinary Catheter Infections
Authors: Ma Zhe , Chung Kevin W. 
Published: March 2023

Abstract
Catheter-related bloodstream infections (CRBSIs) are a common cause of morbidity and mortality in critically ill patients. All types of intravascular catheters are associated with some risk; however, nontunneled central venous catheters (CVCs) and pulmonary artery catheters (PACs) carry the highest risk. Recent guidelines favor subclavian and internal jugular over femoral catheterization; meta-analyses have shown no difference in CRBSI across the three sites, particularly including considerations for operator skill, risk of mechanical complications, and specific patient factors. Prolonged catheterization increases the risk of CRBSI, but routine replacement of catheters is not recommended unless a catheter complication is noted on inspection or its clinical need has been met. CRBSI is often diagnosed by exclusion as alternative bacterial sources should be investigated given the presentation of nonspecific symptoms. Treatment of CRBSI should allow for empiric therapy to cover common drug-resistant organisms, ultimately tailored to specific patient culture data. Decision for catheter removal should include considerations for clinical indication and risks involved with replacement. Bacteriuria in patients with indwelling bladder catheters is another common occurrence. Risks factors for the development of urinary tract infection (UTI) include duration of catheterization, female sex, older age, and diabetes mellitus. UTIs can occur as a result of extra- or intraluminal infections. Diagnosis typically requires the presence of bacteriuria with 105 CFU/mL or more in a clean-catch specimen or collection from catheter port proximal to the collection bag along with UTI symptoms. Antibiotic therapy should be tailored to culture data and whether the infection has extended beyond the bladder.
Antimicrobials
Authors: Shirur Mo , Chung Kevin W. 
Published: March 2023

Abstract
Antibiotics play a ubiquitous role in the daily life of an anesthesiologist, in both the perioperative setting and the intensive care unit (ICU). Generally classified based on their mechanisms of action, antibiotics were traditionally broadly separated into two main categories: bactericidal antibiotics, which show in vitro activity in killing bacteria, and bacteriostatic antibiotics, which show the ability to diminish bacterial growth. This chapter discusses the major antibiotics used in the clinical setting today. A simpler classification based on activity against gram-positive and gram-negative bacteria is used. Additionally, the most common antifungal agents and followed by anesthetic considerations in this regard are discussed.
Mechanical Ventilation
Authors: Abdelmalak Mena , Chung Kevin W. 
Published: March 2023

Abstract
Mechanical ventilation is one of the most critical tasks performed by anesthesiologists. It is imperative for the anesthesiologist to understand the different modes of mechanical ventilation, their advantages and roles, and possible complications. Volume control ventilation (VCV) ensures a set minute ventilation is delivered, while pressure control ventilation (PCV) regulates the airway pressures delivered. Synchronized intermittent-mandatory ventilation (SIMV) shares many similarities to VCV but with the added benefit of supporting patient-generated respiratory efforts. SIMV is often used when transitioning from mandatory ventilation to pressure support ventilation (PSV), which consists entirely of patient-generated respiratory efforts given mechanical support. Weaning a patient from mechanical ventilation consists of progressively diminishing ventilatory assistance, and there are many factors that may result in difficulty in weaning. Barotrauma and volutrauma are two notable complications related to mechanical ventilation.
Introduction
Authors: Berman Carol W. 
Published: March 2023

Abstract
Why theater is important for our brains and lives may not be immediately clear to people. I have found it essential in my life. First I studied medicine and became a psychiatrist. Then I had the opportunity to learn playwriting, which I did at the Neighborhood Playhouse. Many of my plays have been produced here in New York City. New neural networks are developed in the brain when we watch plays. It is not a dying media as some critics claim. It is alive and well. Shakespeare is understandable, especially when his plays are seen live on the stage. Transference occurs when people project their early emotions on to people in their present lives. Meisner technique stresses that actors must focus on each other and interact with them, whereas Stanislavski requires the actor to focus on inner feelings.
Modern Plays
Authors: Berman Carol W. 
Published: March 2023

Abstract
This chapter considers modern plays. In modern plays, like The Cherry Orchard and The Seagull, Chekhov shows us characters denying reality and suffering as a result. August Strindberg gives us sadomasochistic behaviors in Miss Julie. In Tennessee Williams’ The Glass Menagerie, Laura, who may be schizophrenic or on the autistic spectrum, regresses as she tries to deal with the “gentleman caller.” Eugene O’Neill shows us numerous examples of complexes, unconscious impulses, and ego and superego struggles in his play Long Day’s Journey Into Night. The chapter examines how plays reveal various perspectives, prejudices, individual and group psychology, and, of course, various psychiatric principles of psychoanalysis.
Identity Issues
Authors: Berman Carol W. 
Published: March 2023

Abstract
How the patient sees him or herself is essential to understand when doing any kind of therapy. The identity of a character includes who the person is in terms of what values they hold, how they see themselves, their roles in society, their memories, experiences, relationships. There is identification with someone, like identification with the aggressors in Mamet’s Glengarry Glen Ross. Introjection is a way of establishing identity as well. In introjections people may have identification with a victim, as Willy Loman does in Arthur Miller’s Death of a Salesman. In the play Transnormal, there is understanding of how identity changes with gender. Through these identifications neural networks are formed that would never have considered.
What We Learn From Plays
Authors: Berman Carol W. 
Published: March 2023

Abstract
What better way is there to learn psychiatry and psychology than to have exciting examples of personality disorders, depression, and psychosis from playwrights? Every time a person goes to the theater, an experience of “psychiatry on the stage” can occur. If a professor returns to the clinic after such theater presentations, examples are available to present to psychiatry residents. In addition, new brain pathways are formed that will be invaluable. Greek playwrights, Shakespeare, and modern playwrights have given us invaluable gifts with their plays. Great playwrights like Tom Stoppard stimulate our brains with their brilliant works. I look forward to viewing many more plays to maintain my brain functions.
Central nervous system tumours
Authors: Ajithkumar Thankamma 
Published: March 2023

Abstract
Central nervous system tumours, which can arise from any structures within the cranial vault and spinal canal, are heterogeneous with different histological subtypes. The clinical behaviour of these tumours depends on the site of disease and histologically. While most tumours are locally invasive, some have a predilection for leptomeningeal spread. The current WHO classification of tumours is based on histology, immunohistochemistry, and cytogenetics. This chapter discusses the clinical and imaging features of common types of central nervous system tumours, the role of radiotherapy, integration of systemic treatment with radiotherapy, and practical details on radiotherapy planning. It also summarizes the evidence underpinning current clinical practice.
Thoracic cancers
Authors: Ajithkumar Thankamma 
Published: March 2023

Abstract
Lung cancer is the commonest cause of cancer death in the industrialised world. For therapeutic purposes, lung cancers are divided in small cell lung cancer and non-small cell lung cancer. Radiotherapy has a well-established role in the curative and palliative management of lung cancer. Radiotherapy has also been used in the management of malignant mesothelioma and thymoma. This chapter discusses the clinical and imaging features of lung cancers, malignant mesothelioma, and thymoma, the role of radiotherapy in these tumours, and practical details on radiotherapy planning. The role of prophylactic cranial irradiation in small cell lung cancer is also discussed. It also summarizes the evidence underpinning current clinical practice.
Haematological malignancies
Authors: Ajithkumar Thankamma 
Published: March 2023

Abstract
Over the last couple of decades, the role of radiotherapy for haematological malignancies has progressively diminished. Nevertheless, radiotherapy still plays a curative role in the management of early-stage lymphomas. Radiotherapy is an essential component of the treatment of early-stage classical Hodgkin lymphoma and high-grade lymphomas. Definitive radiotherapy is the treatment of choice for early-stage nodal and extranodal indolent lymphomas. Definitive radiotherapy is curative in approximately 50% of solitary plasmacytomas. Consolidation radiotherapy is considered in advanced-stage lymphomas after definitive chemo-immunotherapy if there are inadequate response at sites of initial bulky disease or has residual active disease. Radiotherapy is also used for conditioning for transplantation, bridging strategy during CAR-T and for palliation in incurable disease.
What to do in the first few days
Authors: Harwood Rowan H. , Huwez Farhad Umer , Guyler Paul , Alam Sajid , Gaynor Catherine 
Published: March 2023

Abstract
This chapter tackles what to do in the first few days after a stroke. It starts with the need to focus immediately on assessment for, and delivery of, re-perfusion therapies. The role of Hyperacute Stroke Units (HASU) is described, and the medical functions they deliver. Specific acute medical management of cerebral infarcts and bleeds is described, along with the management of coma, acute nursing care, and monitoring requirements.
Rehabilitation
Authors: Harwood Rowan H. , Huwez Farhad Umer , Guyler Paul , Alam Sajid , Gaynor Catherine 
Published: March 2023

Abstract
Rehabilitation, is more of a way of thinking than a treatment in itself. Rehabilitation comprises elements of re-ablement, resettlement, and readjustment. Rehabilitation aims to maximize functional ability and increase the options patients have over their eventual discharge. Progress is the best assessed by monitoring disability, which has three key dimensions: mobility, continence, and behaviour, amongst many other functional activities that may be affected. The chapter emphasises the importance of multi-professional working including rehabilitation nursing. It describes different trajectories of recovery. It also considers the various issues patients encounter while recovering from a stroke, such as depression, urinary continence, and shoulder pain. Family involvement is a key feature of successful stroke recoveries.