bluuebunny/crossref_metadata_2025_split huggingface dataset:
Guillain-Barré Syndrome
Authors: O’Farrell Justin L. , Eckmann Maxim S. 
Published: March 2023

Abstract
Guillain-Barré syndrome is an acute immune-mediated paralytic neuropathy secondary to prior infection. There are multiple variants of Guillain-Barré syndrome that describe the mechanism by which the neurodegeneration occurs. The most common presenting symptoms include areflexia in addition to caudad-to-cephalad progressive muscle weakness. The diagnosis of Guillain-Barré syndrome is made by clinical evaluation of symptoms and laboratory studies. While disease-modifying treatment involves plasmapheresis or intravenous immunoglobulin (IVIG), the majority of care is supportive due to severe dysfunction of the respiratory, cardiopulmonary, and autonomic nervous systems. Patients require close monitoring due to the rapid progression of muscle weakness, which often occurs in the intensive care unit. Complete recovery of Guillain-Barré syndrome may occur over a period of up to 4 weeks; however severe cases may lead to permanent paralysis.
Hyperkalemic Periodic Paralysis
Authors: Simmons Brett , Matteson David 
Published: March 2023

Abstract
The review chapter on hyperkalemic periodic paralysis (HyperPP) examines the genetics, epidemiology, and pathophysiology of this hereditary neuromuscular disorder. It compares the disorder to another related skeletal muscle channelopathy, hypokalemic periodic paralysis. The role of the NaV1.4 sodium channel and the relationship between sodium and potassium homeostasis at the skeletal muscle cell membrane are reviewed. The clinical presentation, red flags, prevention, and treatment considerations, including the roles of acetazolamide, intravenous calcium, and glucose-rich foods, are summarized. The chapter highlights the most common and relevant triggers of HyperPP episodes. Finally, a discussion of the preoperative, intraoperative, and postoperative anesthetic considerations emphasizes the importance of avoiding high potassium levels, carbohydrate depletion, and other common triggers when caring for patients with HyperPP.
Hypokalemic Periodic Paralysis
Authors: Simmons Brett , Matteson David 
Published: March 2023

Abstract
The review chapter on hypokalemic periodic paralysis (HypoPP) examines the epidemiology, genetic basis, and pathophysiology of this rare hereditary channelopathy. It discusses diagnostic considerations, prevention, and treatment options, including the role of acetazolamide. Comparisons are made between type 1 HypoPP, which is caused by a defective dihydropyridine-sensitive calcium channel, and type 2 HypoPP, which results from a defective skeletal muscle sodium channel. The general presentation and prevention of the disorder are reviewed and contrasted with another disorder of potassium homeostasis producing muscle weakness, known as hyperkalemic periodic paralysis. Finally, a discussion of the preoperative, intraoperative, and postoperative anesthetic considerations highlights the importance of avoiding low potassium levels and common triggers when caring for patients with HypoPP.
Anesthetic Actions Different From Adults
Authors: Fadumiye Christopher O. 
Published: March 2023

Abstract
Anesthetic actions and clinical practices vary vastly from the adult population to the pediatric population. This chapter places emphasis on various practices and actions that differ in the nonadult population. Understanding the physiologic and pharmacological principles among neonates, infants, and children and how they compare to adults are primary focuses of this chapter. Specific focus is on how to approach anesthetic actions from a system-wise approach, a perioperative and anesthetic consideration approach, and potential medical and surgical considerations pertinent only to the pediatric population. 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 anesthetic actions different from the adult population making, it a handy and quick review for board examination prep.
Thermal Regulation
Authors: Bennett David , Ohliger Shelley 
Published: March 2023

Abstract
Neonates rely primarily on nonshivering thermogenesis via brown adipose tissue to generate heat as they lack many of the mechanisms with which adults regulate their temperature, such as behavioral modifications and shivering. Nonshivering thermogenesis is inhibited by many of the drugs used in anesthesia, and given the unique anatomy of neonates, which includes increased body surface area to volume and reduced subcutaneous fat stores, as compared to the adult, hypothermia is a serious perioperative concern. Hypothermia is associated with respiratory depression, bradycardia, metabolic acidosis, coagulopathy, and decreased wound healing. Hyperthermia is most commonly iatrogenic in origin and is associated with tachycardia, dehydration, and lethargy.
Bronchopulmonary Dysplasia
Authors: Klein Jonathan W. 
Published: March 2023

Abstract
Bronchopulmonary dysplasia (BPD) is a profound lung condition affecting premature infants. Historically, this chronic lung disease was noted in premature infants who required prolonged oxygen therapy and mechanical ventilation. These patients that required high levels of oxygen and/or mechanical ventilation displayed high lung resistance due to fibrosis of the lung and airway inflammation from cytokine involvement. Severe BPD is regarded as “an infant’s need for supplemental oxygen requirement at 28 days of life and a greater than 30% oxygen and/or positive pressure at 36 weeks of corrected gestational age (CGA) in an infant born at less than 32 weeks of gestational age.” Mechanical ventilation strategies have emerged not only to manage severe BPD but also to aid in the prevention of this chronic lung condition.
Cyanotic Defects
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Cyanotic congenital heart disease (CCHD) is often complex, with multiple lesions present in a single heart. CCHD accounts for 1300 per million live births with congenital heart disease. This review covers the physiology of chronic cyanosis and adaptations and the common cyanotic heart diseases: hypoplastic left heart syndrome (HLHS), d-transposition of great arteries (d-TGA), and tetralogy of Fallot (TOF). Medical and surgical treatments as well as the usual palliative course are reviewed. Additionally, the spectrum of disease in TOF is classified. Late complications of these diseases are mentioned ; they are reviewed in the chapter on chronic congenital heart disease.
Major Vascular Malformations
Authors: Kloesel Benjamin , Horvath Balazs 
Published: March 2023

Abstract
Major vascular malformations encompass a wide variety of conditions. While some involve the peripheral vasculature, this chapter focuses on the group that affects central blood vessels. Within the group of congenital major vascular malformations, the chapter discusses (1) coarctation of the aorta, where the aortic isthmus is narrowed and impairs blood flow to the lower body; (2) patent ductus arteriosus, which describes the persistence of a fetal structure that allows blood to bypass the pulmonary circulation in utero, and its persistence after birth causes diastolic runoff into the pulmonary arteries, thereby jeopardizing lower body perfusion; and (3) vascular rings, a group of aortic arch abnormalities that can result in tracheal and esophageal compression.
Pyloric Stenosis
Authors: Batakji Mariam , Diaz Christina D. 
Published: March 2023

Abstract
Pyloric stenosis is a medical neonatal emergency that requires stabilization and eventual surgical intervention within the first few weeks of life. It is a result of idiopathic thickening of the pyloric musculature, leading to a gastric outlet obstruction syndrome. Infants present with projectile vomiting and various degrees of dehydration and metabolic derangements. Vomiting leads to hypochloremia hypokalemic metabolic alkalosis because of the depletion of gastric contents, which contains sodium, potassium, and hydrochloric acid. It is relatively common, with an incidence of 2 to 4 per 1000 live births, with a male predominance. It is crucial that before proceeding to the operating room, infants are resuscitated appropriately, and their electrolyte derangements have normalized. These infants are at high risk for aspiration because of the incomplete gastric emptying, therefore prompting the importance of preinduction suctioning of the stomach and consideration of a rapid sequence induction. The use of intravenous opioids should be avoided because of an increased risk of apnea and delayed awakening due to the persistent pH derangement in the cerebrospinal fluid. Extubation occurs at the end of the procedure when infants are fully awake with intact airway reflexes. Premature neonates less than 44–60 weeks of gestation should receive appropriate monitoring for postoperative apnea. Oral feeds are usually resumed 4 to 6 hours after surgery.
Omphalocele and Gastroschisis
Authors: Karroum Rami Edward 
Published: March 2023

Abstract
Omphalocele and gastroschisis are two distinct congenital anatomical defects of the abdominal wall. They are usually diagnosed in the antenatal period by fetal ultrasound. They are both considered surgical emergencies and need to have surgical repair soon after birth. Surgical repair of the defect is the only available treatment. Omphalocele is usually associated with other congenital anomalies, while gastroschisis may be associated with prematurity and low birth weight. Anesthetic considerations are similar for both defects, and they are often discussed together. The main objective of anesthesia is to preserve perfusion for the herniated viscera while maintaining normothermia, euvolemia, and acid-base/electrolyte balance.
Pneumo-, Hemo-, and Chylothoraces
Authors: Gyorfi Michael J. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
The pleural space holds a negative pressure thanks to the elasticity of the lungs. Different pathologies result from injuries to the lung, with the pleural space losing its pressure gradient or being filled with something other than air. A pneumothorax, hemothorax, and chylothorax may all result from traumatic lung injuries and chronic lung conditions and ultimately result in decreased vital capacity, hypoventilation, and possibly decreased cardiac output. General anesthesia is a risk factor for countless conditions, and a pneumothorax is no exception. Although an intraoperative pneumothorax is rare, the incidence is approximately 0.5%. Management involves supplemental oxygenation and ultimately chest tube placement or surgical intervention.
Upper Respiratory Infections (Colds, Epiglottitis, Laryngotracheobronchitis), Bronchopulmonary Dysplasia, Cystic Fibrosis
Authors: Salik Irim , Kelley Ashley 
Published: March 2023

Abstract
Upper respiratory tract infections are the most common acute illnesses evaluated in an outpatient setting. They can range from the common cold, generally mild and self-limited, to more severe, potentially life-threatening, infections, including croup and epiglottitis. This chapter reviews the etiologies, common comorbidities, clinical interventions for treatment, and anesthetic implications of common upper respiratory tract infections as well as bronchopulmonary dysplasia and cystic fibrosis. The common cold is a viral infection of the upper respiratory tract that causes a substantial social and economic burden. Epiglottitis most commonly has a bacterial etiology and leads to a life-threatening inflammation of structures above the glottis. Croup is a pediatric respiratory tract illness that represents the most common cause of inspiratory stridor, barking cough, and hoarseness in febrile children. Bronchopulmonary dysplasia is a form of chronic lung disease that develops in preterm neonates commonly treated with positive pressure ventilation and oxygen therapy. Cystic fibrosis is a multisystemic disease of the exocrine glands that results in chronic respiratory infections, with end-stage lung disease as the leading cause of death. Anesthesiologists should be well versed in the perioperative considerations and implications for each of these disease processes.
Skeletal Abnormalities in Children
Authors: Montone Gina , Adams Jonathan 
Published: March 2023

Abstract
Abnormal development of bone or cartilage in children causes many alterations in anatomy and physiology. With over 400 distinct syndromes and subtypes, it is notable that there is an incidence of 15.7 per 100,000 live births of disproportionate shortening of limbs or trunks. Down syndrome is the most common genetic disorder, with other disorders, such as achondroplasia, Klippel-Feil syndrome, Marfan syndrome, osteogenesis imperfecta, and Morquio syndrome, also being relatively common. These syndromes can present anesthetic challenges, such as difficulty with intubation, proper positioning, and management of cardiopulmonary comorbidities. These issues should be anticipated when determining an anesthetic plan for these children.
Trisomy 21 (Down Syndrome) and VATER Association
Authors: Batakji Mariam , Diaz Christina D. 
Published: March 2023

Abstract
A syndrome is an association of phenotypical traits that occur together due to a specific genetic abnormality. Diagnosis of genetic disorders is usually done through karyotyping, chromosomal microarray (CMA), or fluorescence in situ hybridization (FISH). Due to medical advancements in the management of these children and their increased life span, more of these children are presenting for anesthesia for diagnostic and therapeutic procedures. Therefore, it is important to understand the specifics of each syndrome and the anesthetic considerations and challenges in order to provide a safe anesthetic. Trisomy 21 is the most common chromosomal disorder in live-born infants and occurs in one in 700–800 infants. Trisomy 21 (Down syndrome) affects almost all organ systems and poses specific anesthetic challenges. This chapter summarizes the clinical manifestations of Down syndrome and the different anesthetic considerations and challenges that might be faced during preoperative, intraoperative, and postoperative periods.
Pediatric Anesthesia Outside the Operating Room
Authors: Masters Hannah , Diaz Christina D. 
Published: March 2023

Abstract
The chapter on pediatric anesthesia outside the operating room (OOR) examines the unique procedures and anesthetic considerations for providing safe patient care outside of the traditional OR environments, where pediatric anesthesia providers are increasingly more involved in diagnostic and therapeutic procedures. Anesthesia services can be required for diagnostic imaging and interventions, including computed tomography (CT), magnetic resonance imaging (MRI), interventional radiology, nuclear medicine, and radiation therapy. Each OOR location has its own unique considerations related to the needs of the team, procedure, and patient. Proceduralist considerations include patient positioning and the need for breath holds. Procedure-related considerations include the use of intravenous contrast, radiation exposure, MRI contraindications and compatibility, as well as patient monitoring challenges from a distance. Patient factors include appropriate preoperative assessment of comorbidities and fasting (nothing by mouth [NPO] status.
Oxytocic Drugs
Authors: Al-Jindi Piotr , Shah Nimit K. 
Published: March 2023

Abstract
It is estimated that postpartum hemorrhage affects 10% of deliveries. Oxytocic drugs are used to increase uterine tone and for the prevention of postpartum hemorrhage and its treatment. They are divided into three groups: oxytocin, prostaglandins, and methylergonovine. Oxytocin can be used in prevention and treatment, and it is considered the first-line treatment for postpartum hemorrhage. It can be given intravenously and intramuscularly. The most common side effect is hypotension. Second-line drugs include Carboprost (IM, intrauterine), which is contraindicated in asthma due to its ability to induce bronchospasm; Misoprostol (per rectum, sublingually) is safe in asthma; and methylergonovine (IM), which is contraindicated in hypertension.
Fetal Disposition of Drugs
Authors: Heidari Afshin , Aquino Ben 
Published: March 2023

Abstract
Fetal Disposition of Drugs looks at maternally administered medications and their effects on fetal well-being and development. Due to immature metabolism and potentially teratogenic consequences during organogenesis, fetal disposition of medications is critically important. The first trimester of pregnancy is especially important due to the organogenesis that takes place during this period; drugs given during this time are important. The chapter also looks at medications that are commonly given in the perinatal period and the effects they can have on fetal well-being. Placental characteristics and fetal physiology also play roles in the fetal disposition of drugs, and these are examined as well.
Respiratory Disorders
Authors: O’Conor Devin , Chung Kevin W. 
Published: March 2023

Abstract
Respiratory failure represents a significant source of morbidity in the pregnant population. While a variety of etiologies exists, this group presents a unique challenge to the anesthesiologist. In patients who have airway hyperresponsiveness, tracheal intubation can be a potential trigger for bronchospasm in the perioperative period. β2-Agonists are a mainstay of therapy for bronchospasm treatment, although these medications carry the risk of decreasing uterine tone. By administering β2-agonists locally via aerosolization, their systemic effects can be minimized. Neuraxial anesthesia is often the gold standard for parturients with respiratory disease as it allows the provider to provide adequate analgesia and surgical conditions while minimizing airway manipulation. When neuraxial techniques are not an option, the decision of how to proceed must take into account the risk of aspiration, airway reactivity, uterine tone, and hormonal and physiologic changes during pregnancy.
Renal Changes in Pregnancy
Authors: Shah Jarna 
Published: March 2023

Abstract
Pregnancy is associated with multiple changes in renal physiology and function. Physiologic renal dysfunction can adversely affect the health of the fetus and mother. These impact anesthetic and peripartum management of the parturient. Maternal hormone shifts, including elevated progesterone levels, affect glomerular filtration rates, creatinine clearance, and kidney blood flow. Normal pregnancies demonstrate upregulation in the renin-angiotensin-aldosterone system, an increase in circulating volume, and glomerular hyperfiltration and decreases in oncotic pressures, among many other changes. Normal laboratory values in an adult nonpregnant patient are not considered to be normal in the parturient. If abnormalities are detected, these laboratory tests should be monitored closely in the peripartum period.
Aspiration of Gastric Contents
Authors: Ahmed Muhammad Fayyaz , Kamel Ihab 
Published: March 2023

Abstract
The risk for aspiration pneumonia is increased during pregnancy. The reported incidence of aspiration pneumonia has significantly dropped in recent years due to liberal use of neuraxial anesthesia. Aspiration of a significant volume of particulate acidic gastric contents can lead to higher morbidity and mortality. Factors determining the morbidity and mortality associated with aspiration include the type and volume of aspirate, the therapy administered, the physical status of the patient, and the criteria used for making the diagnosis. Aspiration pneumonia is best managed by prevention using pharmacological agents and rapid sequence induction. If aspiration occurs, prompt recognition of the complication and following current management recommendations may limit the extent of lung injury.
Cord Prolapse
Authors: Ahmed Muhammad Fayyaz , Kamel Ihab 
Published: March 2023

Abstract
Umbilical cord prolapse is an obstetric emergency. The prolapse occurs when the cord slips ahead (overt umbilical cord prolapse) or alongside (occult umbilical cord prolapse) the presenting part of the fetus and protrudes into the cervical canal or beyond. Compression of the prolapsed cord leads to occlusion of the umbilical vein and vasospasm of the umbilical artery, which compromises fetal oxygenation. The discussion includes common risk factors, prevention, pathophysiology, clinical presentation of cord prolapses, prevention, and management to improve neonatal outcome. The anesthetic technique that provides the shortest induction time is the best choice. Although regional anesthesia can be used, general anesthesia is usually chosen for an emergent delivery.
Neonatal Resuscitation
Authors: Salik Irim , Doherty Tara 
Published: March 2023

Abstract
The ability to provide appropriate life-saving resuscitation techniques in the first minute of life can play a crucial role in an infant’s overall survival and well-being. A small fraction of neonates will require respiratory assistance, and even fewer will necessitate cardiac intervention. Proper clinical assessment as well as the application of evidence-based guidelines are integral to proper management of newborn infants. A few examples of preexisting risk factors such as prematurity, maternal disease, meconium aspiration, and asphyxia can predispose to the birth of nonvigorous infants. Although the vast majority of infants will respond to gentle stimuli, others will necessitate ventilatory support, chest compressions, or medication administration, including epinephrine. Appropriate thermoregulation is also critical to reduce infant morbidity and mortality. Preparedness for neonatal resuscitation requires assessment of perinatal risk, assembly of experienced personnel to initiate intervention, access to appropriate supplies and equipment, and standardization of behavioral skills that enable effective communication and teamwork.
Umbilical Cord Blood Gas
Authors: Tarwade Pritee , Acho Christine 
Published: March 2023

Abstract
Umbilical cord blood gas along with the Apgar score is a useful tool to assess fetal well-being. Both umbilical artery and venous blood samples should be obtained, especially in case of fetal distress, to differentiate placental insufficiency from cord abnormalities. There is a strong correlation between umbilical cord gas abnormalities and fetal morbidity and mortality, but no proven predictive value has been found. Choice of anesthesia for labor analgesia and cesarean section and its effect on umbilical cord gas has been extensively studied but failed to show any consistent correlation. Factors that are deemed predictive of decreasing umbilical arterial pH are maternal body mass index (BMI), noncephalic presentation, spinal start to delivery interval, uterine incision to delivery, and maximum reduction in blood pressure from baseline.
Intrauterine Surgery
Authors: Shah Jarna 
Published: March 2023

Abstract
Many fetal abnormalities can be treated in the antepartum period. However, often with certain underlying conditions, intervention is required prior to delivery. Techniques utilized include minimally invasive surgery, open fetal surgery, and ex utero intrapartum treatment (EXIT) procedures. Fetal surgery prior to delivery, otherwise known as maternal-fetal surgery, is a very specialized intervention. It is considered only for select fetal conditions or when delivery prior to surgical correction would be associated with high morbidity or mortality rates. This procedure is offered at a select number of large academic centers, and these patients require complex care, with management including both maternal and fetal considerations.