bluuebunny/crossref_metadata_2025_split huggingface dataset:
Addiction Versus Tolerance
Authors: Shah Anuj A. , Zaky Christine S. 
Published: March 2023

Abstract
Addiction involves a state of maladaptive behavior, such as the compulsion for taking a habit-forming substance, while tolerance is the decrease in the pharmacological effect of a drug. Addiction involves activation of the reward pathway that leads individuals to favor immediate reward over delayed but favorable responses. Tolerance to opioids, for example, according to two different theories, may involve desensitization and downregulation of opioid receptors. Management strategies of opioid tolerance include opioid-sparing therapies and opioid rotation. It is important for patients presenting for anesthesia and analgesia, from the active to the recovering addict, including those experiencing various effects of substance abuse, to work with an interdisciplinary healthcare team to manage their condition. This includes a comprehensive preanesthesia assessment and evaluation that provides insight for optimal care. Perioperative anesthetic management strategies may differ with the abused substance.
Acetaminophen
Authors: Uzodinma Ifomachukwu 
Published: March 2023

Abstract
Acetaminophen (APAP) is one of the most commonly used analgesic and antipyretic agents around the world. APAP works by central inhibition of cyclooxygenase (COX), thus limiting the adverse effects that are commonly seen with other nonsteroidal anti-inflammatory drugs (NSAIDs). APAP works synergistically with other analgesic agents and can specifically decrease opioid requirements. Acetaminophen is typically dosed at less than 4 g/d in healthy patients and greater than 2 g in individuals with any underlying liver pathology or alcoholism. If APAP is consumed at toxic levels, hepatocellular necrosis and progression to acute liver failure may result. Excess APAP creates reactive metabolites, specifically increased levels of NAPQI (N-acetyl-p-benzoquinone imine), which leads to glutathione depletion and eventual cytotoxicity. N-Acetylcysteine is treatment for APAP-induced liver toxicity as it helps replenish glutathione stores and reduces NAPQI to a nontoxic metabolite.
Coma
Authors: Robertson Hess , Boysen Philip G. 
Published: March 2023

Abstract
Coma is defined as a state of profound unconsciousness caused by disease, injury, or poison. A medical description would also include a patient that cannot be awakened, fails to respond to painful stimuli (or light and sound), and does not initiate voluntary actions. Coma is a medical emergency, unlike most diagnostic processes that follow an orderly progression. Two overriding principles apply to the comatose patient. The first is that coma is a true medical emergency. The second principle follows from the first principle. Managing the coma patient requires beginning diagnostic and therapeutic measures at the same time to improve patient outcome.
Paraplegia, Quadriplegia, Spinal Shock, Autonomic Hyperreflexia, Acute Spinal Cord Injury
Authors: Papapetrou Peter , Ferguson Kris 
Published: March 2023

Abstract
Spinal cord injury brings unique considerations and challenges to the anesthesiologist. These patients have altered physiologic changes to their cardiovascular and respiratory systems and necessitate meticulous airway management. For patients with lesions of T6 or higher, they can experience the unique though catastrophic consequences of autonomic hyperreflexia. Evaluation of the timing and location of the spinal cord lesion is important to anticipate the extent of these physiologic changes. Succinylcholine should be avoided in patients that sustained spinal cord injuries between 3 days and 6 months prior to surgery, as they may have a massive hyperkalemic response that can result in ventricular fibrillation and cardiac arrest.
Tetanus
Authors: Forrest Patrick 
Published: March 2023

Abstract
Tetanus caused by Clostridium tetani infection is a rare disease still prevalent in the developing world. Toxins from the infection cause damage to the inhibitory synaptic pathways of the central nervous system, resulting in muscle rigidity, spasm, and, in the most severe forms, autonomic instability. Diagnosis is made clinically, and treatment comprises human antitetanus immunoglobulin, antibiotics, and stabilization of the sympathetic and parasympathetic nervous systems through medication classes, including benzodiazepines, opioids, α- and β-adrenergic blockers, and α2-agonists. Anesthetic implications include hemodynamic optimization prior to arrival at the operating room, use of anesthetics that can promote muscle relaxation, and close postoperative observation with possible need for ventilatory support following surgery.
Cerebral Protection
Authors: Kim Roy , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Research has demonstrated that perioperative injury to brain tissue can stimulate active responses in the brain that can persist well after substrate delivery has been restored to baseline levels. Cerebral protection involves understanding the metabolic demands of cerebral tissue to avoid ischemic and/or hypoxic injury. Insults to the brain during surgery and anesthesia can be categorized as global (involving the entire brain) or focal (a defined region of the brain). Such injury can potentially produce devastating results; therefore, it is paramount to prevent or limit ischemic damage by utilizing cerebral protective therapies and strategies throughout the perioperative period. Current available evidence is extrapolated largely from animal studies and limited data from clinical human subjects.
Ventriculostomy
Authors: Kim Roy , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Endoscopic third ventriculostomy (ETV) has become the standard neurosurgical procedure for treating noncommunicating hydrocephalus in both adult and pediatric patients. Although this is a minimally invasive procedure, ETV can rarely lead to serious perioperative complications that both the surgeon and anesthesiologist should be aware of. ETV involves establishing a connection between the third ventricle and prepontine subarachnoid space, allowing the flow of cerebrospinal fluid to bypass the aqueduct. It is faster and simpler than conventional shunt surgery and avoids major brain retraction or dissection. Complications included hemodynamic alterations, bleeding, delayed recovery from anesthesia, cerebrospinal fluid leaks, and electrolyte imbalances. Understanding possible complications and prompt detection can help minimize these risks and ensure optimal outcomes.
Normal Acid-Base Regulation
Authors: Alcibiade Erica , Mechlin Maggie W. 
Published: March 2023

Abstract
Maintaining a normal pH (7.35–7.45) is necessary for normal physiologic function. Beyond a normal range, widespread organ dysfunction ensues. Normal acid-base physiology is critical for numerous physiologic functions, including enzyme activity, chemical reactions, and transport of oxygen throughout the body. Numerous situations in the perioperative period can rapidly alter acid-base status, and general anesthesia can blunt the normal physiologic homeostatic response. Optimal pH is important for enzyme activity, chemical reactions, and transport of oxygen throughout the body. Thus, anesthesia providers must be able to recognize, diagnose, and treat acid and base disorders within the perioperative period. This chapter briefly discusses normal acid-base regulation and compensatory mechanisms that allow optimal physiologic function.
Strong Ionic Difference
Authors: Giordano Christopher , Patel Ravi 
Published: March 2023

Abstract
Physicians and scientists have been using the Henderson-Hasselbach equation to decipher acid-base imbalances since the early 1900s. By using the concentration of arterial CO2 (partial pressure of CO2) and the concentration of bicarbonate [HCO3−], the Henderson-Hasselbach approach helps differentiate between respiratory and metabolic derangements. Subsequently, the concept of anion gap was created to help further differentiate metabolic derangements. However, these traditional models often struggled to explain why acid-base derangements occurred in certain patient populations, such as hypoalbuminemic patients. In 1981, Peter Stewart introduced a novel concept that redefined the independent and dependent variables that affect pH. This new concept, sometimes referred to as the physicochemical approach or the strong ion approach, posits that the three independent variables affecting pH are partial pressure of CO2, total concentration of nonvolatile weak acids, and the strong ion difference. Similar to the traditional approach, Stewart’s approach splits acid-base disturbances into respiratory and metabolic derangements; however, unlike the traditional approach, Stewart’s approach further splits metabolic derangements into strong ion and buffer ion derangements. Perhaps the most controversial aspect of Stewart’s approach is that the concentration of bicarbonate is considered a dependent variable; changes in bicarbonate concentration do not cause pH changes but rather occur in response to pH changes.
Obstructive Lung Disease
Authors: Hierlmeier Bryan J. , Rugnath Anesh 
Published: March 2023

Abstract
Obstructive airway diseases are a commonly tested topic in anesthesia for both the written and oral examinations and are separated into upper airway (obstructive sleep apnea [OSA]), tracheobronchial (foreign body), and parenchymal disorders (mediastinal masses). Obstructive disorders have resistance to airflow which leads to air trapping and in turn increases the residual lung volume and total lung capacity. Obstructive sleep apnea patients typically have daytime somnolence, increased incidence of hypoxia, dysrhythmias, hypertension, myocardial ischemia, and pulmonary hypertension and have increased sensitivity to narcotics with respect to respiratory depression. Foreign body aspiration and mediastinal masses can be an anesthetic dilemma; serous preparation should be completed prior to induction of anesthesia as the consequences can possibly lead to loss of airway and cardiovascular collapse. This chapter concentrates on a few disorders in each major category that are commonly encountered.
Bronchopleural Fistula
Authors: Lepkowsky Adam , Coyne Dane 
Published: March 2023

Abstract
A bronchopleural fistula is an abnormal communication between the bronchial tree and the pleural space that can be caused by a number of surgical and nonsurgical etiologies. They are most commonly seen postpneumonectomy due to failed bronchial stump closure. Bronchopleural fistulas present with an air leak in the chest tube along with sudden onset dyspnea, cough, and increase of air-fluid levels on chest radiograph. The patient may also have fever and leukocytosis if empyema is present. Bronchopleural fistulas can lead to life-threatening pneumothorax. Diagnosis is usually made clinically and is then confirmed with either a bronchoscopy or a computed tomographic scan. One-lung ventilation is used to provide positive pressure ventilation to the healthy lung without loss of minute ventilation while reducing the risk of contamination from the affected lung. The safest approach is awake fiber-optic intubation with the patient breathing spontaneously to avoid a pneumothorax from positive pressure ventilation. Confirmation of lung isolation is necessary before positive pressure ventilation is applied to prevent a possible pneumothorax from inadequate isolation. Extubation should be attempted as early as possible to avoid barotrauma to the surgical stump.
Complications and Side Effects of Mechanical Ventilation
Authors: Mahboobi Sohail K. , Sohail Mahad 
Published: March 2023

Abstract
Mechanical ventilation is routinely used not only in critical care units but also on regular floors. Caring for a patient on a ventilator requires knowledge and understanding of the ventilator, its functioning, indications for placing a patient on the ventilator, choice of optimum ventilator mode, and sedation. In spite of the life-saving nature of mechanical ventilation, it is not free of complications and side effects. In fact, prolonged mechanical ventilation affects almost every organ system of the body, including the cardiorespiratory, gastrointestinal, renal, brain, hematologic, and immune systems. Successful outcome depends on prevention of possible complications, and adequate knowledge and planning are required to achieve this goal. This chapter summarizes the complications related to mechanical ventilation systematically.
Preconditioning
Authors: Helou Mada , Nazemian Ryan 
Published: March 2023

Abstract
The concept that brief manipulation(s) could protect an organ or tissue from subsequent ischemic injury was first put forth by Bob Jennings of Duke University. In the ensuing 35 years, ischemic preconditioning has been shown in preclinical studies to protect all commonly transplanted organs from myriad pathophysiologic insults; however, the translation of this phenomenon into clinical practice has not been smooth. Nonetheless, under controlled scenarios where there is a high probability of an ischemic event, various human preconditioning trials have demonstrated benefit with respect to improved organ function and reduced morbidity and mortality. Volatile anesthetics (VAs) have been shown to directly precondition or indirectly enhance ischemic preconditioning of a variety of different organs. The importance of preconditioning and its implications during general anesthesia and specifically during surgery are still controversial.
Off-Pump Coronary Artery Bypass (OPCAB)
Authors: Krebs Ryan , Sanders Joseph 
Published: March 2023

Abstract
Off-pump coronary artery bypass graft surgery (OPCAB) is an alternative to standard coronary artery bypass graft (CABG) surgery. This procedure is performed similarly to CABG and involves one or more coronary arteries bypassed via a midline sternotomy approach. OPCAB has the advantage of avoiding the complications of cardiopulmonary bypass (CPB), such as coagulopathy, the inflammatory response, and manipulation of the aorta. Compared to the use of CPB, the lack of optimal surgical conditions and increased hemodynamic instability with OPCAB are challenges the surgeon and anesthesiologist will face. The anesthesiologist must be prepared to handle patient hemodynamic instability during OPCAB, which is different from full hemodynamic support provided during CPB.
Percutaneous Valve Repair/Replacement
Authors: Mohammed Asif Neil , Potchileev Iordan 
Published: March 2023

Abstract
Percutaneous valve replacement and repair have become a rapidly emerging treatment modality in the field of cardiology and cardiothoracic surgery due to the less invasive nature and the ability to prolong the lives of patients with significant comorbidities. When percutaneous techniques were introduced, most patients were treated under general anesthesia. However, studies and experience demonstrated over time that moderate sedation led to improved outcomes in the majority of patients. Methods to repair the valve include balloon valvuloplasty, edge-to-edge repair, annuloplasty, or complete valve replacement. Physical approaches can be performed via transfemoral, subclavian, axillary, radial, transcarotid, or, less commonly, transapical routes. Hemodynamic goals vary according to the type of valvular lesion being repaired, but the anesthesiologist should strive to maintain sinus rhythm, preload and afterload, and contractility of the heart through inotropic support.
Anesthetic Management of Kidney Transplantation
Authors: Helou Mada , Nazemian Ryan 
Published: March 2023

Abstract
Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). With recent advancements in the field of transplantation, especially with an expanded donor pool and postoperative care, kidney transplants are now viewed as relatively straightforward surgeries. More than 23,000 kidney transplants were done in the United States in 2019, yet there still remains major unmet need for more organs. As of June 20, 2020, there were more than 93,000 patients on the waiting list to receive a kidney transplant. Thus, optimum anesthetic management is an integral part of patient and graft survival. The majority of transplanted kidneys are procured from deceased donors following death by neurological criteria (DNC). Therefore, due to the unpredictable and emergent nature of the surgery, in addition to routine preoperative evaluation, unique considerations need to be addressed. This chapter reviews the major considerations for pre-, intra-, and postoperative care of kidney transplantation.
Urologic Surgery
Authors: Dalton Allison K. 
Published: March 2023

Abstract
Patients presenting for urological surgery represent a spectrum of genitourinary disease states. Common presenting diagnoses include hematuria, urinary obstruction, and benign and malignant tumors. Urologic procedures run a continuum of risk from simple cystoscopy to open cystectomy. While open procedures are associated with increased morbidity and mortality, minimally invasive procedures utilizing robotic assistance create distinct issues for anesthetic management. Each individual urologic procedure presents its own challenges to the anesthesiologist: concern for intraoperative blood loss, electrolyte derangements, risk of nerve injury, and altered respiratory and cardiovascular physiology. In addition, due to common risk factors for malignancy, patients presenting for urologic surgery may have significant medical comorbidities, which will require meticulous preoperative planning, intraoperative execution, and postoperative monitoring.
Anticoagulants and Antagonists
Authors: Devangam Suhas , Lemmink Gretchen A. 
Published: March 2023

Abstract
The realm of pharmacological anticoagulation has changed rapidly in the past two decades, expanding from the narrow field of aspirin (ASA), heparinoids, and vitamin K antagonists to the myriad classes of anticoagulants available in the modern era. Patients may present for surgery on any combination of the aforementioned drugs. Conversely, they may be taking one of the newer classes of antiplatelet agents (often in combination with ASA), direct oral anticoagulants, or even a parenteral direct thrombin inhibitor. Anesthesiologists will encounter all of these drugs during their career in a variety of clinical settings from elective surgery to unplanned procedures and life-threatening emergencies. An astute perioperative physician must understand the numerous indications for anticoagulation as well as the pharmacokinetics of these agents, how to monitor their anticoagulant activity, and how best to reverse each specific drug in an emergency. This chapter discusses the most common anticoagulants and antithrombotics used in clinical practice today and antagonist agents that are used to counteract them.
Coagulopathy in Trauma Patients
Authors: Ford Timothy , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Despite advances in trauma care, trauma remains a leading cause of disability and death globally due to uncontrolled hemorrhage. This is because one-quarter to one-third of trauma patients develop a biochemically evident coagulopathy. Coagulopathy arising in trauma patients is complex and multifactorial, with overlapping etiologies disrupting the balance of hemostatic and fibrinolytic processes. Contributing etiologies include acidosis, hypothermia, dilutional resuscitation, disseminated intravascular coagulation, platelet dysfunction, and trauma-induced coagulopathy. The last is due to a combination of tissue injury and shock resulting in molecular and physiologic perturbations. Ultimately, this complex coagulopathy in trauma patients manifests as uncontrolled hemorrhage, organ failure, thromboembolic complications, and death.
Transfusion Indications and Reactions
Authors: Scott Courtney L. , Boydston Elaine A. 
Published: March 2023

Abstract
Understanding both the indications for blood product transfusion and the potential complications is crucial to the knowledge base of an anesthesiologist. In the setting of anemia, the available evidence generally supports transfusion of packed red blood cells (pRBCs) when a patient’s hemoglobin level is between 7 and 10 g/dL depending on the patient’s comorbid conditions, the potential for ongoing blood loss, and signs or symptoms of organ ischemia. Transfusion of fresh frozen plasma and/or platelets is generally indicated in the setting of bleeding attributable to an inherited or acquired deficiency in these factors. Similarly, cryoprecipitate is indicated for bleeding due to hypofibrinogenemia or dysfibrogenemias. Transfusion-related complications vary in severity on the spectrum from symptomatically mild to severe and fatal. The most common complications are relatively benign and include febrile nonhemolytic transfusion reactions (0.5%–1% of all transfusions) and urticarial reactions. More severe reactions are fortunately less common and include anaphylactic reactions (most commonly due to a recipient with immunoglobulin [Ig] A deficiency who receives a blood transfusion containing IgA) and acute hemolytic transfusion reactions (due to transfusion of ABO-incompatible blood most commonly due to clerical error). The risk of transmission of bloodborne pathogens has decreased due to improved testing of the donor blood supply; however, bacterial contamination, especially of platelets (due to their storage at room temperature, which is optimal for bacterial growth), may still occur. Transfusion-related acute lung injury (TRALI) is an illness like acute respiratory distress syndrome (ARDS) appearing within 6 hours of receiving a blood transfusion and is the most common cause of death attributable to blood transfusion. Metabolic derangements, including acidemia, hyperkalemia, and hypocalcemia, are more commonly associated with transfusion of large volumes of blood products.
Thyroid Gland
Authors: Romanov Evgenev , Noguera Edward 
Published: March 2023

Abstract
Anesthesiologists should be familiar with thyroid gland anatomy, pathophysiology, and clinical management of thyroid disorders. The thyroid gland is in the neck in front of the thyroid cartilage. It consists of two lobes connected by the isthmus. The thyroid gland secretes thyroid hormones that play a major role in the regulation of metabolism, development, growth, and brain development. Each lobule is filled with microscopic follicles that are the functional units of the thyroid gland. For instance, thyroid storm, although rare, carries high perioperative mortality. There are multiple airway considerations in patients with a thyroid mass. Furthermore, patients who are not euthyroid can have different clinical responses to anesthetic agents.
Carcinoid Syndrome
Authors: Sam Sabrina S. , Ragheb-Mueller Nawal E. 
Published: March 2023

Abstract
Carcinoid syndrome is a paraneoplastic syndrome secondary to vasoactive substances secreted by carcinoid tumors. The most common vasoactive substances secreted by carcinoid tumors are serotonin, histamine, and kinins. The trademark triad consists of flushing, diarrhea, and bronchospasm. Right-sided heart disease is a serious complication. Diagnosis is confirmed by discovery of serotonin metabolites in the urine. Treatment with octreotide, a somatostatin analogue, is the mainstay of treatment for controlling symptoms related to serotonin. Definitive therapy is possible in some cases with surgery. Avoidance of surgical and anesthetic triggers that lead to the release of vasoactive substances is essential. Chemoprophylaxis is provided with octreotide.