bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Respiratory Failure
Authors: Boysen Phil , Newman Patrick 
Published: March 2023

Abstract
Respiratory failure is the loss of the body’s ability to maintain appropriate oxygen delivery to the blood and removal of carbon dioxide from the blood. Respiratory failure can be classified as hypoxemic, hypercarbic, or mixed. The timeline is also used to describe it: acute, chronic, and acute on chronic. Significant morbidity and mortality occur due to respiratory failure, which is a common reason for hospital and intensive care unit (ICU) admission. As such, timely and effective management, both in the ICU and the operating room (OR), is extremely important. This chapter takes a look at management of respiratory failure and anesthetic considerations for patients in respiratory failure.
Lung Transplantation
Authors: Amiri Yamah , Kurian Dinesh J. 
Published: March 2023

Abstract
Patients with end-stage lung disease can be candidates for lung transplant therapy and get prioritized based on lung allocation score (LAS). It is critical to evaluate preoperative factors related to patient lung disease, including studies evaluating right and left heart function and V/Q (ventilation-perfusion) scan. The complexity of the procedure requires adequate equipment, including a double-lumen endotracheal tube, difficult airway adjuncts, arterial line, central line, large-bore intravenous lines, transesophageal echocardiography, and a second ventilator. Uniquely, hemodynamic instability can necessitate the use of inotropes to support right ventricular function and careful fluid resuscitation to minimize pulmonary edema. Native and donor lungs require different ventilation strategies. Furthermore, coordination with the pulmonary transplant team requires planning for immunosuppression medication and timing, along with antibiotic therapy. Anesthetic planning for a transplanted lung requires consideration of complications related to transplant, including infection, immunosuppression, ventilation strategies, aspiration risk from gastroesophageal reflux disease (GERD) or decreased esophageal sphincter tone, kidney function, and appropriate blood product use.
Ischemic Heart Disease
Authors: Parga Daniel Ramirez , Jamroz Tatiana 
Published: March 2023

Abstract
Ischemic heart disease occurs when the blood supply does not meet the oxygen demand of the heart. There are several reasons for this mismatch. The most common is atherosclerotic disease, wherein endovascular endothelium damage and plaque rupture with thrombus formation cause the imbalance. Common symptoms include chest pain, sweating, and shortness of breath. Diagnosis is usually clinical, with laboratory and imaging confirmation. Acute coronary syndrome is an emergency that should be treated as soon as possible to prevent serious complications and to improve patients’ outcomes. Therapy could be pharmacological or interventional (reperfusion and revascularization). Myocardial injury, even though it is a prerequisite for the diagnosis of myocardial infarction, is also recognized as an entity itself. It is defined by an elevated cardiac troponin value and is frequently encountered clinically. It is associated with an adverse prognosis. An elevated cardiac troponin value reflects injury to myocardial cells from a variety of underlying pathophysiological mechanisms, ischemic and nonischemic alike. Myocardial injury after noncardiac surgery (MINS) is troponin elevation apparently from cardiac ischemia. It occurs postoperatively, usually silently, and is independently associated with risk of death and cardiovascular complications over the initial postoperative year.
Postobstructive Pulmonary Edema
Authors: Kloesel Benjamin , Horvath Balazs 
Published: March 2023

Abstract
Postobstructive pulmonary edema (POPE) can occur in the perioperative period. A variety of causes, including upper airway obstruction due to oropharyngeal anatomical and functional variations, oversedation, laryngospasm, and occlusion of the endotracheal tube, may result in supraglottic or glottic obstruction. Respiratory efforts against an obstructed airway can generate negative pleural pressures significantly below the physiological level. The large pressure gradient increases venous return to the heart and facilitates fluid movement from the alveolar capillary network into the alveoli. The ensuing pulmonary edema causes dyspnea, hypoxemia, and cough. POPE is frequently self-limited with a good prognosis but, depending on the severity, may require treatment ranging from supplemental oxygen to mechanical ventilation and potentially even extracorporeal life support.
Pulmonary Hypertension
Authors: Barrack Frank , Noorda Bryan 
Published: March 2023

Abstract
Providing effective care of patients with pulmonary hypertension requires a thorough understanding of the etiology and severity of the disease. Persons with pulmonary hypertension can experience a range of symptoms, from shortness of breath, chest pains, fatigue, to syncope. These effects on the body stem from increased right heart strain and eventually right heart failure in advanced disease. Pulmonary hypertension is divisible into five groups with different mechanisms. Differentiation of pulmonary hypertension by group has important implications in the treatment of the disease for a specific patient, although some principles of management are applicable for all types. Important considerations to keep in mind for preoperative, intraoperative, and postoperative care of patients with pulmonary hypertension are also discussed.
Mechanical Circulatory Assist Devices
Authors: Leonardi James , Cormican Daniel 
Published: March 2023

Abstract
Ventricular assist devices (VADs) are technologies used to provide mechanical support to failing ventricles in order to improve cardiac output to ensure adequate tissue perfusion. VADs are used as a bridge to transplant, bridge to recovery, or destination therapy for failure of the right ventricle, left ventricle, or both ventricles and may be used as either temporary or long-term treatments. They can utilized as temporizing measure to stabilize blood pressure for patients in acute, severe cardiogenic shock associated with respiratory failure refractory to ventilator management. Each VAD device is associated with nuances that must be considered in order to provide optimal therapeutic benefit and reduce risk of harm; the reader is referred to the chapters within this text that are specific to each device for additional information. An overview of the aforementioned devices in presented in the chapter.
Extracorporeal Membrane Oxygenation (ECMO)
Authors: Morkos Michael , Cormican Daniel 
Published: March 2023

Abstract
Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary bypass used as a last resort effort following unsuccessful medical management in patients with severe, but reversible, cardiopulmonary pathology. Physicians should be well versed in the different modes of support available and appropriate patient selection for each mode. Outcomes are optimized when the configuration is tailored to each individual’s needs and comorbidities. Specific indications and contraindications exist for each approach to ECMO as well as multiple options for cannulation that may alter hemodynamic monitoring. Many complications often arise during ECMO that must be addressed in a timely manner to reduce morbidity and mortality.
Parenteral Nutrition
Authors: Fayed Mohamed , Valliani Arif 
Published: March 2023

Abstract
Parenteral nutrition refers to the provision of nutrition via the parenteral route. Nutrition should provide calories, protein, electrolytes, vitamins, minerals, trace elements, and fluids. Adequate nutritional support is essential for the management of critically ill patients. This chapter reviews the daily nutritional requirements and the timing of parenteral nutrition. It also summarizes the effects of malnutrition and of overfeeding in the critically ill patient. It also discusses immune-enhancing nutrition and provides a quick overview of refeeding syndrome and its management. This chapter and the enteral nutrition chapter complement each other in providing the basic principles of nutrition in critically ill patients.
Postoperative Hepatic Dysfunction
Authors: Nielson Peter , Kaufman Michael 
Published: March 2023

Abstract
While the causes of postoperative hepatic dysfunction are numerous, a systematic approach involves an evaluation based on analysis of intraoperative events as well as a pattern of laboratory value abnormalities. Elevated enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) should raise suspicion for direct damage to the liver, usually through a low-flow state or via drug or immunologic damage. Bilirubinemia will likely be from disruption of the pathway of bile excretion or from an increase of heme breakdown products. Halogenated anesthetic-induced hepatitis, while a theoretical cause of postoperative liver dysfunction, might be considered a diagnosis of exclusion until other causes are investigated in the modern era.
Liver Transplant Surgery
Authors: Mattimore John , Kaufman Michael 
Published: March 2023

Abstract
Liver transplantation surgery is a life-saving treatment for people with end-stage liver disease, often with very short life expectancies. Liver transplantation has become the mainstay treatment for most causes of hepatic failure, with 8250 cases performed in the United States in 2018, and graft 1-year survival rates reaching greater than 91%. Liver transplant surgery presents the anesthesiologist with very complex hemodynamic challenges requiring constant vigilance, a plethora of advanced monitoring devices, and close collaboration with surgical colleagues. This chapter covers the recipient selection process; the stages of a transplantation surgery with specific concerns of the anesthesiologist at each stage, including the intraoperative electrolyte and hemodynamic changes; and the evaluation of postoperative graft function.
Perioperative Oliguria and Anuria
Authors: Earls Brent , Sivanesan Eellan 
Published: March 2023

Abstract
Perioperative oliguria and anuria are common clinical signs associated with reduced kidney function and acute kidney injury (AKI). AKI in the perioperative period is a common complication associated with increased morbidity and mortality. A standard definition and staging system for AKI has been developed that is based on urine output and serum creatinine. Future classification schemes may seek to incorporate the use of novel biomarkers to detect kidney damage before or without traditional serum markers like creatinine. During the intraoperative period, urine output may be reduced in the absence of kidney injury or the presence of kidney injury, with or without fluid responsiveness. Several risk factors for AKI are important to assess in surgical patients. These include comorbidities such as chronic kidney disease and chronic heart failure. Increased risk of in-hospital AKI has also been associated with medications such as diuretics, contrast agents, and nephrotoxic drugs, which are commonly used throughout the perioperative period. Intraoperatively, episodes of hypotension should be avoided when possible since even short periods of hypotension are associated with an increased risk of AKI. Emergency surgery, procedures in the critically ill, and even open surgical techniques have also been associated with higher rates of AKI. The Kidney Disease: Improving Global Outcomes guidelines from 2012 suggested implementing preventive strategies in high-risk patients. Prevention includes hemodynamic goal-directed therapy, restoration of circulating volume, functional hemodynamic monitoring, and avoidance of nephrotoxic agents and hyperglycemia.
Dialysis and Hemofiltration
Authors: Gyorfi Michael J. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Renal replacement therapy (RRT) is designed to replace nonendocrine kidney function. This is important for patients with acute/chronic renal failure, electrolyte/uremic abnormalities, fluid management, and occasionally for some forms of poisoning. Techniques include hemodialysis, hemofiltration, and peritoneal dialysis. All modalities exchange solute and remove fluid from the blood using dialysis and filtration across permeable membranes. Dialysis is an important aspect to factor into pre-, intra-, and postoperative plans. Factors such as drug elimination, electrolyte abnormalities, fluid management, and bleeding risk must be considered for dialysis-dependent patients.
Assessment of Fluid Responsiveness and Goal-Directed Therapies
Authors: Sohn Jacqueline , McNamara Connor 
Published: March 2023

Abstract
An accurate assessment of intravascular volume status and its management is challenging, and there have been many debates over the topic through the years. The clinical assessment of a patient’s intravascular volume is very challenging and controversial. However, the maintenance of euvolemia is critical to electrolyte homeostasis and oxygen delivery to the tissues. This chapter reviews physiological background and various modalities on assessment of fluid responsiveness. The modalities include central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP), esophageal Doppler, pulse pressure variation, and pulse contour analysis. This chapter further discusses goal-directed therapies and the controversies surrounding fluid management strategies.
Hemoglobinopathies and Porphyrias
Authors: Haynes Elizabeth , Hussain Nasir 
Published: March 2023

Abstract
Hemoglobinopathies are genetic blood disorders that include α- and β-thalassemia as well as diseases that cause abnormal hemoglobin structure. Porphyrias also encompass a group of metabolic disorders that interfere with the body’s normal hemoglobin production by altering heme synthesis. A series of blood tests is used to confirm the diagnosis of a hemoglobinopathy. Porphyrias are often difficult to diagnose because of their varied presentations and nonspecific symptoms. The medical therapies for both focus less on curative treatments and aim to provide symptomatic management and prevention of crises. In both disease states, acute attacks can be triggered by many factors during the perioperative period. A thorough preoperative evaluation should be performed to evaluate disease severity and the need for additional testing. Possible triggers for acute attacks should be identified and avoided. Postoperative monitoring is needed as these patients are at an increased risk of having an acute crisis as well as postsurgical complications.
Transfusion Ratios
Authors: Lee Albert , Schulman Nathan 
Published: March 2023

Abstract
This chapter discusses optimum transfusion ratios in the setting of massive transfusion, a critical topic given that blood product transfusions remain one of the most common procedures in hospitals. Component transfusion therapy has been adapted to various transfusion protocols and policies based largely on anecdotal and observational data given the lack of robust, randomized clinical trials (RCTs). This chapter reviews and briefly summarizes the current evidence, including the PROMMTT (Prospective, Observational, Multicenter, Major Trauma Transfusion) and PROPPR trials, meta-analyses, and one of the few RCTs available to date. The available data would favor the utilization of a structured, component-based transfusion strategy in patients with massive transfusion requirements with transfusion ratios of fresh frozen plasma to red blood cells at least greater than/or equal to 1:2. Blood product transfusion inherently carries risks, including those specific to massive product administration. This chapter also briefly reviews citrate, supernatant potassium, transfusion hypothermia, transfusion-associated circulatory overload (TACO), and transfusion-associated lung injury (TRALI) as risks to consider when utilizing a massive transfusion strategy, regardless of ultimate component ratio.
Hypopituitary Disease
Authors: Nalbandyan Ruzanna , Ragheb-Mueller Nawal E. 
Published: March 2023

Abstract
Hypopituitarism refers to decreased secretion of one or more pituitary hormones, which can result from diseases of the pituitary gland or pathology arising in the hypothalamus. The clinical manifestations depend on which pituitary hormone is deficient. Patients may present with nonspecific symptoms or with severe symptoms related to a deficiency in a particular hormone. Preoperative evaluation should include a complete history, physical examination, appropriate laboratory and endocrine evaluation, and include a complete thyroid panel, serum cortisol, corticotropin (formerly adrenocorticotropin, ACTH) growth hormone, insulinlike growth factor 1, follicle-stimulating hormone, luteinizing hormone, prolactin, and testosterone levels. Intraoperative management of patients includes maintenance hormone replacement therapy, continuous hemodynamic monitoring, and monitoring of intraoperative electrolyte and metabolic abnormalities. Emergency conditions such as Addisonian crisis, myxedema coma, and central diabetes insipidus require prompt recognition and treatment. Postoperative management necessitates adequate postoperative analgesia as well as appropriate fluid and electrolyte monitoring.
Multiple Sclerosis
Authors: O’Farrell Justin L. , Eckmann Maxim S. 
Published: March 2023

Abstract
Multiple sclerosis is an immune-mediated inflammatory disease causing demyelination of axons in the central nervous system. The location of demyelination and plaque development correlates with clinical symptoms observed in patients with multiple sclerosis. Classic presenting symptoms include nystagmus, dysarthria, and intention tremors. Patients with multiple sclerosis may present with different patterns of disease progression and acute exacerbations. The diagnosis is mainly clinical and can be supported with magnetic resonance imaging. Managing comorbid symptoms and acute exacerbations is critical along with long-term disease-modifying therapy. There are no curative therapies for multiple sclerosis. Patients will require close monitoring throughout the periods of acute disease exacerbation. Due to variability in disease presentation, critical preoperative assessment of patients with multiple sclerosis is needed to avoid the use of medications that may complicate perioperative management.
Myasthenia Gravis
Authors: Morkos Michael , Cormican Daniel 
Published: March 2023

Abstract
Myasthenia gravis is the result of autoimmune antibodies targeted against acetylcholine receptors on postsynaptic membranes of the neuromuscular junction. The majority of patients will describe drooping of the eyelids and blurred vision as their initial symptoms with worsening weakness associated with continued muscle use. Typically treated with pyridostigmine, other options such as intravenous immunoglobulin and plasmapheresis, exist for severe symptoms associated with myasthenic syndrome. The anesthetic plan must be thoughtfully considered, taking into account premedication, induction agents, and neuromuscular blocking drugs administered. Most importantly, extubation must be done in a well-planned manner to ensure adequate neuromuscular function to allow appropriate ventilation.
Postherpetic Neuralgia
Authors: Abd-Elsayed Alaa , Mauer Kim 
Published: March 2023

Abstract
This is a brief abstract of postherpetic neuralgia. Post-herpetic neuralgia can be a troubling diagnosis, but it is also known as a classic example of a neuropathic pain condition and is well studied. It provides a clear example of how a peripheral nerve change can lead to dysfunction of the central nervous system. Postherpetic neuralgia is the most common complication of shingles, which is characterized by its classical dermatomal rash. The pain is a classical neuropathic, burning pain The etiology of postherpetic neuralgia and common treatments are discussed; also, demographic and prevalence information is given about postherpetic neuralgia. Some investigational uses of therapies for postherpetic neuralgia are mentioned (these investigational uses need additional studies).
Apparatus and Breathing Circuits
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Breathing circuit apparatus choice for infants and children is often pragmatic. It relies on ability to maintain heat and humidity while minimizing work of breathing required to sustain normocarbia. This chapter discuss breathing circuits as they apply to neonatal and pediatric patients. Circle systems conserve heat and humidity at the potential expense of volume loss to the circuit and errant delivery of dangerous tidal volumes. Meanwhile, the Jackson-Rees circuit minimizes work of breathing during spontaneous respiration but predisposes to airway desiccation and heat loss. Finally, infant t-piece resuscitators effectively minimize dead space but carry the risk of breath stacking and inaccuracy of tidal volume delivery.
Induction Techniques
Authors: Shaik Sadiq S. , Boyette Lydia C. 
Published: March 2023

Abstract
Anesthetic induction in pediatric patients can safely be performed using multiple modalities but requires a multifaceted review and discussion with the patient and the patient’s parents or legal guardians. Intravenous (IV), intramuscular (IM), rectal, and inhaled anesthetics are all options for pediatric anesthetic induction; however, the technique chosen should be based on review of patients’ medical, surgical, and anesthetic histories; physical examination findings; and the planned procedure. The thorough review of patients’ histories and discussions with their families will not only facilitate rapport between the anesthesiologist and the aforementioned parties, but also provide information that may aid in early identification and treatment of complications associated with induction.
Drug Toxicities Preferentially Occurring in Children
Authors: Yao Caylynn , Peterson Elisha 
Published: March 2023

Abstract
Drug Toxicities Preferentially Occurring in Children reviews medication toxicities of relevance to an anesthesiologist concerning neonates, infants, and children. Toxicities can manifest in the setting of immature organ function in neonates, genetic variability of cytochrome p450 enzymes or due to medication-induced mitochondrial dysfunction. Identifying toxicities in a preverbal/limited verbal patient population is an added challenges that often results in late symptom identification. This chapter outlines the considerations in the pharmacokinetics and pharmacodynamics of young patient populations that render them vulnerable to toxicity in certain analgesics and hypnotics. Codeine and amide local anesthetics are discussed in greater detail. Reyes syndrome and propofol infusion syndrome (PRIS) are covered. The mechanisms underlying PRIS and the role of aspirin in Reyes syndrome have yet to be clarified.
Regional Anesthesia
Authors: Hoffmann Cassandra , Frazee Tiffany 
Published: March 2023

Abstract
Many differences exist between pediatric and adult regional anesthesia, including differing neurocognitive states, anatomy, physiology, and pharmacodynamics. In pediatric patients, regional procedures are performed under general anesthesia; many children cannot tolerate the placement of an awake block. Infant spine anatomy involves a low-lying conus medullaris and an increased volume of cerebral spinal fluid per kilogram with rapid turnover. These differences affect both block placement and duration. Physiologically, infants and children undergoing neuraxial procedures tolerate sympathetic blockade, and blood pressure remains preserved. Pharmacodynamics are affected by decreased levels of α1-glycoprotein, which result in decreased protein binding of local anesthetics and can increase toxicity risk. Despite these challenging differences, pediatric regional anesthesia can result in improved postoperative analgesia, decreased intraoperative anesthetic requirements, and decreased opioid requirements.