bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fluid Therapy and Blood Replacement
Authors: Bilga Iana , Tzonkov Anna 
Published: March 2023

Abstract
Neonates, infants, and young children are more susceptible to overhydration and dehydration in the perioperative period than adults. There a lot of controversies related to fluid management in modern anesthesia. Fluid therapy in pediatric patients is focused on four main targets: replacement of preoperative deficit, maintenance fluids, and ongoing intraoperative losses. The selection of fluid in pediatric patients depends on age and settings. Decisions regarding blood transfusion must be based not purely on estimated blood loss but also patient’s blood volume, preoperative hematocrit, underlying medical conditions, nature of the surgical procedure, and risks versus benefits of transfusion. Knowledge of physiology and demand of pediatric patients is the key to the best fluid management and blood product therapy.
Neonatal Physiology
Authors: Dua Nupur , Fromer Ilana R. 
Published: March 2023

Abstract
To safely care for newborns in the operating room, anesthesiologists need a thorough understanding of the neonatal physiology at different gestational ages and anticipate how immature organs might respond to surgery and anesthetic agents. There are differences in neonatal, pediatric, and adult physiology. The neonates have transitional circulation during the first few weeks of life, and various factors need to be considered to avoid reversion to fetal circulation. There are major differences in the neonatal and adult airway that require modification in the choice of equipment and intubation technique. It is important to know that the respiration is less efficient in neonates, and they are more prone to hypoxia. Most of the major organs, such as kidneys, liver, and heart, are immature at birth and develop at different rates as the neonate grows. Similarly, metabolism and fluid distribution are very different from adults. This involves consideration with the use of anesthetic agents and management in the operating room. Neonates are especially vulnerable to intraoperative hypothermia. Preoperative evaluation is arguably the most important part of anesthetic care. The purpose of this chapter is to allow anesthesia providers to administer safe care to newborns based on an understanding of developmental physiology.
Pulmonary Hypertension
Authors: Kloesel Benjamin , Horvath Balazs 
Published: March 2023

Abstract
Pulmonary hypertension is defined by a resting mean pulmonary artery pressure equal or greater than 25 mm Hg. In the perioperative setting, children diagnosed with pulmonary hypertension are at 20-fold higher risk for cardiac arrest and death. It is associated with significant morbidity and mortality and requires a carefully planned and executed approach to deliver a safe anesthetic. A feared complication in children with pulmonary hypertension is the development of a pulmonary hypertensive crisis. This emergency, which can potentially result in cardiopulmonary arrest, requires prompt intervention aimed at reducing pulmonary vascular resistance and interrupting the vicious cycle that ultimately results in right ventricular failure.
Chronic Congenital Heart Disease
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Presently there are many more adults than children living with congenital heart disease (CHD). The adult with CHD will likely have had at least one previous intracardiac repair and transitioned care from a pediatric cardiologist to a general or adult congenital cardiologist. Therefore, expert care of this population relies on knowledge of previous anatomy, repair, present anatomy, and long-term complications. A high index of suspicion must be maintained for subtle historical or physical examination features that suggest progression or complication of disease or subacute bacterial endocarditis. Compliance with instruction, medication, and cardiology follow-up should help to optimize each patient prior to elective surgery and anesthesia.
Tracheoesophageal Fistula
Authors: Wasson Cassandra , Diaz Christina D. 
Published: March 2023

Abstract
Tracheoesophageal fistula (TEF) is a congenital fistula between the trachea and esophagus. Prenatal ultrasound suggests a diagnosis of TEF by findings of polyhydramnios and a small or absent fetal stomach bubble. There are five subtypes of TEF, which are determined by the location of the fistula and presence or absence of esophageal atresia, the most common being type C. Additional congenital anomalies occur in 50% of patients with TEF. Many of these congenital anomalies are part of the VACTERL (vertebral defects, anal atresia, cardiac anomalies, TEF, renal agenesis and dysplasia, and limb anomalies) sequence. A 12-lead electrocardiogram (ECG) and echo should be obtained to diagnose associated congenital heart disease. Treatment for TEF is by surgical repair (cervical dissection, thoracotomy, or thoracoscopy) or endoscopic procedures. TEF repair is generally an urgent operation to minimize aspiration pneumonia and begin enteral nutrition. The preferred endotracheal tube for intubation is a microcuff endotracheal tube. Historically, TEF was 100% fatal. However, survival rates are now as high as 95%. Postoperative analgesia options include an opioid infusion, epidural catheter, caudal catheter, subcutaneous wound catheter, and local infiltration. Regional anesthesia can facilitate earlier extubation by reducing the risk of apnea with opioid analgesia.
Respiratory Distress Syndrome
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Respiratory distress syndrome (RDS) is a condition of the newborn in which lack of pulmonary surfactant predisposes to atelectasis, intrapulmonary shunting, hypoxemia, and hypoventilation. These problems lead to reopening or failed closure of the patent ductus arteriosus, bronchopulmonary dysplasia (BPD), and pulmonary hypertension. RDS is commonly found in premature infants as their surfactant production is inadequate or has yet to occur or infants of diabetic mothers whose lungs are often immature for their gestational age. In addition to anesthetic considerations for newborns, those with RDS will benefit from a lower oxygen saturation target; avoidance of cold, dry respiratory gas; and maintenance of continuous positive airway pressure throughout the perioperative period.
Chromosomal Abnormalities and Other Common Pediatric Syndromes
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 disorders other than trisomy 21 include trisomy 13 (Patau syndrome) and trisomy 18 (Edwards syndrome). Even though trisomy 13 and 18 infants generally have a shortened life span (many less than a year), they can still present for diagnostic and therapeutic procedures and pose certain anesthetic risks. Other major syndromes that result in anesthesia challenges in the pediatric population include micrognathia syndromes (Pierre Robin, Treacher Collins, and Goldenhar syndrome), CHARGE syndrome, VACTREL association, metabolic syndromes, and muscular dystrophies. This chapter summarizes the clinical manifestations of the most common pediatric chromosomal abnormalities and syndromes that require unique considerations from the pediatric anesthesiologist.
Anesthesia for Pediatric Ophthalmologic Surgeries
Authors: Dua Nupur , Nguyen Wendy 
Published: March 2023

Abstract
Commonly performed pediatric ophthalmologic procedures performed under anesthesia include eye examination for tonometry, fundoscopy, and assessment of visual evoked potentials, cryotherapy or laser therapy for retinopathy of prematurity or retinoblastoma, strabismus repair, lens extraction in cataracts, and enucleation, which are predominantly performed in the ambulatory setting. However, special considerations are needed in premature infants with congenital disorders associated with pathology of the eye. An understanding of oculocardiac reflex (OCR) and postoperative nausea and vomiting (PONV) is more pertinent to pediatric ophthalmic surgeries. Differing from adult ophthalmic surgeries, use of regional blocks are not commonly used. Therefore, perioperative pain management needs to be considered, especially with more invasive procedures. This chapter describes the anatomy and physiology of the eye and the perioperative anesthetic management of commonly performed ophthalmic procedures in the pediatric population.
Systemic Medications and Routes of Administration
Authors: Saklayen Samiya L. , Graul Thomas 
Published: March 2023

Abstract
A comprehensive approach to pediatric pain management aims to address the multidimensional, biopsychosocial components of pain. Pharmacological measures to treat postoperative pain in children are often combined in a multimodal approach and may include regional anesthesia, and opioids as well as nonopioid analgesics. Many small studies have demonstrated beneficial opioid-sparing effects with the use of nonopioid adjuncts in children. Opioids continue to be predominant in providing adequate pain control for surgeries associated with significant postoperative pain, but not without risk. Certain medications, including codeine and tramadol, are now contraindicated by the Food and Drug Administration for treatment of postoperative pain following tonsillectomy in children.
Amniotic Fluid
Authors: Urness James , Attali Ami 
Published: March 2023

Abstract
Amniotic fluid is a complex, free-flowing fluid that surrounds the developing fetus and changes in function, composition, and volume as the pregnancy progresses to term. This medium supports the developing fetus in various ways, by forming a protective environment preventing injury from the outside, allowing free movements, serving as a means of nutrient and signaling transfer, and working as a defense system against foreign microbes. The production and maintenance of amniotic fluid balance rely on a number of sources depending on the stage of fetal development, maternal hydration, hormonal status, and placental perfusion. During routine antenatal visits, the amniotic fluid volume is measured and expressed as an objective amniotic fluid index compared to expected volumes. If there is less or more amniotic fluid than expected, it is termed oligohydramnios and polyhydramnios, respectively, and the timing of volume irregularities correlate to various problems in development of the fetus. During delivery, an amniotic fluid embolism (AFE) is one of the most feared and devastating obstetric complications for maternal prognosis, which can present with respiratory distress, cardiovascular collapse, and coagulopathy.
Spontaneous Abortion
Authors: Younger Joshua D. , Prasad Monica 
Published: March 2023

Abstract
Abortion can occur both spontaneously and electively. An abortion can be performed either medically or surgically. Medical abortions are usually managed with medications such as methotrexate, mifepristone, and misoprostol. Surgical abortions are performed with a manual vacuum aspirator (MVA), metal curette, a suction device, or any combination of these. Of note, 5% of all pregnancy-related maternal deaths are associated with either an elective or a spontaneous abortion. These maternal deaths are usually linked to sepsis and/or hemorrhage. The anesthetic considerations are dependent on the active issues that present when the patient enters the operating suite. The most concerning of them is the rapid management of hemorrhage and infection.
Endocrine Disorders
Authors: Zhou Eric P. , Chung Kevin W. 
Published: March 2023

Abstract
Endocrine disorders have an important impact on maternal morbidity and mortality. Due to the multisystemic nature of these diseases, significant effects on electrolyte balance and hemodynamic stability can occur. Diabetes and thyroid disease are the most common endocrine disorders in the parturient. According to the Centers for Disease Control and Prevention, approximately 1% to 2% of pregnant women have type 1 or 2 diabetes, while the prevalence of gestational diabetes is between 6% and 9%. The most common thyroid disorders encountered during pregnancy are hyperthyroidism and hypothyroidism. Both can lead to an increased risk of perinatal morbidity and preterm delivery. Pheochromocytoma is a rare disease but one with profound medical and anesthetic implications. An understanding of the pathology and management of these disorders during pregnancy is crucial for the anesthesiologist in caring for pregnant patients.
Fetal Monitoring
Authors: Jain Shuchi , Younger Joshua D. 
Published: March 2023

Abstract
The goal of fetal assessment and monitoring is to improve neonatal outcomes by reducing neonatal mortality and neurologic morbidity. A knowledge of electronic fetal monitoring (EFM) allows one to anticipate problems and communicate concerns regarding fetal well-being. Fetal monitoring allows for the detection of poor fetal oxygenation and acid-base abnormalities for prompt interventions. Even though fetal monitoring technology has improved over the past 50 years, accurate fetal assessment in labor remains challenging. High surgical delivery rates and persistent cases of fetal/neonatal neurologic injuries demonstrate a need to further optimize fetal assessment tools. Anesthetics can have direct effects on the fetal heart rate and, knowledge of these complications is important when selecting appropriate anesthetics for the population.
Maternal Cardiopulmonary Resuscitation
Authors: Zhou Steven , Hussain Nasir 
Published: March 2023

Abstract
Cardiac arrest during pregnancy is a relatively rare phenomenon, as the majority of parturients tend to be younger with fewer comorbidities. While rare, cardiac arrest in pregnancy must be promptly recognized to avoid harm or even death of the mother or fetus. Etiologies are broad, ranging from pathologies related to heart disease or pulmonary embolism and to pregnancy specific-diseases such as preeclampsia or amniotic fluid embolism. While basic life support/advanced cardiac life support protocols should always be followed, the gravid patient always poses challenges. Thus, cardiopulmonary resuscitation must be initiated by an interdisciplinary team familiar with the physiologic changes of pregnancy and the specialized interventions necessary to mitigate harm.
Fever and Infection
Authors: Pappas Helen , Lange Elizabeth 
Published: March 2023

Abstract
Maternal fever, defined as temperature of 38°C (100.4°F) or greater, can result from a number of infectious and noninfectious etiologies and complicates up to one-third of all labors. The most common infectious causes include intra-amniotic infection, urinary tract infection, respiratory tract infections (both bacterial and viral), and sepsis. Noninfectious etiologies include epidural fever, high ambient temperatures, and drug fever. Maternal fever is associated with a number of maternal and neonatal complications, so it is aggressively managed to minimize the risk to both. The association between neuraxial labor analgesia and maternal fever has been well established, with women receiving epidural analgesia having a significantly higher incidence of fever. Research continues to evaluate proposed mechanisms for this association and targets for prevention and therapeutic intervention.
Airway Endoscopy, Microlaryngeal Surgery, and Laser Surgery
Authors: Naftalovich Rotem , Schiffenhaus James 
Published: March 2023

Abstract
Endoscopic airway surgery includes procedures performed on the tongue base, pharynx, larynx, and proximal esophagus. Microlaryngeal surgery refers to surgery of the larynx and vocal cords and generally requires aid of a microscope. These surgeries are unique in that they require the surgeon and anesthesiologist to share the surgical field (“shared airway”). Additionally, they require the anesthesiologist to employ unique techniques of airway management to ensure safe oxygenation, and surgical exposure, such as jet ventilation, intermittent or spontaneous ventilation, apneic oxygenation, or conventional ventilation via microlaryngeal tubes. Endoscopic airway surgery may also employ the use of lasers, which produce focused beams of electromagnetic energy and offer precise surgical control and minimal collateral damage to airway structures. The anesthesiologist must be prepared for the various complications associated with laser surgery, the most feared of them being an airway fire. It is imperative for the anesthesia provider to be familiar with the components of the fire triad, common operating room objects that can constitute the triad, precautions that can minimize the risk of airway fires, and steps to take should an airway fire occur. Patients requiring ear, nose, and throat (ENT) surgery can present anesthesiologists with challenges and unique airway management considerations.
Anesthesia for Laparoscopic Surgery
Authors: Ramirez Maria F. , Cata J. P. 
Published: March 2023

Abstract
Laparoscopic surgery is considered a common procedure that is performed around the world every day. Its advantages compared to conventional open abdominal surgery include the reduction of (1) postoperative pain and ileus, (2) respiratory complications, (3) blood loss, and (4) reduction of hospital stays, which allows a rapid return to normal activities. Laparoscopic surgery requires insufflation of the intraperitoneal cavity with carbon dioxide (CO2) to create space for visualization and surgical manipulation. Anesthetic concerns for patients undergoing laparoscopic surgery include cardiopulmonary effects of pneumoperitoneum, systemic absorption of CO2, venous air embolism, unintentional injuries to intraperitoneal structures, and patient positioning. Laparoscopic surgery is routinely performed under balanced general anesthesia with controlled ventilation. Appropriate anesthesia techniques and monitoring improve surgical conditions and allow early detection of fatal complications. Prevention of cardiovascular complications may be accomplished by a deep understanding of the hemodynamic consequences of pneumoperitoneum and by close communication with surgical colleagues.
Anesthesia for the Trauma Patient
Authors: Rothkrug Alexander , Fikry Karim 
Published: March 2023

Abstract
Anesthesiologists play a crucial role in management of the trauma patient. Understanding the priorities of the management of this patient population is critical to a holistic approach for effective care. Caring for the trauma patient can be challenging as there may be multiple, and sometimes undiagnosed, injuries. The evaluation of the trauma patient has to be carried out in a systematic and consistent fashion, prioritizing life-threatening conditions first. Evaluation always starts with ABC (airway, breathing, circulation). All trauma patients should be evaluated for cervical spine injury. They should all be assumed to have a full stomach unless proven otherwise. In unstable patients, damage control surgery (DCS) should always be considered. In patients with massive trauma, adequate intravenous access and proper hemodynamic monitoring is necessary, as massive blood loss should be expected and prepared for.
Hemorrhagic Shock
Authors: Tanner Colby B. , Boydston Elaine A. 
Published: March 2023

Abstract
Hemorrhagic shock is a significant cause of morbidity and mortality in trauma and surgical patients. Hemodynamically significant hemorrhage, when coupled with the physiologic derangements associated with trauma and surgery, results in oxygen debt, acidosis, organ dysfunction, coagulopathy, and ultimately death if not treated aggressively. Early detection of hemorrhagic shock allows for the prompt initiation of resuscitation and supportive care, mitigating these risks. Volume expansion via transfusion of whole blood or a balanced ratio of blood products is the intervention proven to have the most significant impact toward improving patient outcomes and should be employed to prolong life while patients await definitive surgical, endoscopic, or angiographic control of hemorrhage. Careful physical examination coupled with use of available laboratory tests and imaging techniques can aid in the development of a plan for resuscitation.
Mass Casualty Events
Authors: Manepalli Ashok Kumar , Watt Stacey 
Published: March 2023

Abstract
No hospital system is immune to mass casualty events and as such should be adequately prepared with disaster plans and personnel trained to act in crises. Anesthesiologists are well suited for the role of triage leaders and coordinators due to their experience in a wide array of hospital environments and ability to take care of critically ill patients. One of the most important aspects of mass casualty events is categorizing patients according to the severity of their injuries and allocating resources appropriately. This allows staff to prioritize patients who are salvageable from those with nonrecoverable injuries or not critically ill.
Anesthesia for Outpatient Surgery
Authors: Anthony Cometa M. , Giordano Christopher 
Published: March 2023

Abstract
Outpatient surgery is the most common setting to perform surgical procedures in the United States. It started as a way to overcome limited resources and financial constraints. As outpatient surgery has expanded and become more frequently used, ambulatory anesthesia has become a recognized subspecialty through the guidelines that were developed by the Society for Ambulatory Anesthesia (SAMBA). Important considerations must be taken into account when selecting the appropriate surgical procedures and the patient population that will undergo surgery on an outpatient basis. The anesthesiology provider is pivotal to ensure a safe and efficient perioperative outcome. This is achieved through appropriate communication, planning, preoperative assessment, intraoperative surgical and anesthetic management, and postoperative recovery and readiness for a safe discharge home.
Shock States
Authors: Eden Nikki , Rajan Shobana 
Published: March 2023

Abstract
Shock is hypoperfusion of tissues and vital organs, which may then result in organ failure and death. Shock is caused by many different mechanisms, broadly defined as hypovolemic, cardiogenic, distributive, and obstructive shock states. These states have defining factors that illustrate the underlying pathophysiology; however, there are often overlaps seen between them, and a patient may present in mixed states of shock. Septic shock due to infection and overwhelming systemic immune response is the most common form of shock. Given the serious morbidity and mortality associated with shock, quickly and correctly identifying this disease and beginning treatment is vital. The sequential organ failure assessment (SOFA) score can be useful in emergency settings for risk stratifying the mortality based on degree of organ damage.
Postoperative Headache
Authors: Osmani Feroz , Chung Kevin W. 
Published: March 2023

Abstract
Postoperative headaches are a relatively common phenomenon. It is important to conduct a thorough evaluation to rule out more serious etiologies. Postoperative headaches may be related to the patient’s prior medical history, the surgical procedure, or the anesthetic. Treatment options include intravenous hydration, adequate oxygenation, caffeine supplementation, and tighter blood pressure control. In the case of a postdural puncture headache, an epidural blood patch is the gold standard of treatment after more conservative options have failed. It is important to recognize which patients have a history of headache disorder and to treat them accordingly. Effective preoperative assessment and planning can reduce the incidence and morbidity of a common yet incredibly uncomfortable patient condition.