bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperbaric Medicine
Authors: Covington Derek Brady , Giordano Christopher 
Published: March 2023

Abstract
Hyperbaric oxygen therapy (HBOT) is the medical use of oxygen at higher than atmospheric pressures. HBOT occurs in monoplace or multiplace chambers. Along with the hyperoxygenation that occurs when increased pressure dissolves additional oxygen into the plasma, HBOT induces several additional therapies via alternative mechanisms of action. For instance, HBOT induces vasoconstriction, angiogenesis, fibroblast proliferation, and antibiotic synergy. The only contraindication to HBOT is an untreated pneumothorax because increased pressurization could exacerbate a pneumothorax as well as evolve into a tension pneumothorax. The most common complication secondary to HBOT is middle ear barotrauma or the inability to equalize the middle ear space with resultant otalgia. Although an oxygen-induced seizure may manifest secondary to central nervous system toxicity, these are exceedingly rare and often benign. When treating a mechanically ventilated patient, it is imperative to consider the volume of the endotracheal cuff. In accordance with Boyle’s law, as pressure increases, volume decreases. Thus, on pressurization of the chamber, gas must be added to the endotracheal tube cuff to maintain an adequate seal on the tracheal mucosa. On depressurization, gas must be removed from the endotracheal tube cuff to prevent excessive expansion and damage to the trachea. The use of a manometer while adding or removing gas from the endotracheal tube facilitates the maintenance of a proper cuff volume and subsequent seal. If critically injured patients require HBOT, it is imperative that ventilators, syringe pumps, and all other medical devices are safe for hyperbaric oxygen.
Electroencephalograms
Authors: Abdallah Rany T. , Coleman Gabriel M. 
Published: March 2023

Abstract
An electroencephalogram (EEG) is a device used to measure electrical activity in the brain by placing several pairs of electrodes at specific positions over the scalp. When an axon excites a neuron, a small, varying electrical field is generated that is picked up by the nearest electrode. Each pair of electrodes receives activity from different populations of neurons, which are transferred to a medium in a readable pattern. Distinct cortical areas will display similar electrical activity, which can be used to isolate and observe specific activity. The EEG has multiple uses in clinical practice, such as for determination of insomnia, hypothermia, hypercapnia, and brain death. EEG is also used in anesthesia monitoring. It is affected differently by different anesthetics.
Peripheral and Autonomic Nerve Blocks
Authors: Flaherty James , Jimenez-Ruiz Federico 
Published: March 2023

Abstract
Peripheral and autonomic nerve blocks involve the targeted injection of local anesthetics to reduce neuronal signal transmission. This chapter aims to provide an introduction to high-yield, American Board of Anesthesiology keyword–based topics related to their performance. A brief review of indications and contraindications for peripheral and autonomic nerve blocks is presented first. The chapter then provides a comparison of available techniques for nerve localization, with a focus on ultrasound guidance. An evidence-based review of complications from peripheral nerve blocks (nerve injury, bleeding, infection, and toxicity) is then provided. Finally, evidence supporting the provision of continuous, catheter-based, peripheral nerve blocks is presented.
Extremity Nerve Blocks
Authors: Flaherty James , Jimenez-Ruiz Federico 
Published: March 2023

Abstract
Peripheral nerves carry sensory, motor, and autonomic signals to and from the central nervous system. Advances in the study of functional anatomy and the application of ultrasound guidance have contributed significantly to the development of precise and novel peripheral nerve blocks. Regional anesthesia can be used as an alternative to general anesthesia or as a highly effective way to provide pain control and decrease opioid consumption. This chapter compiles high-yield facts and commonly tested material related to upper and lower extremity blocks. It is not intended to be a thorough presentation of all relevant information pertaining to the clinical application of regional anesthesia.
General Concepts in Pharmacology
Authors: Kapp Daniel Gonzalez 
Published: March 2023

Abstract
Pharmacology is the basic science of drug discovery, drug composition, pharmacokinetics, pharmacodynamics, and toxicology. A drug’s underlying pharmacology is fundamental to its potential therapeutic benefits and risks when used in clinical practice. Key chemistry-related concepts within pharmacology that describe a drug’s properties include pH, pKa, and protein binding. Perioperative assessment should include evaluation of chemistry-related factors affecting the transportation and distribution of drugs across body compartments. Patient-specific conditions to evaluate include those affecting blood pH (e.g., hyperventilation), plasma protein binding (e.g., low albumin due to malnutrition), and the pH of local environments (e.g., low pH in tissue due to infection).
Addiction
Authors: Shah Anuj A. , Zaky Christine S. 
Published: March 2023

Abstract
Addiction is a chronic physiological need for a habit-forming substance despite the harmful consequences. The drug addiction cycle includes three stages: preoccupation, withdrawal, and intoxication. In 2016, alcohol dependence was shown to be the most prevalent substance use disorder globally, while cannabis and opioid use disorders were found to be the most common drug use disorders. The pathophysiology of drug addiction involves changes in brain circuitry and critical neurotransmitters such as dopamine. The first steps in diagnosing a substance use disorder require acknowledgment of the disorder and the seeking of treatment along with assessment by an addiction specialist. Treatment of a specific drug addiction is dependent on the presence of acute intoxication, withdrawal, and/or abstinence. Acutely, alcohol intoxication is managed by long-acting benzodiazepines, while acute opioid intoxication is managed with naloxone. Pharmacological treatments have shown to be the most effective when combined with group meetings, psychological support, and physician advice. In all cases, early intervention has proven to be the most beneficial.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Authors: McGinty Lauren 
Published: March 2023

Abstract
The nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used as prescription and over-the-counter medications to treat pain, inflammation, and fever associated with a variety of medical conditions. This chapter reviews the indications, mechanisms of action, therapeutic effects, adverse effect profiles, and special precautions associated with these different agents. It also provides information on the physiologic and the pathophysiologic roles of cyclooxygenase (COX) and prostaglandins and discusses the impact of COX selectivity. Finally, this chapter addresses key drug interactions and the available routes of administration for the different NSAIDs and highlights unique advantages and disadvantages of the agents in this medication class.
Antiemetics
Authors: Eapen Jeffery James , Bang Jason 
Published: March 2023

Abstract
Antiemetics are classes of medications that are cornerstones of a complete anesthetic care model. Postoperative nausea and vomiting has 20%–30% occurrence overall and is rated by many patients as more concerning than postoperative pain. This chapter focuses on the varying categories of antiemetics, their mechanisms of action, and common side effects. 5-Hydroxytryptamine (5-HT3), dopamine 2 receptor, histamine 1 receptor, and neurokinin 1 receptor antagonists are discussed as options for the management of nausea and vomiting. These medications exert their effects in areas that stimulate the vomiting center of the central nervous system, such as the area postrema and nucleus of the tractus solitarius. Notable side effects to pay particular attention to include QT prolongation with ondansetron and droperidol. Miscellaneous medications, such as propofol, can be used as rescue therapy for postoperative nausea and vomiting (PONV) refractory to conventional methods of treatment.
Chronic Opioid Dependence and Therapy
Authors: Parker Nicholas M. 
Published: March 2023

Abstract
Opioid use disorder (OUD) is highly prevalent, and its treatment presents several challenges to providing adequate but safe analgesia during and after surgery. Three medications are used to treat OUD: naltrexone, buprenorphine, and methadone. Each has distinct pharmacological properties and implications for anesthesia, as well as unique and complex legal restrictions on their use. The anesthesiologist must have a detailed understanding of OUD and these three medications to safely and legally provide analgesia without undue risk of overdose or relapse. Widespread naloxone prescribing and use of prescription drug monitoring systems (PDMPs) are other strategies to improve the safety of opioids for all patients.
Sympathetic Nervous System
Authors: George Shelley 
Published: March 2023

Abstract
The sympathetic nervous system combines with the parasympathetic system to form the autonomic nervous system, and together they help control bodily functions that are unconsciously directed. The sympathetic nervous system (SNS) extends throughout the whole body and allows the body to prepare for physical activity necessary in situations where the body needs to be on high alert. Although it has an afferent element, it is mostly known for its efferent component. The sympathetic fibers of the system are what contribute to the fight-or-flight response and forms from the thoracolumbar (T1-L3) segments of the spinal cord, whereas the parasympathetic fibers form from the cervicosacral portion of the spinal cord. The SNS employs an intricate system of nerve fibers, neurotransmitters, and receptors to achieve desired organ function.
Intracranial Aneurysms and Arteriovenous Malformation
Authors: Alkhalili Kenan , Nasr Ned F. 
Published: March 2023

Abstract
Intracranial vascular lesions are relatively common abnormalities that may require elective or emergent intervention. Advances in neuroimaging has led to an increase in the discovery of patients harboring incidental cerebral aneurysms. The overall prevalence of unruptured intracranial aneurysms (UIAs) is estimated to be 3%. The most feared complication is subarachnoid hemorrhage (SAH) from aneurysm rupture, which poses a worldwide health burden with high fatality and permanent disability rates. Arteriovenous malformations (AVMs) represent a different entity of vascular anomalies, more predominant in younger population. The arteries are directly connected to venous drainage, bypassing the capillary system and resulting in a high-flow, low-resistance anomaly. Brain AVMs are of special concern because of the inherent high risk of bleeding of the abnormal blood vessels, which can cause neurological damage. Anesthetic management of patients with complicated aneurysms/AVMs is challenging because of the emergency nature of the presentation, complex pathology, and varied intracranial and systemic manifestations. This chapter discusses the epidemiology, pathophysiology, management, and anesthesia considerations in unruptured and ruptured intracranial aneurysms and AVMs.
Interventional Neuroradiology
Authors: Alkhalili Kenan , Nasr Ned F. 
Published: March 2023

Abstract
Interventional neuroradiology (INR) is a rapidly evolving field with an expanding variety of indications and techniques. It encompasses the diagnosis and treatment of many neurovascular and spine conditions, including but not limited to cerebral aneurysm, arteriovenous malformations, cerebral vasospasm, and stroke management. To facilitate the close teamwork required between interventionists and anesthesiologists necessary for the successful outcome, it is important to have full understanding of cerebral protection strategies and the potential pitfalls of each procedure. Under normal circumstances, anesthesia goals revolve around maintaining patient immobility, avoiding hemodynamic alterations, and ensuring rapid recovery to facilitate postprocedure neurological evaluation. Interventional radiology suites pose challenges in anesthetic care due to their “off-site” location, remote from the main operating room area, which necessitates special preparations.
Pituitary Adenomas
Authors: Mori Benjamin B. G. , Nasr Ned F. 
Published: March 2023

Abstract
Pituitary adenomas are benign lesions commonly encountered in clinical practice. Functioning adenomas often result in symptoms related to hormone excess, whereas nonfunctioning adenomas often present later with symptoms secondary to mass effect of the tumor. Diagnosis is done by way of laboratory testing and magnetic resonance imaging (MRI). Transsphenoidal pituitary resection (TPR) is the mainstay of treatment for pituitary adenomas and poses unique challenges as it involves the principles and practices of both endocrine and neurosurgical management. Airway management may be difficult in patients with acromegaly or Cushing disease. The anesthetic management for pituitary surgery requires comprehensive preoperative assessment of hormonal function and airway anatomy. Intraoperative management revolves around facilitating surgical exposure while providing hemodynamic stability and allowing for rapid emergence. Postoperative disorders of sodium balance and pituitary hormone deficiency are common after pituitary surgery.
Postoperative Visual Loss
Authors: Teixeira Camila , Minear Steven 
Published: March 2023

Abstract
Postoperative visual loss (POVL) is an uncommon event that has a deep impact on the quality of life of patients undergoing surgical procedures, especially spine surgeries. Many causes have been addressed regarding POVL, although ischemic optic neuropathy (ION) is the most frequently described. Visual loss occurring after nonocular surgery with general anesthesia typically results from anterior ischemic optic neuropathy (AION), posterior ischemic optic neuropathy (PION), central retinal artery occlusion (CRAO), or cortical blindness. Current research and expert opinion indicate that there is a correlation with prolonged surgical times and intraoperative substantial blood loss. The American Society of Anesthesiologists developed a practice advisory for the prevention of this complication. Anesthetic techniques are designed to avoid hemodilution, hypotension, and, when possible, staging prolonged procedures. Risk factors should be assessed in the preoperative assessment, and it is recommended to inform patients at high risk for this complication.
Hypothermia
Authors: Bang Jarrod , Sharma Archit 
Published: March 2023

Abstract
A complication attributed to typical mild intraoperative hypothermia is prolonged duration of postanesthetic recovery. Temperature management is an important aspect of providing care for a patient in an operating room. Hypothermia is caused by heat loss, a decrease in heat production, or inhibition of the body’s innate thermoregulatory mechanisms. All three of these mechanisms can occur during general or regional anesthesia, resulting in the common occurrence of hypothermia during surgery. Perioperative hypothermia may prolong recovery by augmenting anesthetic potency, delaying drug metabolism, producing hemodynamic instability, or depressing cognitive function. This chapter discusses the different causes of perioperative hypothermia and their effects on a patient’s disease state and morbidity.
Arterial Blood Gas Interpretation
Authors: Maben Sarah 
Published: March 2023

Abstract
The arterial blood gas (ABG) provides information about a patient’s pH, oxygenation, and ventilation and can indicate whether an acid-base disorder is primarily metabolic, respiratory, or mixed. The four basic categories of acid-base disorders are respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis. The anion gap (AG) is calculated from the difference in cations and anions and can be used to tailor a differential diagnosis based on the mechanism of the acid-base disorder. The lungs and kidneys affect acid-base disorders by compensatory mechanisms that must be considered during ABG interpretation. Additionally, the patient’s clinical history is important for further narrowing a differential diagnosis. Taken together, ABG interpretation can provide a concise differential diagnosis for a particular acid-base disorder.
Management of Patients With Respiratory Disease
Authors: Roberman Dmitry , Suero Felipe F. 
Published: March 2023

Abstract
Patients with respiratory diseases are at increased risk of perioperative complications. There is increasing awareness of the importance of postoperative pulmonary complications in contributing to morbidity, mortality, and increased hospital length of stay. Because of the prevalence of smoking and obesity, many patients may be at increased risk of developing postoperative pulmonary dysfunction. Patients with known disease should have their pulmonary function optimized preoperatively, with careful consideration given to the choice of general versus regional anesthesia. A choice of invasive and noninvasive monitors should be considered when providing anesthesia to patients with respiratory compromise. Be mindful that an invasive monitor such as an arterial line can provide a wealth of information during operation.
Preoperative Evaluation and Preparation of the Patient With Pulmonary Disease
Authors: Brown Anna-Kaye , Hauck Ellen 
Published: March 2023

Abstract
Surgical candidates with pulmonary disease are at increased risk of postoperative pulmonary complications. This chapter discusses important components of the preoperative evaluation and preparation for patients with pulmonary hypertension, obstructive airway disease, restrictive lung disease, and obstructive sleep apnea. The preoperative evaluation indicates the stability of cardiopulmonary conditions, identifies risk factors that necessitate additional workup, and estimates the perioperative risk for surgery. After preoperative evaluation, including use of pulmonary risk indexes to estimate the risk of postoperative pulmonary complications, patients can then receive appropriate preoperative preparation and optimization. Preoperative optimization strategies such as respiratory and pharmacologic therapies are addressed. Additionally, smoking cessation techniques and the benefits of quitting prior to surgery are discussed. Understanding the preoperative evaluation and preparation for patients with respiratory disease may reduce the risk of postoperative pulmonary complications.
Mode of Ventilation
Authors: Kapisoda Katarina , Crimi Ettore 
Published: March 2023

Abstract
Mechanical ventilation provides an artificial lung support that completely or partially supports the work carried by respiratory muscles. It is indicated in patients with inadequate respiratory drive, hypoxia, and failure to maintain adequate ventilation. Delivery of air into the lung under positive pressure via an artificial airway (endotracheal tube/tracheostomy tube) is referred to as invasive ventilation. Noninvasive ventilation uses a different interface (mask) and provides support without invasive artificial airway. The mode of mechanical ventilation defines the relationship between the type of breath (spontaneous, assisted, or mandatory) and a group of control variables (volume, pressure) and phase variables (trigger, limit, cycle) that regulate the pattern of breath delivery. Modes of ventilation include assist control, SIMV (synchronized intermittent mandatory ventilation), pressure support, pressure controlled and inverse ratio, APRV (airway pressure release ventilation), and high-frequency ventilation.
Management of Bronchospasm
Authors: Eapen Jeffery James , Bang Jason 
Published: March 2023

Abstract
Bronchospasm is a respiratory complication encountered with anesthesia practice; this chapter provides a review of the condition in terms of pathophysiology and its management in the perioperative period. Bronchospasm is a manifestation of a complication from reactive airway disease (asthma), chronic obstructive pulmonary disease (COPD), anaphylaxis, release of vasoactive substances, or interventions by an anesthesiologist. It is caused by increased activity of smooth muscles surrounding the bronchioles, resulting in airflow obstruction and impacting primarily the expiratory phase of the respiratory cycle. Diagnosis is confirmed by physical examinations revealing end-expiratory wheezes and increased peak airway pressures during mechanical ventilation. Management includes administering 100% oxygen, use of β2-agonists such as albuterol, increasing the inspired concentration of bronchodilating inhaled anesthetics, and using bronchodilating intravenous agents such as ketamine.
Echo Heart Anatomy
Authors: Gibson Christina , McConnell Matthew 
Published: March 2023

Abstract
Echocardiographic Heart Anatomy describes the 11 basic views utilized in the basic perioperative echocardiographic examination as well as the structures visualized in real-time diagnoses. The 11 views are seen in the midesophageal, transgastric, and upper esophageal portions of the gastrointestinal tract. Perioperative echocardiography is a useful tool and a relatively safe procedure, with very low morbidity and mortality. The primary goal of the basic echocardiographic examination is intraoperative monitoring, which aids in diagnosing hemodynamic instability in surgical patients. Such diagnoses include, but are not limited to, intravascular volume status, left ventricular dysfunction, right ventricular dysfunction, valvulopathies, cardiac tamponade, pulmonary emboli, and aortic dissection.
Subacute Bacterial Endocarditis Prophylaxis
Authors: Burger Melissa Anne , Jones Todd Everett 
Published: March 2023

Abstract
The American College of Cardiology and American Heart Association (ACC/AHA) guidelines for subacute bacterial endocarditis (SBE) prophylaxis now recommend SBE prophylaxis in only the high-risk subset of patients with prosthetic valves, congenital heart disease, or a cardiac transplant. SBE prophylaxis should be given for procedures involving manipulation of gingival tissues, the periapical region of teeth, perforation of the oral mucosa (including routine dental cleanings), or invasive respiratory tract procedures, but it is no longer recommended for genitourinary or gastrointestinal tract procedures. Parturients in select high-risk categories may benefit from antibiotics 30 minutes prior to vaginal delivery. Perioperative antibiotic selection should cover organisms most likely to cause SBE, notably Streptococcus viridans, and is based on the patient’s ability to tolerate oral medication and any penicillin allergy.
Myocardial Preservation During Cardiac Surgery
Authors: Trusheim Jay , Pappas Marisa 
Published: March 2023

Abstract
During cardiopulmonary bypass, there are several mechanisms utilized to protect the myocardium. These include the use of a cardioplegia solution, systemic and myocardial cooling, and decompression of the heart. Cardioplegia can be delivered either antegrade via the aortic root or retrograde via the coronary sinus in order to silence the electrical activity of the heart. Cooling can be accomplished either directly by ice, via the cardiopulmonary bypass machine, or by underbody coolers. Decompression is achieved with adequate venous drainage through the venous cannula allowing for decreased wall tension and thus decreased oxygen demand. With adequate myocardial protection, it is hoped the patient can be separated from bypass without new or worsening ventricular wall dysfunction.