bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep Apnea
Authors: Mahboobi Sohail K. 
Published: March 2023

Abstract
Obstructive sleep apnea (OSA) is the most common type of sleep apnea that occurs predominantly in overweight males, but nonobese patients, females, and children can also develop this condition, particularly in the presence of certain anatomical conditions (e.g., tonsillar hypertrophy and craniofacial abnormalities). OSA is characterized by episodes of obstruction, leading to apnea and hypoxemia during sleep that can ultimately result in cardiac arrhythmias, pulmonary hypertension, and heart failure. Preoperative assessment for the presence of OSA is important and requires a detailed history, physical examination for assessment of airway, and the signs of heart failure. Optimization is required to plan and execute safe anesthesia for these patients. The STOP-BANG questionnaire provides early screening to evaluate further for the presence of OSA. These patients are prone to develop early hypoxia, can have a difficult airway, and are at high risk for postoperative respiratory complications. Regional and subarachnoid anesthesia should be considered if possible, and multimodal analgesia should be planned for general anesthesia to reduce opioid requirements and to avoid respiratory depression. Continuous positive airway pressure (CPAP) device should be used in the postoperative period. The patient should be treated with supplemental oxygen therapy with monitoring, and discharge planning should include evidence of complete recovery to baseline.
Volutrauma, Barotrauma, and Biotrauma
Authors: Mahboobi Sohail K. , Bolanos Joshua F. 
Published: March 2023

Abstract
Mechanical ventilation may lead to harmful effects on lungs, also known as ventilator-induced lung injury (VILI). Three types of VILI are barotrauma, volutrauma, and biotrauma. In barotrauma, there is an increase in pressure in the alveoli compared to extra-alveolar tissues, which leads to their rupture. In volutrauma, alveolar overdistension due to excessive volume creates a disruption of the alveolar basement membrane and intracellular junctions, which can result in increased capillary permeability and alveolar edema. In addition, alveoli experience trauma from shear forces due to “cyclical atelectasis” or the repetitive opening and closing of alveoli. Finally biotrauma is the release of inflammatory mediators following lung damage. Adopting lung-protective techniques such as maintaining low tidal volumes of 6–8 mL/kg of ideal body weight, plateau pressures less than 30 cm H2O and peak inspiratory pressures less than 40 cm H2O can reduce the risk of developing VILI. Muscle relaxants, extracorporeal membrane oxygenation, and ventilation in prone position are also used with some success.
Normal Anatomy of Heart and Major Vessels
Authors: Rodrigue Marc , Bandi Subramanya 
Published: March 2023

Abstract
Cardiac anatomy plays a vital role in its function. Basic anatomy is well described and illustrated in a numerous texts. Often, this is demonstrated as a self-activating, 4-chambered organ that circulates blood in series to the pulmonary and systemic vasculature. An intricate system of one way valves, complex blood supply system, and an automatic electrical conduction system regulates the performance of this organ with each heartbeat. An in-depth knowledge of cardiac anatomy, and the clinical implications, cannot be undervalued in the practice of anesthesiology.
Cardiac Catheterization
Authors: de Gala Virgilio , Sofjan Iwan 
Published: March 2023

Abstract
The growing number of types and complexity of procedures performed in the cardiac catheterization laboratories has led to an increased involvement of the anesthesiologist. Such procedures include left and right heart catheterization, coronary angiography, electrophysiological studies, implantation of pacemakers and defibrillators, and various percutaneous structural heart interventions. In addition to the anesthetic concerns related to the particular procedure and the patient’s cardiac disease, catheterization laboratories are often located outside the main operating room areas, which presents a unique set of challenges, especially in case of emergencies. This section focuses on right and left heart catheterizations, coronary angiography, and anesthesia concerns with delivering care in the catheterization laboratories.
Conduction Abnormalities and Rhythm Defects
Authors: Gray Ellyn , Sharma Archit 
Published: March 2023

Abstract
Cardiac arrhythmias are commonly encountered perioperatively, and these can be associated with increased perioperative risk. The causes of the conduction abnormalities and rhythm abnormalities can be reversible. Their etiologies can be classified into several broad categories, including bradyarrhythmias, supraventricular arrhythmias, ventricular arrhythmias, and inherited disorders. Inherited disorders include prolonged QT syndrome and Brugada syndrome. This chapter discusses the details of these conduction abnormalities, including perioperative considerations, medical and surgical management, and management with pacemakers and automated implanted cardioverter/defibrillators (AICDs). Diagnosis includes an electrocardiogram at minimum. Also, the management of pacemakers and AICDs are reviewed, including their indications, types and possible settings, and reprogramming perioperatively.
Ablations, Cryotherapy, and Maze Procedure
Authors: Moskal Anna 
Published: March 2023

Abstract
Cardiac arrhythmias are common and an important source of mortality and morbidity. Current management options include surgical and catheter ablative techniques using surgical incisions, cryotherapy, or radio-frequency (RF) energy. General indications include drug-resistant arrhythmias, drug intolerance, severe symptoms, or a desire to avoid lifelong symptoms. Ablative procedures can abolish the origins of arrhythmias by interposition of scar tissue along a reentry pathway or by isolating an ectopic area. Paroxysmal atrial fibrillation (PAF) often results from ectopic beats originating in the pulmonary veins, and ablative strategy involves pulmonary vein isolation (PVI). Catheter ablation for persistent atrial fibrillation (AF) is less effective and requires an additional ablation of sites identified during a stepwise mapping process. Surgical ablation for atrial fibrillation (i.e., Maze procedure) can be performed without an additional risk of operative mortality or major morbidity and is recommended at the time of concomitant open heart surgery to restore sinus rhythm. The Cox maze III procedure achieved high cure rates and became the surgical gold standard for the treatment of atrial fibrillation. Different ablation techniques have unique complications and requirements for anesthesia. Monitored anesthesia care (MAC) is most commonly utilized to prevent arrhythmia suppression. However, patients who are unable to lie still, flat, or tolerate the procedure under sedation may require general anesthesia. Protracted procedures involving left atrial ablation and transseptal puncture may be better performed under general anesthesia. Major complications of ablation procedures include cardiac tamponade and esophageal injury.
Heart Failure and Cardiomyopathy
Authors: Arora Lovkesh L. , Sharma Surangama 
Published: March 2023

Abstract
Heart failure (HF) is one of the most prevalent diseases of the elderly patient. Heart failure is defined as a clinical condition arising from impaired ventricular relaxation or systolic ejection of the cardiac ventricles. The underlying pathophysiology varies considerably, and approximately 50% of the patients suffer from HF with reduced left ventricular ejection fraction. Mortality in the perioperative period is increased in patients with HF and therefore needs careful planning and management. The role of adequate preoperative evaluation and preparation of patients with HF is vital to overall a patient’s survival. It becomes clear that the New York Heart Association classification and parameters like brain natriuretic peptide play a crucial role in risk stratification and prediction of outcome.
Systolic Versus Diastolic Dysfunction
Authors: Ahmed Andaleeb A. , Mahboobi Sohail K. 
Published: March 2023

Abstract
The intricate interplay between systolic and diastolic function is required for maintaining adequate cardiac output. Any impairment in systolic and diastolic function can lead to the clinical syndrome of heart failure. Isolated systolic and diastolic dysfunction are independent risk factors for adverse cardiovascular outcomes. The hallmark of systolic dysfunction is reduced ejection fraction. Diastolic dysfunction is characterized by impaired relaxation and/or increased chamber stiffness. The clinical syndrome of heart failure secondary to systolic dysfunction is termed as heart failure with reduced Ejection fraction (HFrEF), and heart failure in the presence of diastolic dysfunction with normal or near-normal ejection fraction (&gt;50%) is termed as heart failure with preserved ejection fraction (HFpEF). Diagnosis of systolic and diastolic dysfunction is made with echocardiography.
Heart Transplantation
Authors: Leonardi James , Cormican Daniel 
Published: March 2023

Abstract
Cardiac transplantation is indicated in patients with end-stage heart failure; medical management alone of end-stage heart failure has an abysmal long-term prognosis. Many patients may be on mechanical circulatory support, such as a ventricular assist device (VAD), as A means to bridge the patient to transplant. Anesthetic management of patients undergoing orthotopic heart transplantation (OHT) requires great care in induction of general anesthesia of the graft recipient, specific knowledge of the surgical conduct of the transplantation procedure, and understanding of potential issues uniquely related to the immediate posttransplant period. Prognosis for cardiac transplant recipients is improving with immunosuppressive regimens to reduce the risk of allograft rejection.
Constrictive Pericarditis
Authors: Grandhi Ravi K. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Constrictive pericarditis (CP) is a condition caused by different etiologies, such as pericardial disease and cardiac surgery. CP is caused by a fibrotic pericardium. CP can be symmetric or asymmetric, affecting the right or left side predominantly, which affects ventricular interdependence. CP most commonly occurs after pericardial disease or cardiac surgery or for idiopathic reasons. In the developing world and immunocompromised patients, tuberculosis has to be considered. CP causes pressure on the different cardiac chambers, impairing cardiac function to different degrees depending on the severity of the condition. CP, if mild, can be treated conservatively; severe disease will require pericardiectomy.
Cardiopulmonary Bypass
Authors: Sung Kim , Arora Lovkesh L. 
Published: March 2023

Abstract
Cardiopulmonary bypass (CPB) is a technique that is often used in surgical procedures that involve the heart and major vessels. It is an essential method to provide a bloodless field for cardiac surgeries. This technique can support or take over the cardiac output of the patient, which allows surgeons to operate on the heart and major vessels without compromising adequate perfusion to vital organs. It is important to understand the CPB system and components to safely manage the patient as the patient goes on CPB and comes off CPB. Anesthesiologists have a critical role in managing patients’ hemodynamics, coagulation, anesthetic, and electrolyte balance while on CPB.
Ventricular Assist Devices
Authors: Patel Priyanka H. , McConnell Matthew 
Published: March 2023

Abstract
Ventricular assist devices (VADs) are utilized in patients with heart failure for whom medical therapy is no longer effective. The utilization of VADs in management of heart failure has been shown to be superior to medical treatment alone. The classification of VADs is broad and includes any device that assists a ventricle’s function. Common complications of VADs include right heart failure, infection, and thrombosis. Previously, cardiopulmonary resuscitation (CPR) during cardiac arrest was contraindicated in patients with VADs, but recent guidelines suggest in patients with low-flow states, CPR may be indicated. Proper evaluation of patients is essential prior to proceeding with surgical interventions.
Pulmonary Embolism
Authors: Arora Lovkesh L. , Sharma Surangama 
Published: March 2023

Abstract
Surgery predisposes patients to pulmonary thromboembolism even as late as 1 month postoperatively. Acute pulmonary embolism is a life-threatening condition that can lead to both acute and long-term morbidity and mortality. Despite significant advances in the prophylaxis and diagnosis of deep venous thrombosis, the mortality and recurrence rate of pulmonary embolism remain high. The clinical presentation of acute pulmonary thromboembolism ranges from shock or sustained hypotension to mild dyspnea. Pulmonary embolism may even be asymptomatic and diagnosed by imaging procedures performed for other purposes. Depending on the clinical presentation, the case fatality rate for acute pulmonary embolism ranges from 1% to 60%. Anticoagulation is the mainstay of therapy for pulmonary embolism.
Pulmonary Edema
Authors: Punia Sangini , Arora Lovkesh L. 
Published: March 2023

Abstract
Pulmonary edema refers broadly to the abnormal accumulation of fluid within the extravascular lung tissue, adversely affecting gas exchange across the capillary membrane. Pulmonary edema can cause acute respiratory insufficiency, resulting in a life-threatening emergency event. Although diagnostic classification differentiates between cardiogenic and noncardiogenic pulmonary edema, the pathobiology is more complex than the hydrostatic versus permeability dichotomy alone. Patients need early stabilization of oxygenation and ventilation, preferably with high-flow nasal cannula oxygen or noninvasive ventilation while the diagnostic cause is investigated with echocardiography and other testing. For the best possible patient outcomes, it is essential that physicians in all clinical areas are equipped to accurately recognize, assess, and manage patients with acute pulmonary edema.
Hypertension
Authors: Sung Kim , Arora Lovkesh L. 
Published: March 2023

Abstract
Hypertension (HTN) is a common medical disorder that an anesthesiologist can face during the perioperative period. The etiology of the disease can be complex, and causes of primary hypertension are not yet fully understood. It is important to understand the many different aspects of hypertension to adequately manage the patient. Although generally managed by primary care providers such as internists, family practitioners, and nurse practitioners, severe perioperative HTN may result in excess surgical bleeding, myocardial ischemia and/or infarction, congestive heart failure (CHF), and acute pulmonary edema (APE). Therefore, it is very vital for the anesthesiology team to have a thorough knowledge and plan to take care of these patients.
Effect of Intracardiac Shunts on Inhalation Induction
Authors: Geara Elie , Alhaddadin Caroline 
Published: March 2023

Abstract
Congenital heart disease (CHD) encompasses a variety of abnormalities that are mostly detected in infancy, early childhood, or less commonly adulthood. With the current surgical and medical treatment, an increasing number of patients with CHD may survive to adulthood and be encountered during non cardiac procedures. Conduct of stable inhalational anesthetic induction in patients with intracardiac shunts requires sound knowledge of the fundamental physiology specific to the underlying shunt lesion; as this can alter the induction time, so if delivery of anesthetic agent is not carefully titrated, it can consequently lead to hemodynamic instability. The inhalational induction of anesthesia is delayed in patients with right-to-left shunt compared to patients with a left-to-right shunt. The anesthesiologist needs to have an in-depth understanding of the physiology and effect of shunt lesions on the uptake, delivery, and equilibration of anesthetic drugs.
Peripheral Arteriosclerotic Disease
Authors: Tadros Racha , Hussain Nasir 
Published: March 2023

Abstract
Peripheral arteriosclerotic disease (PAD) commonly affects the lower extremities. Signs and symptoms of PAD are variable and can present classically with claudication or in an advanced state through chronic limb ischemia. To evaluate a patient with risk factors for PAD, a thorough history, review of systems, and physical examination should be obtained. An ankle-brachial index (ABI) less than 0.9 is sensitive and specific for arterial stenosis and diagnostic for PAD. Management typically involves goal-directed medical therapy (GDMT), such as antiplatelet therapy, statins, exercise rehabilitation, and lifestyle modifications (e.g. smoking cessation). Vascular interventions are typically reserved for patients with severe claudication impairing quality of life.
Advanced Cardiopulmonary Resuscitation
Authors: Laborde Donnie 
Published: March 2023

Abstract
Advanced cardiovascular life support (ACLS) is a set of algorithms created to guide practitioners in treating life-threatening cardiovascular emergencies by implementing and integrating both basic and advanced life support. The majority of victims, in both in-hospital and out-of-hospital settings, do not receive high-quality cardiopulmonary resuscitation (CPR). Successful ACLS outcomes will continue to improve with post–quality assessments, reviewing each link in the chain of survival. Pediatric advanced life support (PALS) certification offers a progressive and organized approach to pediatric assessment. PALS training has been developed for healthcare professionals who respond to emergencies for infants (ages &lt; 1 year) and children (age 1 year to puberty) and assists health service providers with skills and knowledge for treating critically sick infants and children. Professionals acquiring this certification are those who respond to emergency cases, such as pediatric care providers, emergency responders, intensive care unit staff, and emergency room personnel. In 2015, approximately 80% of hospitalized patients with cardiorespiratory arrest had abnormal vital signs documented up to 8 hours before the actual arrest. Early recognition and high-quality CPR are crucial for survival, regardless of the victim’s age. Thanks to the American Heart Association’s commitment and research, the survival rate in hospitals has improved from 23.1% in 2012 to 25.5% in 2015. The American Heart Association’s research has also revealed how organization, coordination, and review of performance is vital for both present and future victim survival.
Pathophysiology of Renal Disease
Authors: Taco Erika , Noguera Edward 
Published: March 2023

Abstract
One of the most feared postoperative complications is acute kidney injury. Postoperative renal failure increases both morbidity and mortality. The blood flow to the kidneys is 20%–25% of the cardiac output, and kidney ultrafiltration is 20% (renal plasma blood flow). About 90% of kidney blood flow is dedicated to cortex. Considering these figures, renal function is very sensitive to hemodynamic changes if kidney autoregulation is exhausted. There are different stages of renal dysfunction; the most severe forms will require renal replacement therapy. Dialysis is a very resource-intensive therapy that increases care costs and is associated with poor quality of life.
Perioperative Electrolyte Abnormalities
Authors: Earls Brent , Sivanesan Eellan 
Published: March 2023

Abstract
Electrolyte imbalance is an important cause of morbidity and mortality in the perioperative patient. These imbalances can lead to dramatic fluid compartment shifts, changes in the electrical conduction of the nervous system, hormone imbalances, and a variety of other pathologies if left untreated. Early recognition and a high index of suspicion is important to reduce complications. Identification of the underlying cause will help avoid overtreatment or undertreatment of electrolyte dyscrasias. Understanding intrinsic regulation of these electrolytes will also assist with identifying potential contributing factors leading to the imbalance. This chapter discusses major causes, clinical signs, and treatments of the major electrolyte disorders.
Fluid Balance During Surgery
Authors: Streetzel Charlotte , Giordano Christopher 
Published: March 2023

Abstract
The endothelial glycocalyx (EG) is a complex and dynamic structure that lines the innermost surface of all vessels in the human body. Its discovery and implications in the Starling principle led to important realizations about the mechanisms of fluid shifting in the body. Components of the glycocalyx contribute to crucial regulatory functions, including inflammation and recruitment of cells, hemostasis, and homeostasis of intercompartmental fluid shifting. The EG has a remarkable ability to adapt to changes in the local environment to reduce damage to the vasculature; however, it may become damaged when exposed to extreme changes in environment, such as increased shear stress, increased or decreased oxygen availability, and drastic changes in tonicity. Several disease states are associated with degradation of the EG, including heart failure, acute respiratory distress syndrome, nephrotic syndromes, trauma, sepsis, and even cardiopulmonary bypass. Understanding the mechanisms causing damage to the EG and the downstream clinical implications can help physicians avoid and possibly correct these pathologic states.
Esophageal Doppler
Authors: Kim Roy , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Monitoring and assessment of cardiovascular function is often unreliable in critically ill patients. Although pulmonary artery catheterization (PAC) is considered the gold standard for continuous monitoring of cardiac output (CO), it can be difficult to place, and the information provided can be largely misinterpreted or misunderstood. Esophageal Doppler monitoring measures blood flow velocity in the descending thoracic aorta using a flexible ultrasound probe that is much smaller than an ordinary transesophageal echocardiographic probe; it less invasive with a very good safety record. Esophageal Doppler monitoring is an alternative to PAC and can provide important hemodynamic information that can positively affect outcomes.
Anemia
Authors: Shapiro Victoria , Brosnan Heather 
Published: March 2023

Abstract
Anemia is characterized by a decrease in red cell mass and clinically manifests as decrease in circulating red blood cells. Anemia is defined by the World Health Organization (WHO) as a hemoglobin less than 12 g/dL in adult females and less than 13 g/dL in adult males, and it can be classified by morphology and average size of circulating red blood cells or mean corpuscular volume. Preoperative anemia is a significant risk factor for perioperative blood transfusions and is an independent risk factor for perioperative morbidity and mortality. Patients with anemia should be worked up in advance of the elective procedure.