bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intra-Aortic Balloon Pumps
Authors: Barrack Frank , Noorda Bryan 
Published: March 2023

Abstract
The intra-aortic balloon pump (IABP) is the most common and readily available form of mechanical support for a failing heart. IABPs decrease myocardial oxygen consumption while increasing the oxygen supply to the myocardium, improving the oxygen supply/demand balance by a mechanism called counterpulsation. The IABP synchronizes with the heartbeat to inflate during diastole and deflate during systole. Increased diastolic pressure improves coronary perfusion, and systolic unloading decreases the oxygen consumption of the left ventricle. General indications for IABP placement are based on the beneficial physiological effects of the device. Complications arise from the process of placing the device or vascular injury associated with the prolonged use of IABPs.
Aortic Aneurysms
Authors: Bang Jarrod , Arora Lovkesh L. 
Published: March 2023

Abstract
Aortic aneurysms have a relatively high incidence in the general population, and the incidence increases with increasing age. The vast majority of aneurysms present asymptomatically, diagnosed incidentally or through regular screening, although some present emergently in cases of rupture. The location and extent of the aortic aneurysm, and associated disease, greatly affect surgical intervention and therefore anesthetic management. The anesthetic management of aortic aneurysm repair varies considerably depending on location and extent of the aneurysm. Open repair versus endovascular repair have important differences in anesthetic approach. Intimate knowledge of aortic cross clamping and unclamping physiologic responses, vasoactive medications, spinal cord perfusion, blood product administration, and intraprocedural communication are of utmost importance.
Morbid Obesity/Anesthesia for Bariatric Surgery
Authors: Roth Vincent , Giordano Christopher 
Published: March 2023

Abstract
Obesity is a global epidemic that requires special anesthetic considerations. The restrictive pulmonary pathophysiology of obesity increases sensitivity to apnea, while underlying cardiovascular comorbidities may put obese patients at greater risk of hemodynamic instability during anesthesia. Changes in airway anatomy can lead to obstructive sleep apnea (OSA) and other disordered breathing patterns that further exacerbate these risks. To minimize anesthetic risk, careful preoperative assessment must be done, including administration of the STOP-BANG questionnaire to screen for OSA, a 12-lead electrocardiogram, smoking cessation, and initiation of appropriate thromboprophylaxis. Intraoperatively, special attention must be paid to patient positioning, with the head and thorax ideally in the ramped position and the body in reverse Trendelenburg. This should facilitate successful intubation and minimize the effects of body habitus on respiratory function. Choice of drugs should be carefully considered, giving preference to drugs that are less lipophilic and more predictably metabolized whenever possible. Postoperatively, respiratory support and pain control must be properly attended to with use of continuous positive airway pressure (CPAP), aggressive pulmonary toilet, early ambulation, and a multimodal approach to pain control that averts narcotic-induced respiratory depression.
Renal Anatomy
Authors: Taco Erika , Noguera Edward 
Published: March 2023

Abstract
The kidneys are organs that are very sensitive to hypoxic injury. Prolonged hypoxemia or toxicity to renal tissues can quickly develop apoptosis and cell death. Low cardiac output states, hypovolemia, uncontrolled hemorrhage, aortic clamping, and some medications and intravenous contrast agents are risk factors for the development of acute kidney injury.
Complications of Transurethral Resection of the Prostate
Authors: Justinger Jacob , Abouhassan Soozan S. 
Published: March 2023

Abstract
Transurethral resection of the prostate (TURP) is a common urologic procedure. Despite this, it presents several challenges to the anesthesia provider. As benign prostatic hyperplasia (BPH) is a disease of aging, TURP is frequently performed in an older population with comorbid conditions. The surgical technique poses risks, notably the absorption of large volumes of irrigation fluid. While various irrigation fluids are used, each presents its own risk profile. The constellation of symptoms resulting from the absorption of irrigation solution is known as TURP syndrome. The anesthesia provider should be on watch for TURP syndrome as it can result in a hypervolemic hyponatremia manifesting in profound neurologic consequences.
Polycythemia
Authors: Shapiro Victoria , Brosnan Heather 
Published: March 2023

Abstract
Polycythemia is a disease of elevated hematocrit or hemoglobin. Primary polycythemia is most often due to polycythemia vera, whereas secondary causes tend to be due to chronic states of hypoxia leading to elevated erythropoietin (EPO) levels, such as sleep apnea, obesity hypoventilation syndrome, chronic obstructive pulmonary disease (COPD), and cyanotic heart lesions. Hyperviscosity of the blood leads to poor flow dynamics, decreased tissue oxygenation, and increased thrombotic risk. Patients with polycythemia can have paradoxical hemorrhage as a result of acquired von Willebrand disease and platelet dysfunction secondary to thrombocytosis. Thus, it is important to do a thorough evaluation prior to surgery. A preoperative hematocrit of less than 45% is ideal, and the anesthesiologist should remain vigilant: avoid hypoxia, maintain volume status, and mitigate deep vein thrombosis (DVT) risk.
Thrombocytopenia and Thrombocytopathy
Authors: Shapiro Victoria , Chang Michael 
Published: March 2023

Abstract
Hemostasis and coagulation are parts of a complex process of bleeding cessation requiring a combination of vascular factors, platelets, and plasma coagulation factors. Through the continuum of primary and secondary hemostasis, a hemostatic plug is formed via platelet aggregation and stabilized by products of the blood coagulation cascade. Patients with disorders affecting the platelet quantity and quality have increased risk of perioperative hemorrhage. These disorders may be congenital or acquired, but ultimately may necessitate platelet transfusions to achieve hemostasis. For patients with thrombocytopenia or platelet dysfunction undergoing surgeries, the bleeding risk of the procedure should be assessed, as some procedures are more invasive and prone to bleeding than others.
Congenital and Acquired Factor Deficiencies
Authors: Hughes Meghan C. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Coagulation factor deficiencies can be either congenital or acquired. Hemophilia is possibly the most recognized type of factor deficiency, but it is certainly not the only one. Hemophilia comes in three forms, two of which are quite well known: A and B. Hemophilia A is an inherited factor VIII deficiency and is an X-linked recessive disorder. Hemophilia B is an inherited deficiency of factor IX and is also an X-linked recessive disorder. The lesser known, hemophilia C, is an inherited deficiency of factor XI. Acquired factor deficiencies are most commonly the formation of an autoantibody to factor VIII; they are sometimes referred to as “acquired hemophilia”; however, in an effort to minimize confusion, they are typically referred to as “acquired factor inhibitor” or “acquired factor deficiency.”
Pancreas Transplantation
Authors: Maria Gorneva , Anna Tzonkov 
Published: March 2023

Abstract
Pancreas transplantation is a surgical treatment for complicated cases of diabetes mellitus type 1 and occasionally type 2. Patients with a history of frequent, severe metabolic complications (marked hypoglycemia or hyperglycemia, ketoacidosis) and failing insulin management are typical candidates. The procedure was first performed in humans in 1966. Now, due to development of better immunosuppressive agents (specifically cyclosporine and anti–T-cell antibodies), advanced surgical techniques, and better patient selection, more than 700 of various types of pancreatic transplants are performed yearly in the United States alone. Most patients receive a pancreas from a cadaver donor, but donation by a living related donor is also possible. The goals of transplantation are to restore glucose-regulated endogenous insulin secretion, arrest the progression of the complications of diabetes, and improve quality of life. There are several types of such treatment as follows: pancreas transplant alone (PTA), simultaneous pancreas-kidney transplant (SPK), pancreas after kidney transplant (PAK), and islet transplant (developing technology). SPK is the most common type of transplant, which is performed on patients with diabetes type 1 complicated by end-stage renal disease. Complications following pancreas transplant occur more frequently than in other abdominal solid organ transplants. Although major complications following pancreas transplant are uncommon, several, including pancreatitis, exocrine duct leaks, and pancreatic pseudocysts, are unique to this transplant. The most common reason for graft failure overall is immunologic rejection. Both pancreas and islet transplantation require lifelong immunosuppression to prevent rejection of the graft.
Motor Neuron Diseases
Authors: Dalton Allison K. 
Published: March 2023

Abstract
Motor neuron diseases are a group of rare, heterogenous disorders characterized primarily by skeletal muscle weakness. Diseases are classified as affecting primarily upper motor neurons, lower motor neurons, or both. Upper motor neuron diseases are characterized by muscle weakness, hyperreflexia, and spasticity, while lower motor neuron diseases are characterized by weakness, muscle atrophy, and fasciculations. Disease course is typically progressive. Age of onset, symptom severity, and disease course differ depending on the exact diagnosis and neurons affected. Patients with advanced disease may suffer from respiratory, pharyngeal, and skeletal muscle weakness, which have significant implications for preoperative, intraoperative, and postoperative management.
Congenital Myasthenic Syndromes
Authors: Sam Sabrina S. , Ragheb-Mueller Nawal E. 
Published: March 2023

Abstract
Congenital myasthenic syndromes (CMSs) are rare disorders caused by hereditary mutations leading to an abnormal response to acetylcholine. There are three main categories of CMS: presynaptic, postsynaptic, and synaptic. A CMS is characterized by fatigable muscle weakness, but severity and onset of symptoms can vary greatly. Early onset corresponds to more severe features. CMS is diagnosed with electrodiagnostic testing and a Tensilon test. Genetic testing is required to differentiate between the subtypes. CMS does not respond to steroids or immune modulation as it is not an autoimmune disorder. The management of CMS is dependent on the genetic mutation. CMS can also be exacerbated by many commonly used drugs. It may be prudent to avoid muscle relaxation for intubation if the surgical procedure allows it.
Cancer Pain
Authors: Vorenkamp Kevin E. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Pain is one of the most troubling symptoms for the nearly 17 million cancer patients in the United States. For many patients, traditional medications and treatments are not effective, and they are severely debilitated by their pain, causing needless suffering at the end of life. Overall, a recent meta-analysis demonstrated a prevalence rate of moderate or severe pain in 38% of all patients with a cancer diagnosis, but these rates are nearly doubled for patients with advanced, metastatic, or terminal cancer diagnoses. In this chapter, pharmacological approaches incorporating the World Health Organization (WHO) analgesic ladder are reviewed and inherent limitations discussed. Interventional treatment strategies, including neurolytic blocks and neuraxial infusions, are described, including appropriate patient selection.
Complex Regional Pain Syndrome
Authors: Mauer Kim , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Complex regional pain syndrome type 1 and type 2 were formerly called reflex sympathetic dystrophy type 1 and type 2. Type 2 reflex sympathetic dystrophy (RSD) was also more commonly referred to as “causalgia.” While the terminology has changed, the disease condition has not. Complex regional pain syndrome types 1 and 2 are very similar. The syndrome is difficult to diagnose and treat. It usually affects an arm or a leg. Most of the clinical characteristics are shared. The understanding is continuing regarding this sympathetically mediated pain. In addition, new therapies for it are constantly being discovered, and there has been newer diagnostic criteria, the Budapest criteria.
Neuraxial Opioids
Authors: Jenkinson Robert H. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Opioid administration into the epidural or intrathecal space is a commonly employed technique for both acute and chronic pain management. Epidural and intrathecal opioids can provide profound analgesia in significantly smaller doses than if administered parenterally. Opioids are commonly coadministered with other medications, such as local anesthetics and α-adrenergic agents, in order to produce profound levels of analgesia. Though neuraxial opioids can provide safe and effective pain control, their clinical pharmacology is complex. Therefore, a careful understanding of key underlying principles is needed in order to choose the appropriate opioid agent, neuraxial route of administration, and dose for each clinical situation.
World Health Organization (WHO) Analgesic Ladder
Authors: Jenkinson Robert H. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
The 1986 World Health Organization (WHO) report on cancer pain management included an analgesic ladder and was a landmark publication. The report offered a logical, simple and sequential approach to analgesic escalation that could be implemented even in low-resource areas. The use of the analgesic ladder for chronic noncancer pain, which was not the intent of the WHO guidelines, remains a controversial subject. Modifications that more strongly incorporate interventional therapies as well as integrative medicine therapies have garnered substantial support. However, the principles of sequential escalation based on analgesic strength, pain severity, and response to prior therapy are still applicable.
Cardiovascular System
Authors: Iana Bilga , Gwam Chike 
Published: March 2023

Abstract
An understanding of the unique characteristics of the pediatric cardiovascular system is essential for the safe delivery of anesthetic care to the pediatric patient. Knowledge of fetal development, fetal circulation, the transition to extrauterine life, as well as age-specific physiological, hemodynamic, and functional differences of the pediatric cardiovascular system is crucial in the anesthetic management of neonates and young children.
Fetal Hemoglobin
Authors: Chung Alex Y. , Carollo Dominic S. 
Published: March 2023

Abstract
Fetal hemoglobin (HbF) is a physiologic variant of the adult hemoglobin (HbA) protein. It is primarily present in the fetus. HbA has a lower oxygen affinity than HbF. A newborn’s hemoglobin transitions from HbF to HbA with 70% HbF at 40 weeks’ gestational age to almost 0% at 6 months after birth. Transfusion with HbA blood or premature birth can affect the rate and timing of this transition. The change in proportion of HbF will affect the degree of oxygen saturation of hemoglobin for a given partial pressure of oxygen due to the difference in the oxygen-hemoglobin dissociation curve. A thorough history and careful evaluation of monitoring devices allow the anesthesiologist to optimize oxygen delivery perioperatively.
Prematurity
Authors: Gyorfi Michael J. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Approximately 12.5% of births in the United States are preterm. This is defined as a birth occurring before 37 weeks of gestation. The risk of mortality and morbidity are inversely related to gestational age. Preterm infants weighing 1500 g or less are termed as having a very low birthweight; this is associated with numerous complications. Preterm neonates contribute disproportionately to infant morbidity and healthcare costs. Short-term complications include respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), and intraventricular hemorrhages. Preterm infant complications pose numerous challenges for proper administration of anesthesia. Challenges range from managing a delicate respiratory system to assessing pain control in nonverbal neonates.
Altered Uptake/Distribution of Intravenous and Inhalation Anesthetics
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Intravenous drug doses in pediatrics are often weight based, assuming a linear relationship between clearance kinetics and weight. This is strategy is flawed as metabolic processes are not linearly related to body mass. Rather, they are related to the combination of organ maturation, changes in body composition with somatic growth, and organ maturation, such as glucuronide conjugation. Further, these processes are difficult to study without practical methods of measuring pharmacodynamic effects of drugs in young children. In contrast, inhalational anesthetics are quite insoluble and undergo negligible amounts of metabolism. In this chapter, the focus is on rate of uptake and impact on the neonatal myocardium.
Noncardiac Surgery
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Children with heart disease who undergo noncardiac surgery present substantial anesthetic risk. The incidence of congenital heart disease has been estimated as 6/1000. Related anesthetic risks include cardiac lesions, inpatient versus outpatient setting, type of surgery, surgical approach, and postoperative disposition. Robust literature has frequently pointed to the following as involving high risk: single ventricle, pulmonary hypertension, Williams-Beuren syndrome, and cardiomyopathy (dilated, hypertrophic, restrictive). While risk data are robust, management tips and guides are rarely evidence based. Mitigating risk preoperatively may improve outcomes in this population.
Neonatal Lobar Emphysema
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Respiratory distress is common among newborns and has many potential etiologies. It may also be the first sign of neonatal lobar emphysema (NLE). NLE is characterized by hyperinflation with progressive air trapping and respiratory distress. Initial goals in management are to make an accurate diagnosis (as chest roentgenogram appearance is similar to simple pneumothorax) and prevent further enlargement of the lobe and its consequent mass effect on cardiorespiratory structures. This can be accomplished by maintenance of spontaneous ventilation and avoidance of positive pressure. Management is surgical with a lobectomy of the affected lung lobe (usually left upper). Outcomes are acceptable; however, controversy exists surrounding the optimal surgical technique, namely, open versus thoracoscopic.
Myelomeningocele
Authors: Karroum Rami Edward 
Published: March 2023

Abstract
Spinal dysraphism is a group of congenital defects involving the midline structures of the back. Myelomeningocele is the most common type. It is usually diagnosed with fetal ultrasound during pregnancy. It presents surgical urgency and needs to be performed within 24 hours after delivery to prevent infection and reduce the progression of neurological damage. Hydrocephalus due to Chiari malformation type 2 is a common association. Patients can develop latex allergy later in life; therefore, all centers recommend a latex-free environment from birth. Anesthetic considerations are focused on proper positioning during induction to facilitate intubation and prevent the rupture of the sac. Prone positioning for the procedure is another anesthetic challenge. Maintaining normothermia and normovolemia is another important objective for anesthesia.
Musculoskeletal Disease
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
The spectrum of musculoskeletal disease varies widely. Ambiguity in diagnosis or presentation to the operating room without a definitive diagnosis provides a common challenge to the anesthesiologist. Children with musculoskeletal disease may be uniquely vulnerable to malignant hyperthermia, anesthesia-induced rhabdomyolysis, covert cardiac dysfunction, or respiratory embarrassment. Children with skeletal disorders present unique airway and ventilatory challenges. Postoperative disposition may require escalation in respiratory care with multispecialty input. Finally, analgesia in any child with musculoskeletal disease requires careful consideration regarding risks and benefits of regional analgesics and opioids. This chapter focuses on Duchenne muscular dystrophy, spinal muscular atrophy, and osteogenesis imperfecta. Neither malignant hyperthermia nor cerebral palsy is addressed here.
Developmental Delay, Autism, and Cerebral Palsy
Authors: Berkelhamer Maura C. 
Published: March 2023

Abstract
This chapter examines a constellation of neurologic disorders producing atypical patterns of human development that impact cognitive and motor abilities. Patients affected with these conditions present with a wide spectrum of neurologic impairment. Disorders of other organ systems and comorbidities exist in these patients as a result of their motor and cognitive impairment, including respiratory insufficiency, gastroesophageal reflux, obstructive sleep apnea, hypothalamic dysfunction, growth failure, and growth abnormalities. Understanding typical child developmental milestones is important for comparison. Delivery of anesthesia, beginning with induction, must consider the cognitive and behavioral abilities of the patient affected with developmental disabilities. The patient’s neurologic abnormalities can impair respiratory function and impact the pharmacodynamics of anesthetic drugs. This makes perioperative planning for these patients and their caregivers essential to ensure a safe hospital and postoperative course.
Childhood Obesity
Authors: Salik Irim 
Published: March 2023

Abstract
Childhood obesity is one of the direst medical and public health concerns of our generation. This chapter reviews the etiology, prevalent comorbidities, clinical interventions for treatment, and anesthetic implications of childhood obesity. The prevalence of childhood obesity is unacceptably high, and the rate of increase in severe obesity continues to grow. Because of its complex etiology stemming from the interaction of genetic, biological, environmental, and ecological factors, it has been difficult to manage. The serious medical comorbidities associated with childhood obesity necessitate effective treatment modalities, utilizing a staged approach to management. Children with poor responses to primary care management strategies should utilize a multidisciplinary team with expertise in pediatric obesity. Pharmacotherapy and/or bariatric surgery should be considered if there is no response to structured weight management. Although significantly more research is needed to optimize management strategies, interventions at the level of the primary care provider, family, school, and government have shown success in the prevention of childhood obesity. There are a number of anesthetic implications in obese children, most important of which is the increased incidence of perioperative adverse respiratory events in this population as opposed to normal weight controls. Anesthesiologists should be well versed and adequately prepared to manage airway complications as they arise in obese children.