bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hydrocephalus
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Hydrocephalus and cerebrospinal fluid (CSF) diversion operations are the most common pediatric neurosurgical procedures. Hydrocephalus may be congenital, associated with a syndrome, or occur as a result of trauma, infection, or tumor. Additionally, some syndromes associated with hydrocephalus include Arnold-Chiari and myelomeningocele. Hydrocephalus may be noncommunicating or communicating. Noncommunicating hydrocephalus is obstructive, and communicating hydrocephalus occurs when CSF absorption is inadequate. Symptoms may be insidious and subtle. Routine surveillance with head circumference measurements during well-child checks at the pediatrician may raise the first suspicion of hydrocephalus. Open fontanelles afford infants additional protection against dangerous increases in intracranial pressure and herniation. This chapter covers etiologies, pathophysiology, and surgical management of hydrocephalus.
Juvenile Idiopathic Arthritis
Authors: Fritzler Anthony 
Published: March 2023

Abstract
Juvenile idiopathic arthritis (JIA) is a wide-ranging term and includes all forms of arthritis that begin before 16 years of age, persist for more than 6 weeks, and are of unknown origin. The systemic form of JIA is associated with the most anesthesia-related concerns. Most forms of JIA are thought to have an autoimmune etiology. Systemic JIA is unique in that there is an absence of autoantibodies. It is considered to be a polygenic autoinflammatory syndrome. Diagnosis of JIA is based on history, symptoms, multiple laboratory studies, and imaging studies. Treatment of all forms typically consists of nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs). Methotrexate is the standard first-line agent. Elective procedures should only be performed when the patient is in stable remission. Potential anesthetic concerns are considerable and multisystemic in nature, including the cardiovascular and pulmonary systems. Airway management can present a challenge, as cervical spine abnormalities such as ankylosis and subluxation are common. In the perioperative period, it is essential to be cognizant of the constant potential for an exacerbation of systemic JIA or the development of macrophage activation syndrome (MAS), which can be life threatening.
Pediatric Management of Postoperative Nausea and Vomiting
Authors: Santana Lisgelia 
Published: March 2023

Abstract
Postoperative nausea and vomiting (PONV) are frequent but often missed complications and a source of significant morbidity. Various independent risk factors have been implicated in the development of pediatric PONV, including the use of opioids and volatile anesthetics and higher pain scores. The use of multimodal anesthesia, including nonopioid analgesics and total intravenous drugs, in favor of volatile anesthetics and an appropriate regimen of prophylactic pharmacotherapy could potentially mitigate the risk of PONV. Frequently administered drug classes for the prevention of PONV include 5-HT3 (5-hydroxytryptamine, serotonin) antagonists, corticosteroids, and anticholinergics. This chapter provides comprehensive information on the risk factors contributing to the occurrence of PONV in children, outlines the current opinion on the drugs that are commonly used, and provides an overview of the guidelines that are used to help establish the prophylaxis and treatment of pediatric PONV.
Mechanisms of Placental Transfer and Placental Transfer of Specific Drugs
Authors: Ahmed Muhammad Fayyaz , Kamel Ihab 
Published: March 2023

Abstract
The placenta is closely involved in exchange of fetal and maternal blood for transfer of waste, nutrients, gases, and drugs. The placenta allows bidirectional transfer of various substances through an imperfect barrier involving complex transport mechanism. The permeability of the membrane and availability of certain processes limits movement freely. Modes of placental transfer include simple diffusion, facilitated diffusion, active transport, and pinocytosis. Multiple factors impact the placental transfer for nutrients, drugs, and waste substances, such as degree of ionization and molecular size. Knowledge of the drugs that cross the placenta is critical for ensuring fetal safety during pregnancy and delivery.
Other Blocks
Authors: Stram Mark L. 
Published: March 2023

Abstract
Although typically epidural (and intrathecal) anesthesia are considered “first-line” modalities for management of labor pain, there are times when these neuraxial blocks are not possible. This may be due to lack of an experienced provider, as is common in rural areas and undeveloped countries, or there may be contraindications for providing such blocks (e.g., previous spine surgery or a coagulation disorder). The parturient may be unwilling to consider a neuraxial block. An obstetrician typically performs paracervical and pudendal blocks during the first and second stages of labor, respectively. The lumbar sympathetic block is an advanced regional analgesia technique performed by an experienced anesthesia provider during the first stage of labor. These three techniques and important complications are described in this chapter on alternatives to neuraxial labor analgesia.
Physiology of Labor
Authors: Ejiogu Nwadiogo , Orlando Barbara 
Published: March 2023

Abstract
The main changes observed during labor are essentially a considerable increase in cardiac output, even more than during pregnancy, associated with a worsening of the increase in minute ventilation seen during pregnancy. Major airway edema is common and can affect intubating conditions in the case of general anesthesia, which can be worsened by a severe increase in the risk of gastric aspiration during labor, despite the strict fasting (nil per os, NPO) guidelines with clear liquid diet. Last, increased intracranial pressure (ICP) during the pushing period with the Valsalva maneuver can jeopardize the parturient’s health in case of preexisting neurologic conditions.
Influence of Anesthetic Technique on Labor
Authors: Im Mary J. , Kamel Ihab 
Published: March 2023

Abstract
Epidural analgesia is the gold standard modality to alleviate pain associated with labor. Over the past decades, an association between epidural analgesia and undesirable obstetric effects has been reported. Reported undesirable obstetric effects include prolonged labor, increased incidence of assisted vaginal delivery, and increased rate of cesarean delivery. Currently, evidence indicates that the only undesirable effect of labor epidural analgesia is a prolongation of the second stage of labor, with concerns about maternal and neonatal outcomes associated with the duration of the second stage of labor or active pushing. The risks of postpartum hemorrhage, advanced degree of perineal lacerations, chorioamnionitis, as well as neonatal complications, have been observed to be higher with the prolongation of second stage. Prolongation of the second stage of labor can be minimized by using a low-concentration local anesthetic solution for epidural analgesia.
Ectopic Pregnancy
Authors: Noguera Edward 
Published: March 2023

Abstract
Obstetric hemorrhage is leading cause of maternal death. Ectopic pregnancy is the leading cause of maternal deaths due to hemorrhagic complications (10%–15%). A fertilized egg that grows outside of the uterus, an ectopic pregnancy, can lead to rupture of the structure in which the egg is developing, leading to hemorrhage. The prevalence of ectopic pregnancy is 6%–16%. The implantation sites are the fallopian tubes (95%), ovary (3%), and abdomen (2%). A ruptured ectopic pregnancy is a surgical emergency that can cause hemorrhagic shock. Anesthesiologists should be prepared for the management of shock intraoperatively when caring for patients with an ectopic pregnancy.
Heart Disease
Authors: Ahmed Muhammad Fayyaz , Kamel Ihab 
Published: March 2023

Abstract
Cardiovascular disease during pregnancy can lead to significant maternal-fetal morbidity and mortality. Cardiovascular disease affects 1%–4% of pregnancies in United Stated annually. Congenital heart disease, pulmonary hypertension, valvular heart disease, and cardiomyopathy are among the common ailments that can affect patient outcomes. Understanding of the pathophysiology of various cardiac diseases is the quintessential foundation for proper and safe management during and after delivery. The interplay between the physiologic changes of pregnancy, individual patient disease severity, and the pathophysiology of each disease dictates an individualized multidisciplinary care geared toward optimizing hemodynamics and cardiac function during all phases of anesthesia administration.
Hematologic Disorders
Authors: Hyers Benjamin M. , Chung Kevin W. 
Published: March 2023

Abstract
Sickle cell anemia, idiopathic thrombocytopenic purpura, von Willebrand disease, disseminated intravascular coagulation, patients on anticoagulant therapy, and Rh and ABO incompatibility are common hematologic disorders and states seen during a pregnancy. Anesthesiologists caring for these patients need to consider the risk for epidural hematoma formation after placement of neuraxial anesthesia. The perioperative care for these patients involves a multidisciplinary team to ensure the safety of the patient and her fetus. Preoperative assessment and anesthetic considerations are individualized for each patient and are specific to each disease process. Therefore, it is important to understand the pathophysiology and treatment of these diseases.
Neurologic Disorders
Authors: Brakoniecki Katrina , Chung Kevin W. 
Published: March 2023

Abstract
As the medical management of women with underlying neurologic diseases advances, many of these women are carrying healthy babies to term with the aid of maternal fetal medicine colleagues. These patients are particularly complex to manage in both the peripartum and perioperative periods. The physiologic changes of pregnancy can greatly affect these individuals’ anesthetic management. Whether on the labor and delivery floor or in the operative suite, it is important to consider these patients’ respective disease processes and their relationship to neuraxial techniques, pharmacological agents, and general hemodynamics. This chapter discusses those disease processes.
Antepartum Hemorrhage
Authors: Im Mary J. , Kamel Ihab 
Published: March 2023

Abstract
Antepartum bleeding can lead to adverse fetal and maternal consequences if not identified and treated promptly. Antepartum vaginal bleeding may occur in as many as 25% of pregnant women. Maintaining a high index of suspicion in high-risk patients is key to early identification. Proper management will vary according to the etiology of antepartum hemorrhage. The most common etiologies of antepartum hemorrhage are placenta previa, placenta abruption, vasa previa, and uterine rupture. Women presenting with active, ongoing obstetric hemorrhage require stabilization and preparation for delivery by cesarean section. Proper obstetric management and special anesthetic considerations are essential for maternal and fetal well-being.
Preterm Labor
Authors: Taco Erika , Spencer Kevin 
Published: March 2023

Abstract
Prematurity is the leading cause of neonate morbidity and mortality. In the United States, the preterm rate varies widely, from 7.5% to 13.6%, with an average of 11%. Modifiable risk factors should be controlled to avoid preterm labor. Preterm labor is defined as regular uterine contractions accompanied by a change in cervical dilation, effacement, or both occurring at less than 37 and more than 20 weeks’ gestational age. Tocolytic therapy should be used judiciously based on obstetric goals. Anesthesiologists and obstetricians should maintain close communication to improve the fetal outcomes and decrease long-term complications in neonates. Anesthetic management entails similar goals to that of a full-term labor and delivery by favoring neuraxial techniques in the absence of its contraindications.
Multiple Gestation
Authors: Knoblock Steven , Younger Joshua D. 
Published: March 2023

Abstract
Three percent of all births are now a result of twin pregnancies, and 0.2% of pregnancies are higher multiples. It is important to become familiar with the needs and challenges a multiple-gestation pregnancy may present. An anesthesia provider in the obstetric environment is tasked with not only caring for the laboring patient but also tailoring an anesthetic for the most desirable outcomes for the expectant multiples. This necessitates familiarity with how a multiple-gestation pregnancy physiologically differs from a single gestation. It is also essential to acknowledge the fetal effects of a multiple-gestation pregnancy. Last, anesthesia optimization in the setting of multiple gestation is critical to the success during the labor and delivery course.
Nerve Injury Monitoring During ENT Surgery
Authors: Burnett Garrett W. 
Published: March 2023

Abstract
Intraoperative nerve monitoring during otolaryngologic surgery allows for identification of nerves susceptible to injury during surgery using electromyography. Commonly monitored nerves include the facial nerve (VII), recurrent laryngeal nerve (X), and spinal accessory nerve (XI). Specialized equipment is necessary for electromyographic (EMG) monitoring of these nerves, and collaboration between the otolaryngologist and anesthesiologist is required. Medications such as neuromuscular blockade should be avoided in order not to disrupt EMG signals. Careful electrode placement and vigilant monitoring are important components of intraoperative neuromonitoring. Early recognition of postoperative nerve injury is crucial, particularly in recurrent laryngeal nerve injury, which may result in stridor, airway obstruction, or aspiration.
Ophthalmologic Anesthesia
Authors: Teixeira Camila , Minear Steven 
Published: March 2023

Abstract
The goals of ophthalmologic anesthesia include the maintenance of a stable intraocular pressure (IOP) and avoidance of oculocardiac reflex (OCR) in a comfortable, motionless patient. Regional anesthesia in ophthalmologic surgery has several advantages over general anesthesia, such as postoperative analgesia enhancement and nausea and vomiting reduction. Due to its akinetic feature, it also has some advantages over topical anesthesia. To reduce the risk of injury to the major structures in the intraconal space, recently the peribulbar block has been replacing retrobulbar anesthesia. However, even with remarkable widespread use, regional anesthesia can elevate the IOP, and eye blocks often represent a threat for patients at risk of expulsive hemorrhage, especially those with open globe injury. In conclusion, the anesthesia technique choice can be a challenging decision that should be made individually depending on patient cooperation, surgeon skills, type of procedure, and resource availability at the assigned facility.
Anesthesia for MRI
Authors: Cosic Adi , Abouhassan Soozan S. 
Published: March 2023

Abstract
Magnetic resonance imaging (MRI) is an imaging modality that has revolutionized body imaging and has been present for over 40 years. It continues to undergo advancements. Making use of powerful magnetic fields, it is a useful tool in the diagnosis of soft tissue ailments and abnormalities that might otherwise not be seen with other imaging. However, its qualities pose a unique challenge to the anesthesiologist providing care in the radiology suite, which is an unfamiliar setting with inherent risk. Additionally, MRI-created magnetic fields are often many times the strength of Earth’s and require thoughtfulness in regard to how the anesthetics will be provided, the monitors and their position, and potential patient implants.
Pharmacological Implications
Authors: Tinevez Dillon , Jani Jai 
Published: March 2023

Abstract
Inhaled anesthetics are used to provide anesthesia to patients undergoing surgery by acting primarily on the central nervous system. Volatile anesthetics decrease the cerebral metabolic rate of oxygen consumption but may increase cerebral blood flow and intracranial pressure at higher concentrations, while nitrous oxide causes an increase in both. Both volatile anesthetics and N2O decrease the amplitude and increase the latency of somatosensory evoked potentials (SSEPs) in a dose-dependent manner. All volatile anesthetics decrease mean arterial pressure, while nitrous oxide has little to no effect. Volatile anesthetics cause a decrease in tidal volume and an increase in respiratory rate; however, minute ventilation is preserved. All volatile anesthetics potentiate the activity of neuromuscular blocking drugs and are all known triggers of malignant hyperthermia. Fluoride production from the metabolism of other inhaled anesthetics such as sevoflurane shows no association with renal injury. There is a mild and severe form of liver injury that is associated with volatile anesthetics. The severe immune-mediated liver injury may follow any commonly used volatile anesthetic involving massive hepatic necrosis, resulting in fulminant liver failure. The mild form of liver injury caused by a volatile anesthetic follows the administration of halothane and is characterized by transient transaminitis.
Systemic Inflammatory Response Syndrome
Authors: Gorneva Maria , Tzonkov Anna 
Published: March 2023

Abstract
Systemic inflammatory response syndrome (SIRS) is an overactive defense response of the body to an external or internal stressor. The physiological goal is elimination of insult source via release of acute-phase reactants, leading to significant pro-inflammatory immunological changes. In certain individuals, this process leads to an overreactive “cytokine storm,” causing reversible or irreversible end-organ damage. The diagnosis of SIRS can be made by the presence of two or more of the following criteria: (1) body temperature over 38°C or under 36°C; (2) heart rate greater than 90 beats/min; (3) respiratory rate greater than 20 breaths/min or partial pressure of CO2 less than 32 mm Hg; and (4) leukocyte count greater than 12,000 or less than 4000/µL or over 10% immature forms or bands. Early diagnosis and intervention are the key points for improved morbidity and mortality. Interleukin 1, 6, and 8; tumor necrosis factor alpha (TNF-α); and γ-interferon are among the most important mediators. Management of SIRS focuses on treatment of underlying etiology and prevention of end-organ damage.
Ventilator-Associated Pneumonia
Authors: Owen Robert M. , Chung Kevin W. 
Published: March 2023

Abstract
Ventilator-associated pneumonia (VAP) is a serious nosocomial infection that is often encountered in the critical care setting. While there is no firm consensus on the “gold standard” of diagnosis; it is most broadly accepted to be a pneumonia that occurs more than 48 hours after endotracheal intubation. VAP can result in prolonged hospital stays, increased resource utilization, and significant morbidity and mortality. As VAP occurs in patients who already have critical illness, progression to acute respiratory distress syndrome (ARDS), empyema, sepsis, and septic shock are common. Several strategies have been implemented, often in the form of ventilator “bundles,” to prevent VAP as well as other ventilator-associated events. The most common causative organisms for VAP include Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae members. Multidrug-resistant (MDR) pathogens are of increasing concern. Systemic antibiotics serve as the mainstay of treatment. Antibiotic choice should be driven not only from a desire to cover both methicillin-resistant S. aureus (MRSA) and Pseudomonas aeruginosa, but also by the institution’s local patterns of microbial flora and resistance.
Brain Death
Authors: Siddiqui Shahla 
Published: March 2023

Abstract
Since the 1950s, the diagnosis of brain death has come to mean death of the individual. There is a strict set of criteria that are validated and accepted globally as the diagnostic veracity of death. The criteria for such a determination largely remain clinical, including a battery of bedside tests. Knowledge of these clinical criteria as well as the need for ancillary tests for determination of brain death are important during residency training. In the United States, brain death criteria include irreversible coma, lack of brainstem criteria, and apnea. Determination of brain death (or determination of death of an individual) can be a crucial and a deeply emotional aspect of critical care.
Definitions
Authors: Hanna Joseph Salama , Saad Ramsey 
Published: March 2023

Abstract
Patient safety is a healthcare discipline that emerged with the evolving complexity in healthcare systems and the resulting rise of patient harm in healthcare facilities. It aims to prevent and reduce risks, errors, and harm that occur to patients during provision of healthcare. A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events. The occurrence of adverse events due to unsafe care is likely 1 of the 10 leading causes of death and disability in the world. In high-income countries, it is estimated that 1 in every 10 patients is harmed while receiving hospital care. The harm can be caused by a range of adverse events, with nearly 50% of them preventable. Each year, 134 million adverse events occur in hospitals in low- and middle-income countries (LMICs) due to unsafe care, resulting in 2.6 million deaths. This chapter reviews the key definitions, concepts, as well as examples of medication error and adverse and sentinel events.
Freud’s Contribution
Authors: Berman Carol W. 
Published: March 2023

Abstract
Sigmund Freud is considered the first psychiatrist. The oedipal complex (see Chapter 1) is a central tenet of his psychoanalytical theory. Many plays illustrate this complex, as it is an essential feature of family dynamics. Freud, aware of the basic themes of childhood sexuality, named the “Oedipus complex” after Sophocles’s play, Oedipus Rex. Freud also called the childhood aspect of female sexuality, in which the girl wants to eliminate her mother and marry her father, the Oedipus complex. It took Jung to consider another Sophocles play, Electra, and name the female oedipal complex the “Electra complex,” although now we use the Oedipus complex to include females and males alike.
Depression and Bipolar Disorder
Authors: Berman Carol W. 
Published: March 2023

Abstract
Depressed patients have problems eating and sleeping, and their moods are blue. They may have anhedonia and hopelessness. Many are irritable and guilty. The danger is they may commit suicide if their depressions are not treated. Depression is common and strikes fifteen to thirty percent of the population. It is not simply a down mood as many people believe. Chekhov’s Uncle Vanya provides a good example of a depressed character to whom the audience can relate because of his humor and humanity. Many times defenses like humor or sarcasm are used by depressed patients to hide their depressed moods. Bipolar patients can alternate from bouncing around in hypomania, like Chekhov’s Ivanov, or be depressed like Vanya. If a person swings back and forth between a down mood and an up mood, the person may very well have bipolar disorder.
Psychosis
Authors: Berman Carol W. 
Published: March 2023

Abstract
Psychosis is a break from reality in which patients may hallucinate and have delusions. Hallucinations usually involve seeing or hearing things that don’t exist. Delusions are fixed and false beliefs that are not based in reality. In The House of Blue Leaves by John Guare, Bananas, a main character, has a breakdown and has to be hospitalized. Tennessee Williams’s Laura in The Glass Menagerie is believed to be based on the playwright’s schizophrenic sister. Schizophrenia involves psychosis in specific ways. Patients suffering from schizophrenia have problems with thinking, behavior, and emotions. Laura’s glass figurines are objects on which she projects her psychotic fantasies.