bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malignant Hyperthermia in Children
Authors: Edjiu Narbeh , Gutstein Howard B. 
Published: March 2023

Abstract
Malignant hyperthermia (MH) is a life-threatening autosomal dominant disorder of skeletal muscle. Exaggerated calcium release within skeletal muscle results in a severe hypermetabolic state when susceptible individuals are exposed to volatile inhaled anesthetics and/or succinylcholine. A mutation in the ryanodine receptor (RYR1) gene is responsible for most cases. Several congenital myopathies have increased MH susceptibility. Children account for approximately 50% of documented reactions. Early clinical signs include muscle rigidity (particularly masseter spasm), hypercarbia, and tachycardia. Later, hyperthermia, electrolyte abnormalities, severe acidosis, and rhabdomyolysis can develop. Differential diagnosis includes sepsis; thyroid storm; pheochromocytoma; overheating; neuroleptic malignant syndrome (NMS); serotonin syndrome; overdose of abused drugs (cocaine, “ecstasy”); and sudden hyperkalemic cardiac arrest. The caffeine-halothane contracture test (CHCT) remains the most reliable diagnostic test. Dantrolene is the treatment of choice and has reduced mortality to under 20%. This chapter outlines the management of MH susceptibility and episodes in pediatric patients.
Maternal Physiology
Authors: Shah Nimit K. , Al-Jindi Piotr 
Published: March 2023

Abstract
Pregnancy affects almost every organ system in a parturient’s body. Various anatomical and physiological changes in pregnancy that have significant implications for an anesthesiologist caring for a pregnant patient. Pregnant patients are more likely to present with a difficult airway and a high risk of aspiration during anesthesia. The incidence of difficult mask ventilation and difficult intubation is higher than in nonpregnant patients. All patients should be considered as having a full stomach from 16 weeks of pregnancy to 48 hours postpartum. There are significant cardiovascular changes, such as supine hypotension syndrome, which mandates left uterine displacement when a parturient is supine. There is an increase in plasma volume more than red cell volume, resulting in physiological anemia of pregnancy and an increase in both cardiac output and heart rate with a decrease in systolic and diastolic blood pressures—all changes designed for coping with blood loss during delivery. There is a reduction in functional residual capacity (FRC) due to the gravid uterus pushing the diaphragm up. The increased oxygen consumption, along with reduced FRC, can lead to faster desaturation, and adequate preoxygenation is vital. Pregnancy is also a hypercoagulable state meant for minimizing blood loss during delivery, and the incidence of deep vein thrombosis and pulmonary embolism is higher than for nonpregnant patients, so these patients will routinely receive thromboprophylaxis. The minimum alveolar concentration 50 is reduced by about 30%–40% in pregnant patients, and the dose of local anesthetic for neuraxial blocks should be reduced by 25%–40%.
Labor Analgesia
Authors: Uzodinma Ifomachukwu , Al-Jindi Piotr 
Published: March 2023

Abstract
The treatment of labor pain consists of multiple therapies to reduce maternal discomfort while maintaining fetal well-being. Visceral, somatic, and sympathetic contributions lead to the pain experienced by the parturient during labor. Neuraxial modalities provide superior analgesia for the laboring patient. Spinals provide rapid analgesia, epidurals provide maintenance of labor analgesia, while the combined spinal-epidurals offer the benefits of rapid onset and good anesthetic maintenance. Epidural delivery systems have had many changes over the years. Early methods of epidural medication administration started with intermittent boluses by anesthesia providers, progressing to continuous epidural infusions and patient-controlled epidurals. Recent technologies have found that the use of programmed intermittent epidural boluses provides superior analgesia for labor pain based on the concept that bolus dosing of local anesthetics provides improved epidural spread and improved sensory blockade.
Systemic Medications
Authors: Uzodinma Ifomachukwu , Al-Jindi Piotr 
Published: March 2023

Abstract
Systemic medications have been used in the management of labor analgesia since the late 1840s. Inhalational and parenteral medications offer a viable alternative to neuraxial analgesia. The pharmacokinetics of different opioids determine the agent that may be ideal to manage labor pain while limiting the deleterious effects on the parturient and fetus. Morphine and meperidine are opioids with potent metabolites that have long half-lives. When used in the later phases of labor, morphine-6-glucoronide and normeperidine will often result in respiratory alterations and decreased Apgar scores in the neonate. Most recently, remifentanil has been used in patient-controlled analgesia systems for labor analgesia. Remifentanil is a beneficial agent due to its rapid onset of analgesia; it should be used judiciously as it increases maternal respiratory depression. Inhaled nitrous oxide is a popular option used to treat labor pain and may help mitigate anxiety. Despite the variable pain relief offered by nitrous oxide, maternal satisfaction scores are often high due to their increased independence during the childbirth experience. Optimal scavenging systems should always be employed when using nitrous oxide in order to reduce adverse effects to the anesthesia provider.
Complications of Obstetric Anesthesia
Authors: Lampert Peter , Schroeder Kristopher M. 
Published: March 2023

Abstract
Obstetric anesthesia can be both highly rewarding and equally litigious as patient expectations are high; the implications of anesthetic complications can profoundly impact both mother and infant, and anesthetic interventions are frequently performed in an urgent fashion. The complications that can arise during the anesthetic management of obstetric patients are not unique to this patient population. However, the physiologic and anatomic changes associated with pregnancy can impact the incidence and severity of these complications. Understanding and conveying the risks of these complications is an essential component of the informed consent process. In addition, rapid diagnosis and management of these complications should increase the likelihood of a favorable outcome. Frequently encountered complications include postdural puncture headaches and neurologic complications consisting of peripheral nerve palsies. Fortunately, the complications are generally self-limited, but the severity and implications of these complications may prompt patients to seek expedited treatment of these symptoms.
Hazards and Complications
Authors: Naftalovich Rotem , Shah Manan Nimish 
Published: March 2023

Abstract
Anesthesia for ear, nose, and throat surgery necessitates unique considerations for hazards from surgical complications that can jeopardize the airway, preexisting conditions with potential to render difficulty in oxygenation and ventilation, and intraoperative field avoidance. A mass in close proximity to the airway may best be managed by securing the airway in the awake state because general anesthesia and paralysis result in loss of muscle tone that may otherwise be maintaining airway patency. Rigid bronchoscopy, reinforced endotracheal tubes, and emergent proning are potential life-saving options. The nature of aspirated material is a consideration in management. Maintaining spontaneous ventilation is an important consideration with foreign body aspiration since positive pressure ventilation can push the object further downstream in the airway, and so can the endotracheal tube itself. If pooling blood compromises visualization of the vocal cords, air bubbles emitting from the trachea with external stomach compression may clue the provider to the tracheal opening. Edematous tissue is often friable and bleeds easily, which can compromise the airway. Epinephrine is commonly used to decrease bleeding and improve visualization; this often leads to iatrogenic hemodynamic changes, which can easily be misdiagnosed with poor communication. If throat packing is used, it is crucial that removal is not forgotten prior to extubation.
Intraoperative Thyroid and Parathyroid Function Monitoring
Authors: Lacourrege Kelsey E. , Kaye Alan D. 
Published: March 2023

Abstract
Thyroid and parathyroid surgeries are performed for a variety of reasons, including cancer and noncancer. Appreciating the anatomic location and normal physiologic function of both the thyroid and parathyroid glands is imperative to appreciate the potential consequences and complications from surgery in this region. There are a number of safeguards that have become common to minimize complications, including monitoring of the recurrent laryngeal nerve and serial measurement of the parathyroid hormone and calcium levels. In both surgeries, good judgment and careful practice are required to achieve the best outcome. Hematoma and bleeding around the airway can result in morbidity and mortality. This chapter highlights perioperative concerns and practices with added focus on physiology and pathophysiologic states.
Carbon Monoxide Poisoning
Authors: Aquino Ben 
Published: March 2023

Abstract
Carbon monoxide (CO) is a byproduct of a significant number of chemical and biological processes. In high amounts, it can be fatal because of its ability to bind to the hemoglobin (Hb) molecule with an affinity more than 200 times that of oxygen (O2), creating a carboxyhemoglobin (COHb) molecule. This reduces the number of hemoglobin molecules available to bind oxygen and decreases the blood oxygen content. CO also changes the conformation of the hemoglobin molecule in a way that reduces its ability to release bound O2, creating a leftward shift in the oxyhemoglobin dissociation curve. Anesthesiologists need to be mindful of CO because under certain conditions it can build up in the anesthesia circuit and cause dangerously high patient carboxyhemoglobin levels. Carbon monoxide poisoning is difficult to detect because CO is a colorless and odorless gas, and early symptoms of poisoning in an awake patient, like headaches and fatigue, are very nonspecific. No single sign or symptom is pathognomonic for CO poisoning, which puts the onus on the clinician to suspect, diagnose, and treat it properly.
Drowning
Authors: Covington Derek Brady , Giordano Christopher 
Published: March 2023

Abstract
An estimated 500,000 deaths occur from drowning worldwide each year. A drowning happens when a person is submerged or immersed in fluid that subsequently blocks the airway and inhibits respiration. Drownings are labeled as witnessed or nonwitnessed for prognostic value. Regardless of whether the victim lives or dies in this process, they are considered to be involved in a drowning incident. Although shallow-water blackout may result in drowning, it occurs secondary to a specific sequence of events leading to hypoxia and subsequent loss of consciousness in shallow water (i.e., less than 15 feet deep). When someone is initially submerged in fluid during a drowning, they hold their breath until the carbon dioxide accumulates to a level that triggers inhalation. Because there is no surrounding air to inspire, the surrounding liquid is inhaled and laryngospasm may occur, leading to additional breath holding. The victim eventually becomes hypercarbic, hypoxemic, and unconscious. The ultimate mechanism of death is secondary to extreme and irreversible hypoxia. Cardiac arrest during drowning is due primarily to lack of oxygen. Consequently, it is important that cardiopulmonary resuscitation (CPR) follows the traditional airway-breathing-circulation, or ABC, sequence and starts with five initial rescue breaths. Two risk factors associated with a higher incidence of death or severe neurologic impairment include time of submersion longer than 10 minutes and CPR for longer than 25 minutes. Early initiation of basic life support/advanced cardiac life support (BLS/ACLS) and time of submersion of less than 5 minutes are associated with improved outcomes.
Radiological Procedures
Authors: Siddiqui Shahla 
Published: March 2023

Abstract
Radiological cases that require anesthesiology support can be challenging. The hazards of performing general anesthesia or sedation procedures in remote areas include the fact that the providers may not have adequate support and backup personnel and equipment in the case of an emergency. The usual causes of challenge can be in providing anesthesia, airway support, sedation, and hemodynamic support to unstable cases in remote areas; transporting such patients to and from the intensive care unit; and recovering patients in remote areas. Preparation and communication can be vital in such scenarios. Special preparation is required if the patient is COVID-19 positive.
Radiotherapy Planning
Authors: Ajithkumar Thankamma 
Published: March 2023

Abstract
Radiotherapy treatment is still based on the immutable principles of physics and biology and the fundamental approaches of logical thinking, audit, and appropriate analysis of treatment outcomes, including patterns of failure, research, and collaborative working must still underpin practice. This handbook is a guide to modern radiotherapy practice which is firmly based on unchanging principles. Describing advanced radiotherapy techniques as well as simpler field-based arrangements, this handbook provides sufficient information for clinical practice even in regions with limited resources. The site-specific chapters present the underlying principles of current treatment approaches to ensure the handbook will remain appropriate and useful despite future changes. In addition, it provides a discussion of the most important clinical trials which have informed the current approaches to treatment. It also includes imaging features of different tumours to enable clinicians to choose appropriate images for target volume delineation. This handbook will give an accessible introduction to new trainees in the specialty.
Removing barriers to accessing medical cannabis for paediatric patients
Authors: Huntsman Richard J , Elliott Jesse , Lewis Evan , Moore-Hepburn Charlotte , Alcorn Jane , Mansell Holly , Appendino Juan P , Bélanger Richard E , Corley Scott , Crooks Bruce , Denny AnneMarie M , Finkelstein Yaron , Finley Allen , Fung Ryan , Gilpin Andrea , Litalien Catherine , Jacobs Julia , Oberlander Timothy F , Palm Ashley , Palm Jacob , Polewicz Monika , Quinn Declan , Rassekh S Rod , Repetski Alexander , Rieder Michael J , Robson-McKay Amy , Seifert Blair , Shackelford Alan , Siden Hal , Szafron Michael , ‘t Jong Geert , Vaillancourt Régis , Kelly Lauren E 
Published: March 2023

Abstract
Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages. In this manuscript, we explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to MC medicine and research for children.
Cannabis Use and Symptomatic Relapse in First Episode Schizophrenia: Trigger or Consequence? Data From the OPTIMISE Study
Authors: Levi Linda , Bar-Haim Mor , Winter-van Rossum Inge , Davidson Michael , Leucht Stefan , Fleischhacker Wolfgang W , Park Jinyoung , Davis John M , Kahn Renè S , Weiser Mark 
Published: March 2023

Abstract

Background and Hypothesis
This analysis examined the relationship between cannabis use, compliance with antipsychotics and risk for relapse in patients in remission following a first episode of schizophrenia, schizophreniform, or schizoaffective disorder.

Study Design
Analyses were performed on data from a large European study on first episode of schizophrenia, schizophreniform, or schizoaffective disorder (OPTiMiSE). After 10 weeks of antipsychotic treatment, 282/446 patients (63%) met criteria for symptomatic remission; of whom 134/282 (47.5%) then completed a 1-year follow-up. Cross-lagged models and mediation models investigated the temporal relationships between cannabis use, compliance with antipsychotics, social functioning, and symptomatic worsening/relapse.

Study Results
Compared to nonusers, cannabis use increased risk for relapse, adjusted hazard ratio (HR) = 3.03 (SE = 0.32), P &lt; .001, even in patients who were compliant with antipsychotic medication, adjusted HR = 2.89, (SE = 0.32), P &lt; .001. Cannabis use preceded symptomatic worsening and was followed by worsening of Positive and Negative Syndrome Scale total score at the 1-year end-point (standardized β = 0.62, SE = 0.19, P = .001) and by worsening of social functioning (coef = −0.66, P ≤ .001).

Conclusions
In patients in remission from their first episode of schizophrenia, schizophreniform, or schizoaffective disorder, cannabis use increases the rate of relapse in both compliant and noncompliant individuals. Importantly, the temporal relationship between cannabis and relapse was that cannabis use preceded later relapse, noncompliance, and decrease in social functioning, and not that patients began to relapse, then used cannabis. Further research with a precision psychiatry approach might identify those patients in particular danger of relapse when using cannabis.
Safety and effectiveness of laparoscopic appendectomy in patients undergoing abdominal surgery
Authors: Tazeoglu Deniz , Benli Sami , Esmer Ahmet Cem 
Published: March 2023

Abstract

Background
Although laparoscopic appendectomy is the criterion-standard treatment method for acute appendicitis, the decision on laparoscopic or conventional technique is usually made according to individual perspectives. The reasons affecting this individual point of view include whether the disease is complicated, the infrastructure of the hospital, the patient's comorbid factors, and previous intra-abdominal operations. This cross-sectional retrospective study aimed to evaluate the safety of laparoscopic appendectomy in patients with a possible diagnosis of “appendicitis” in patients who had undergone previous abdominal surgery.

Methods
Patients who were operated on with the diagnosis of acute appendicitis in our clinic between March 2021 and March 2022 were retrospectively analyzed. Patients were grouped as those with a history of abdominal surgery (group 1) and without (group 2). In addition, demographic data of the patients (age, sex), body mass index, presence of comorbid disease, history of abdominal surgery, operation time, rate of conversion to open surgery, postoperative hospital stay, complications, and radiological and pathological appendix size were recorded.

Results
A total of 181 patients were included in the study. The mean age was 32.51 ± 15.89 years. Seventy (38.7%) of the patients were female, and 111 (61.3%) were male. Thirty-four patients (18.8%) were in group 1, and 111 patients (81.2%) were in group 2. The mean age, body mass index, and operation time in group 1 were statistically higher than in group 2 (P < 0.001). However, there was no difference between the groups regarding postoperative hospital stay, radiological and pathological appendix size, conversion to open surgery, and presence and severity of complications (P > 0.05).

Conclusion
In line with the data the authors have shown in their study, a laparoscopic appendectomy can be performed safely in patients who have undergone abdominal surgery. Therefore, surgeons should not stray from a laparoscopic appendectomy when they see an abdominal incision.
Increased blood flow of spinal cord lesion after decompression improves neurological recovery of degenerative cervical myelopathy: an intraoperative ultrasonography-based prospective cohort study
Authors: Chen Guoliang , Lin Chengkai , Zhu Zhengya , Tong Kuileung , Li Shiming , Chen Hongkun , Xu Zuofeng , Chen Ningning , Liu Xizhe , Liu Shaoyu 
Published: March 2023

Introduction:
Surgical decompression is a highly effective therapy for degenerative cervical myelopathy (DCM), but the mechanisms of neurological recovery following decompression remain unclear. This study aimed to evaluate the spinal cord blood flow status after sufficient decompression by intraoperative contrast-enhanced ultrasonography (CEUS) and to analyze the correlation between neurological recovery and postdecompressive spinal cord blood perfusion in DCM.

Materials and methods:
Patients with multilevel DCM were treated by ultrasound-guided modified French-door laminoplasty using a self-developed rongeur. Neurological function was evaluated using the modified Japanese Orthopaedic Association (mJOA) score preoperatively and at 12 months postoperatively. Spinal cord compression and cervical canal enlargement before and after surgery were assessed by magnetic resonance imaging and computerized tomography. The decompression status was evaluated in real time by intraoperative ultrasonography, while the spinal cord blood flow after sufficient decompression was assessed by CEUS. Patients were categorized as favourable (≥50%) or unfavourable (<50%) recovery according to the recovery rate of the mJOA score at 12 months postoperatively.

Results:
Twenty-nine patients were included in the study. The mJOA scores were significantly improved in all patients from 11.2±2.1 preoperatively to 15.0±1.1 at 12 months postoperatively, with an average recovery rate of 64.9±16.2%. Computerized tomography and intraoperative ultrasonography confirmed adequate enlargement of the cervical canal and sufficient decompression of the spinal cord, respectively. CEUS revealed that patients with favourable neurological recovery had a greater increased blood flow signal in the compressive spinal cord segment after decompression.

Conclusions:
In DCM, intraoperative CEUS can clearly reflect spinal cord blood flow. Patients with increased blood perfusion of the spinal cord lesion immediately after surgical decompression tended to achieve greater neurological recovery.