bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fibrinolysis
Authors: Tanner Colby B. , Boydston Elaine A. 
Published: March 2023

Abstract
Fibrinolysis is a natural physiologic process that maintains homeostasis by regulating clot formation and degradation. This balance allows for clot remodeling and prevents diffuse thrombosis formation. Fibrinolysis is largely mediated by tissue plasminogen activator (tPA), which cleaves plasminogen into plasmin, ultimately leading to fibrin degradation and clot dissolution. Fibrinolysis can be measured quantitatively via thromboelastography (TEG) and rotational thromboelastometry (ROTEM). Detection of fibrinolysis via these assays and others allows for directed therapy and potential pharmaceutical inhibition of fibrinolysis. This pharmaceutical inhibition, also termed antifibrinolytic therapy, is most commonly performed with medications such as aprotinin, aminocaproic acid, and tranexamic acid. Antifibrinolytic therapy may be indicated in the setting of significant hemorrhage or excessive fibrinolysis (known as hyperfibrinolysis). Because of this, antifibrinolytic therapy has become commonly used in many clinical settings, including trauma, surgery, and cardiopulmonary bypass. When considering initiation of antifibrinolytic therapy, the benefit of decreased hemorrhage and anti-inflammatory effects must be weighed against the theoretical risk of unchecked thrombus formation.
Complications of Transfusion
Authors: Jones Courtney R. , Mechlin Maggie W. 
Published: March 2023

Abstract
Transfusion of blood components is an inextricable part of anesthetic practice when caring for critically ill patients undergoing high-risk surgery. These transfusions can be life-saving in certain patients, but the anesthesiologist must be aware of the most common and highest risk transfusion reactions when analyzing the individual risk-benefit ratio for a particular patient. This chapter reviews the most severe pulmonary reactions with the highest mortality—transfusion associated circulatory overload and transfusion related acute lung injury. The more common complications of febrile, allergic, hypotensive, and hemolytic reactions are also reviewed. If a transfusion reaction occurs, the transfusion should be stopped, and the patient should be given supportive care.
Transfusion Therapy for Massive Hemorrhage
Authors: Tanner Colby B. , Boydston Elaine A. 
Published: March 2023

Abstract
Massive hemorrhage is a major complication of traumatic injury and many surgical operations. Early detection of hemorrhage and appropriate resuscitation is essential to improve outcomes during recovery from the inciting event. Traumatic injury, surgical exposure, and large-volume resuscitation can cause physiologic derangements that result in alterations of the normal coagulation cascade and formation of thrombin clot. Careful balancing of resuscitation using appropriate ratios of packed red blood cells (pRBCs), fresh frozen plasma (FFP), and platelets as well as avoiding crystalloid solutions have been shown to decrease mortality, likely due to improved hemostasis. Additionally, careful evaluation of laboratory values, patient history and pharmacologic exposure can further guide resuscitation efforts and provide information for potential pharmacological intervention.
Parathyroid Disease
Authors: Valenta Karel T. S. , Toth Kenneth S. 
Published: March 2023

Abstract
Parathyroid disease is due to overproduction or underproduction of parathyroid hormone by the chief cells of the parathyroid gland. Parathyroid hormone plays an important part in control of calcium levels. Hyperparathyroidism, or elevated parathyroid hormone levels, can have signs and symptoms of hypercalcemia, such as hypertension, arrhythmias, and altered mental status. Hypoparathyroidism, or low parathyroid hormone, can present with signs and symptoms of hypocalcemia, such as perioral numbness and hypotension. Primary hyperparathyroidism is often treated surgically and can result in hypoparathyroidism postoperatively, leading to hypocalcemia and its sequelae. Perioperative recurrent laryngeal nerve injury is another concern, which if bilateral will require emergent reintubation.
Adrenal Disease
Authors: Dalton Allison K. 
Published: March 2023

Abstract
The adrenal gland is composed of the medulla and cortex. The adrenal medulla secretes catecholamines. Pheochromocytomas are the result of excess secretion of norepinephrine, epinephrine, or dopamine, leading to hypertension, tachycardia, headaches, and diaphoresis. Patients with pheochromocytoma are at high risk of malignant hypertension, arrhythmias, myocardial ischemia, and stroke during surgery unless adequate alpha antagonism is provided preoperatively. The adrenal cortex secretes androgens, mineralocorticoids, and glucocorticoids. Conditions associated with excess or insufficient hormone secretion may lead to alterations in blood pressure, changes in electrolytes, and hyper- or hypoglycemia. Careful assessment of these conditions preoperatively leads to optimization for intraoperative care and postoperative monitoring of patients with adrenal disease.
Charcot-Marie-Tooth Disease
Authors: Fritzler Anthony 
Published: March 2023

Abstract
Charcot-Marie-Tooth (CMT) disease is the most common inherited neuromuscular disease and presents many potential considerations for the administration of anesthesia. Type 1 CMT (CMT1) is the most common, of which 70% of cases are CMT1A. Key characteristics of all types are genetic heterogeneity, age-dependent penetrance, and variable expressivity. The most common type, CMT1A, is inherited in an autosomal dominant (AD) pattern and results from a duplication of chromosome 17, resulting in excess gene expression and overproduction of peripheral myelin protein 22 (PMP22). Diagnosis largely depends on a thorough history and physical examination, nerve conduction studies, and genetic analysis. CMT is a lifelong disease, and treatment is mainly supportive, focusing on symptom management. Anesthetic considerations include the possibility for cardiac conduction anomalies, cardiomyopathy, and impaired pulmonary function. CMT disease is a condition of chronic denervation, which prompts concerns for the use of succinylcholine and triggering agents for malignant hyperthermia (MH). All types of anesthesia have been performed successfully and safely in patients with CMT disease, and the anesthetic should be tailored to the individual needs of the patient.
Muscular Dystrophies
Authors: Berkelhamer Maura C. 
Published: March 2023

Abstract
This chapter outlines the distinctions in muscle dystrophy disorders and their common manifestation of muscle membrane anomalies causing respiratory embarrassment, arrhythmias, and cardiomyopathy. Rhabdomyolysis leading to hyperkalemic arrest is a risk for patients with all types of muscular dystrophies. Severe muscle contraction with triggering anesthetic agents is seen in patients with myotonic dystrophy. However, patients with muscular dystrophies do not have a risk of malignant hyperthermia greater than the general population. Patients with muscular dystrophies are at risk of cardiorespiratory decompensation from the effects of anesthetic well into the postoperative period. Perioperative multidisciplinary care initiated well before the date of surgery is indicated for patients with muscular dystrophies. A strategy to approach anesthetizing patients with undiagnosed hypotonia is presented.
Mitochondrial Myopathies
Authors: Berkelhamer Maura C. 
Published: March 2023

Abstract
This chapter explores how mitochondrial disorders underlie a spectrum of diseases. Mitochondria are involved in cellular energy production and the synthesis of essential molecules for cellular function as well as apoptosis and cell death. Mitochondria membranes host the electron transport chain of protein/enzyme complexes responsible for cellular energy production. Defects in these complexes reduce the cellular energy necessary for normal organ function. The clinical presentations of mitochondrial disorders are numerous. They include mitochondrial myopathies and mitochondrial encephalopathies. Nerve cells in the brain and muscles require a great deal of energy and thus appear to be particularly affected. Because mitochondria are in every cell of the body, mitochondrial disorders can affect every organ system. It is important to recognize the clinical manifestations of these disorders and understand the effects of anesthetic drugs on mitochondrial function to prevent acidosis and metabolic crisis.
Lambert-Eaton Myasthenic Syndrome
Authors: Sam Sabrina S. , Sarrafpour Syena 
Published: March 2023

Abstract
Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune disorder that results in decreased release of acetylcholine at the neuromuscular junction secondary to autoantibodies against calcium channels at the presynaptic nerve terminal. Patients with LEMS generally have proximal limb muscle weakness that is worse in the lower extremities and improves with activity. LEMS is diagnosed via detailed history and physical examination along with electrophysiology. Imaging of the chest should be performed to rule out small cell lung cancer. There is no cure for LEMS not associated with malignancy; therefore, therapy is targeted at symptom relief. Firdapse and Ruzurgi were recently approved for treatment. Individuals with LEMS are sensitive to both depolarizing and nondepolarizing neuromuscular blocking drugs.
Ion Channel Myotonias, Myotonia Congenita, and Acquired Neuromyotonia
Authors: Hughes Meghan C. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Myotonia congenita (MG) and various ion channel myotonias all fall under the umbrella of nondystrophic myotonias (NDMs) and are distinct from myotonic dystrophy because they are caused by dysfunction of key skeletal muscle ion channels alone without any other systemic effects. NDMs are characterized by electrical myotonia, “defined as the prolongation of skeletal muscle relaxation time following sudden voluntary contraction or external mechanical stimulation.” Hyperexcitability of muscles is central to all of these disease states. The NDMs are divided into two groups: the chloride channelopathies (myotonia congenita) and the sodium channelopathies (paramyotonia congenita [PMC] and the potassium-aggravated myotonias [PAMs]). In contrast, acquired neuromyotonia is an autoimmune disease where approximately 40% of affected individuals have antibodies to voltage-gated potassium channels (VGKCs) that directly affect the neuromuscular junction.
Neuropathic Pain States
Authors: Jenkinson Robert H. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Neuropathic pain is defined by the International Association for the Study of Pain as “pain caused by a lesion or disease of the somatosensory nervous system.” Due to this wide neuroanatomic territory, a variety of distinct neuropathic pain diagnoses exist that have unique presentations, including painful diabetic peripheral neuropathy, complex regional pain syndrome, phantom limb pain, lumbar radiculopathy, chronic postsurgical pain, postherpetic neuralgia, and trigeminal neuralgia. Neuropathic pain is not on its own a diagnosis but rather a classification of diagnostic entities. While some neuropathic pain states have distinct imaging or laboratory findings, many are entirely clinically diagnosed based on a neuroanatomically plausible distribution as well as specific qualities and characteristics of the discomfort. As a category, neuropathic pain presents a challenge for clinicians in both diagnosis and treatment. It contributes significantly to the global health burden, and roughly 10% of the general population suffers from some form of chronic neuropathic pain.
Phantom Limb Pain
Authors: Mauer Kim , Abd-Elsayed Alaa 
Published: March 2023

Abstract
This chapter on phantom limb pain and its pathophysiology describes the pathophysiology that is known about phantom limb syndrome. Phantom limb syndrome is defined as the ability to feel sensations and even pain in a limb or limbs that no longer exist. Neuroplasticity, the ability of our neuronal pathways to modify and adjust, is likely responsible for some of the characteristics of phantom limb syndrome. Overall, the etiology and pathophysiologic mechanisms of phantom pain are not clearly defined. Some common treatments for the condition are described as well as a more in-depth description of neuroplasticity and mirror box therapy.
Postoperative Epidural Analgesia
Authors: Rushmer Timothy , Abd-Elsayed Alaa 
Published: March 2023

Abstract
This chapter covers the use of epidurals for postoperative analgesia: indications, contraindications, American Society of Regional Anesthesia and Pain Medicine guidelines for patients on anticoagulants, relevant anatomy and physiology, factors affecting spread, additives, and complications. Epidural analgesia is often used in postoperative patients as part of a multimodal analgesic plan. Epidurals are usually placed prior to surgery in patients undergoing large incisions and/or patients expected to have issues with pain control postoperatively. Occasionally, epidurals are placed after surgery in patients without contraindications or recent anticoagulation. One common situation is patients who develop postoperative ileus and have high opioid requirements, as epidurals can facilitate reduced opioid requirements and improvement of the ileus.
Patient-Controlled Analgesia
Authors: Jenkinson Robert H. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Patient-controlled analgesia (PCA) is one of the most common methods used to provide postoperative pain control to patients. The most common form of PCA utilizes a programmable infusion pump to deliver a standard dose of intravenous opioid on demand by the patient. Although intravenous PCA administration is the most commonly utilized route for acute pain, epidural and intrathecal PCA use has become increasingly popular. PCA provides better pain control and a higher rate of patient satisfaction than traditional intermittent analgesic administration by medical staff. It can be a safe and effective method of providing patients with pain relief but still requires regular monitoring and should be individualized to each patient.
Systemic Multimodal Analgesia
Authors: Lennertz Richard , Bevil Kristin 
Published: March 2023

Abstract
Multimodal analgesia refers to the use of medications with different mechanisms of action to provide analgesia. The combination of medications should promote analgesia while limiting unwanted side effects. While there has been widespread adoption of multimodal analgesia, evidence of its efficacy is conflicting. Opioids provide potent analgesia and continue to play an important role in pain management. In addition, several systemic medications may be used to provide multimodal analgesia. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are the most broadly supported medications used in these regimens. Some evidence supports the use of ketamine and dexmedetomidine. Lidocaine infusions may be effective in colorectal and abdominal surgeries but have not been compared against common regional techniques.
Continuous Spinal and Epidural Anesthesia
Authors: Girma Brook , Kaye Alan D. 
Published: March 2023

Abstract
Neuroaxial anesthesia was first conceived in the 19th century and became an integral part of anesthesia in the 20th century, providing an alternative for general anesthesia. Local anesthetic and opioids are generally administered in the epidural space (epidural anesthesia) or intrathecal space (spinal anesthesia). Some studies have shown that neuroaxial anesthesia was associated with lower postoperative morbidity, diminished surgical stress response demonstrated by decreased hyperglycemia, lower cortisol levels, and some lower pro-inflammatory cytokines. In this regard, it is important to know the anatomy, risks, and indications for neuroaxial blockade and the differences between epidural and spinal anesthesia, which are discussed in detail.
Neurolytic and Nonneurolytic Blocks in Pain Management
Authors: Rushmer Timothy , Abd-Elsayed Alaa 
Published: March 2023

Abstract
As this chapter discusses, neurolytic blocks involve the destruction of afferent somatic or sympathetic nerves. This can be accomplished with a variety of methods, including radio-frequency ablation, cryoablation, and injection of alcohol, glycerol, or phenol. Choice of technique depends on the target and indications for the procedure. Diagnostic nerve blocks should precede most neurolytic blocks to ensure the correct target (and adequate relief of the patient’s pain) prior to neurolysis. Common neurolytic blocks include celiac plexus block, superior hypogastric plexus block, ganglion impar block, lumbar sympathetic block, and stellate ganglion block. Nonneurolytic blocks with local anesthetics can be performed not only for perioperative pain, but also in the setting of chronic or cancer pain. Generally, nonneurolytic blocks provide short-term relief, but can provide pain relief beyond the duration of the local anesthetic in chronic pain patients. Nonneurolytic blocks also allow for opportunities for physical therapy and strengthening and can help reduce opioid use in acute and chronic pain.
Neuromuscular Blockers
Authors: Nathani Harsh , Gwam Chike 
Published: March 2023

Abstract
Neuromuscular blocking agents are used to facilitate tracheal intubation, relax abdominal muscles, maintain immobility during surgery and facilitate mechanical ventilation. Neuromuscular blockers are advantageous for airway management in the pediatric population; however, clinicians must be cautious of the age-dependent changes in the sensitivity to, metabolism of, and adverse reactions of these agents. Clinicians should consider the physiological and pharmacological differences between children and adults when using these agents in the pediatric populations to better titrate neuromuscular blockade when indicated. Commonly used agents are divided into two subcategories: depolarizing agents and nondepolarizing agents; each has their advantages and disadvantages. The reversal of nondepolarizing agents with acetylcholinesterase inhibitors has also been well studied, as has that of sugammadex.
Problems in Intubation and Extubation
Authors: Horvath Balazs , Kloesel Benjamin 
Published: March 2023

Abstract
Endotracheal intubation and extubation in neonates, infants, and children are frequently challenging due to the developing anatomy and physiology. Congenital malformations, syndromes, and coexisting pathology of other organ systems may present additional unique difficulty during securing the airway and ensuring adequate ventilation and oxygenation. Meticulous attention to the steps and anticipating potential pitfalls of airway management from the first moment of encountering the patient until discharge from the recovery room are keys to safe patient care. This chapter reviews the most common problems during endotracheal intubation and extubation that are related to both the normal development and pathological conditions of pediatric patients.
Metabolism, Fluid Distribution, and Renal Function
Authors: Kremen Elizabeth , Keshavarzi Sahel 
Published: March 2023

Abstract
Pediatric physiology differs keenly from adult physiology in a number of ways. This chapter looks at differences in metabolism, fluid distribution, and renal function. Neonates and acutely ill children are more vulnerable to depletion of glycogen stores. Metabolism of medications is often prolonged in neonates due to fewer active enzymes; is more rapid in children; and reaches adult values in adolescence. Infants have a higher body water percentage by weight than adults do. Infants also have more fluid in the extracellular compartment, including the intravascular space, compared to adults. Renal filtration function and urine-concentrating ability in neonates are much less developed than in adults, leading to prolonged clearance rates of renally excreted drugs. Similarly, neonates are also more vulnerable to fluid perturbations and electrolyte imbalances until their homeostatic autoregulatory mechanisms more fully develop.
Congenital Heart and Major Vascular Disease
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Approximately 6 per 1000 live births are affected by congenital heart disease (CHD). While there is no mechanism for decreasing the prevalence of infants born with CHD, mortality from CHD has declined in countries with a higher sociodemographic index. Anesthetic and perioperative care during corrective or palliative cardiac surgery contribute to successful outcomes. Just as the physiology of pediatric patients differs from adults, so does their anesthetic management. This chapter describes and classifies CHD into acyanotic, cyanotic, major vascular disease, and pulmonary hypertension. Discussion of anatomy, physiology, natural history, palliative or treatment course, and anesthetic management is provided in other chapters.
Congenital Diaphragmatic Hernia
Authors: Wasson Cassandra , Diaz Christina D. 
Published: March 2023

Abstract
Congenital diaphragmatic hernias (CDHs) are characterized by herniation of abdominal contents into the chest cavity due to a developmental defect of the diaphragm. This inhibits growth of the lungs and leads to pulmonary hypertension. The most common hernia is posterolateral, or Bochdalek. CDH is usually an isolated finding but can be associated with structural abnormalities, chromosomal defects, or single-gene disorders. The majority of CDH are diagnosed prenatally with routine ultrasound. Herniation of the liver into the chest is a poor prognostic factor. The ratio of observed-to-expected lung area to head circumference helps predict survival outcomes. For severe cases diagnosed prenatally, fetoscopic endoluminal tracheal occlusion is an experimental option. Less severe cases are delivered at a tertiary center and intubated immediately after delivery to avoid insufflation of the stomach, and an orogastric tube is used to decompress the stomach. Permissive hypercapnic ventilation with low inspiratory pressures is utilized as aggressive ventilation may cause a contralateral pneumothorax. CDH is a physiologic emergency, not a surgical emergency, unless herniated bowel is ischemic. Increased abdominal pressure, cephalad displacement of the diaphragm, decreased functional residual capacity, and compression of the inferior vena cava should be anticipated intraoperatively after hernia reduction. Overall survival rate is 70%–90% neonates without extracorporeal membrane oxygenation, but they have long-term morbidity.
Necrotizing Enterocolitis
Authors: Wasson Cassandra , Diaz Christina D. 
Published: March 2023

Abstract
Necrotizing enterocolitis (NEC) is one of the most common diseases in neonates, affecting primarily preterm infants less than 32 weeks’ gestational age. It has a mortality rate of up to 30%. Those patients that survive frequently have a number of morbidities, including short-bowel syndrome and neurodevelopmental delays. The initial signs and symptoms include feeding intolerance, abdominal distention, and bloody stools. Abdominal x-ray findings of portal venous gas and pneumatosis intestinalis (gas within the bowel wall) are pathognomonic for NEC. It is managed either medically or surgically based on the clinical presentation and severity of the illness. Intraoperative anesthetic management requires considerations for premature neonates and special considerations for the disease process itself. Postoperatively, these patients require continued monitoring and management in a neonatal intensive care unit.