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1

Padover, Alyssa, and Jennifer K. Lee. Nonaccidental Trauma. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0061.

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Nonaccidental trauma from child abuse presents unique challenges to the anesthesiologist. Diagnosing abuse is difficult because children may present with nonspecific symptoms and vague clinical histories. Multiple organ systems may be involved, but the greatest risk of death stems from abusive head trauma. Anesthesiologists must know the pediatric traumatic brain injury treatment guidelines and be prepared to treat the complex disease processes of child abuse and abusive head trauma. This chapter discusses anesthesia for nonaccidental pediatric trauma, including abusive head trauma. Topics cov
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2

Watkins, Scott C. Introduction to Pediatric Crises. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0076.

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Clinicians caring for pediatric patients must be prepared to manage the wide range of physiological norms and diverse pathological states that children may pose when presenting for anesthesia and surgery. Anesthesiologists caring for children should be familiar with syndromes and diseases that pose increased risk for difficult airway (e.g., Treacher-Collins, Pierre-Robin), malignant hyperthermia (e.g., King Denborough, central core disease), hyperkalemia (e.g., muscular dystrophies, periodic hyperkalemic paralysis), and sudden cardiac arrest (e.g., William’s, Pompe, myocarditis/cardiomyopathy)
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3

Sutton, Caitlin D., and David G. Mann. Do-Not-Resuscitate Orders in the Operating Room. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0071.

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There are many situations that the pediatric anesthesiologist encounters on a daily basis. However, caring for the patient with do-not-resuscitate (DNR) orders requires attention to a variety of requests that may not be applicable in all scenarios. End-of-life care for pediatric patients is complex and presents many challenges for all physicians. The care of a patient with a DNR order who presents for surgery requires thoughtful, open communication between all stakeholders including the primary team, the surgeon, the anesthesiologist, the patient (when mental status and development allows), an
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4

Zelisko, Michael Blaine. The Opioid-Tolerant Patient. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0036.

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Caring for the opioid-tolerant patient presents several challenges in the perioperative period, including a higher incidence of anxiety, pain, and unanticipated hospital admission. The goal of the anesthesiologist is to provide sufficient analgesia while preventing withdrawal symptoms. This chapter reviews multimodal analgesia techniques, and addresses opioid tolerance, opioid-induced hyperalgesia, opioid rotation, and the use of methadone during the perioperative period.
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Andropoulos, Dean B. Management of Children with Congenital Heart Disease for Noncardiac Surgery. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0025.

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Congenital heart disease (CHD) patients are increasingly presenting for noncardiac surgery, and the anesthesiologist must possess an understanding of the major classes of CHD and their pathophysiology, as well as surgical approaches for correction or palliation. A thorough preoperative evaluation and anesthetic plan, including invasive monitoring, inotropic support, blood transfusion, endocarditis prophylaxis, pacemaker/defibrillator functioning, and intensive care unit admission must be developed, and include a multidisciplinary team. Each patient has a unique pathophysiology and a systematic
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6

Hopkins, Paul, and Laura Ryan. Difficult Airway. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0015.

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The management of the difficult airway is one of the most challenging situations an anesthesiologist may encounter. The pediatric patient provides unique challenges such as lack of cooperation, rapid desaturation while apneic, and the presence of syndromes with craniofacial manifestations not frequently encountered in adults. These craniofacial manifestations may include mandibular hypoplasia, facial asymmetry, and limited mouth opening, to name a few. This chapter presents a case of a 5-year-old boy with Klippel-Feil syndrome and discusses the different aspects involved when dealing with a di
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7

Boudreau, Eric, and Brian Egan. Anesthetic Management of Chiari Decompression. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0028.

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Chiari malformation is a congenital neurodevelopment abnormality affecting the cerebellum and the brainstem. This chapter looks at the etiology, history, diagnostic criteria, physical exam findings, pathophysiology, and treatment for this disease process from the perspective of an anesthesiologist. The signs and symptoms stemming from Chiari malformations including syringomyelia, respiratory dysfunction, and vasomotor instability will be discussed. Preoperative considerations will be examined as well as ways to optimize these patients prior to surgery. Intraoperative anesthetic goals for patie
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8

Bennett, Jeremy, and Kara Siegrist. Myocardial Ischemia. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0005.

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Coronary artery disease is a prevalent and growing problem in the United States leading to significant morbidity and mortality including myocardial ischemia and infarction. Diagnosis and treatment of myocardial ischemia under general anesthesia can present unique challenges for the anesthesiologist including interpretation of diagnostic monitoring data and options for therapeutic interventions. There are many complex factors that determine myocardial oxygen supply and demand; when these become imbalanced, myocardial ischemia occurs that can progress to infarction. Maintaining a high-degree of
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9

Maani, Christopher V., and Gaelen Horne. Anesthesia for Urologic Procedures. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190495756.003.0024.

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With advances in technology over the past few decades and the development of new and less invasive surgical techniques, procedures that once required a traditional operating room can now be accomplished in smaller outpatient settings. Maximizing efficiency and improving patient outcomes, while minimizing hospitalization and recovery time has become a focus of many anesthetic practices throughout the United States. Because more procedures are being performed in outpatient and outside of the OR (OOOR) settings, it is increasingly important for the anesthesiologist to ensure patient and personnel
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10

Alvis, Bret D., and Christopher G. Hughes. Delirium. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0061.

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Delirium in the postoperative period, characterized by inattention, disorganized thinking, disorientation, and/or altered levels of consciousness within the first few days after surgery, has been associated with significant increases in hospital stay, functional decline, prolonged cognitive dysfunction, and mortality. It is underdiagnosed without routine assessments with validated tools such as the Confusion Assessment Method (CAM), the 4AT, the Confusion Assessment Method for Intensive Care Unit (CAM-ICU), or the Intensive Care Delirium Screening Checklist (ICDSC). Prevention strategies for p
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11

Riveros-Perez, Efrain, and Mauricio Perilla. Specialty Practice Situations. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190885885.003.0008.

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Recent advances in surgical and interventional procedures have led to a significant and increased demand for anesthesia services in locations distant from the traditional operating room. Special settings such as ophthalmologic surgery, interventional radiology, and the electrophysiology lab present unique challenges to the anesthesia provider. In addition to the remote location of the procedure rooms, the lack of familiarity with the equipment and distance from emergency back-up make for a challenging situation. Judicious preparation and set up of anesthesia equipment and materials as well as
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12

Richardson, Michael G. STAT Caesarean Delivery. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0043.

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During emergency cesarean delivery (CD), indicated by immediate threat to fetal or maternal life, the anesthesiologist must quickly provide anesthesia that is rapid in onset and safe for both patients. Neuraxial anesthesia using well-functioning in-dwelling epidural catheters is achievable with early enough notification. Still, general anesthesia is often the most expedient method. Advanced airway devices and evolving difficult airway management algorithms have likely contributed to observed reductions maternal morbidity and mortality associated with general anesthesia. Long before the crisis
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13

Cass, Lindy. Intraoperative Wheezing. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0020.

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Wheezing is an important sign for anesthesiologists. At the preoperative consult it usually indicates bronchospasm from poorly controlled asthma, though many other causes are possible. Intraoperative wheezing also has many potential causes, including bronchospasm, airway obstruction, anaphylaxis, or aspiration. Intraoperative wheezing is an anesthetic emergency that can lead to life-threatening respiratory and cardiac complications. Prompt action to maintain oxygenation, removal of any trigger factors, and, if indicated, bronchodilator administration will usually result in a safe outcome.
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14

Renfrow, Jaclyn J., Aqib H. Zehri, Kyle M. Fargen, Jasmeet Singh, John A. Wilson, and Stacey Q. Wolfe. Management of Intracranial Vascular Lesions During Pregnancy. Edited by Emma Ciafaloni, Cheryl Bushnell, and Loralei L. Thornburg. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190667351.003.0016.

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Management of cerebral vascular lesions in pregnancy requires special consideration to an altered natural history in the pregnant patient, such as a higher rupture rate of arteriovenous malformations. Additionally, treatment challenges exist including radiation exposure, medication selection, optimal treatment timing, and modalities. If identified prior to a pregnancy most vascular lesions warrant a definitive treatment discussion to circumvent the risks associated with an intracranial hemorrhage during pregnancy. The treatment team consists of a multidisciplinary approach involving neurosurge
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15

Hagerman, Nancy S., and Anna M. Varughese. Preoperative Anxiety Management. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0001.

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Up to 65% of pediatric patients experience anxiety and fear in the preoperative period, especially during anesthesia induction. Reasons for this anxiety include the child's perception of the threat of pain, being separated from parents, a strange environment, and losing control. Anxiety and poor behavioral compliance associated with inhalation inductions have been related to adverse outcomes including emergence delirium and maladaptive postoperative behaviors such as general and separation anxiety, eating difficulties, and sleep disturbances. Fortunately, there are behavioral and pharmacologic
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16

Khatib, Reem. Anesthesia and Recovery. Edited by Tomasz Rogula, Philip Schauer, and Tammy Fouse. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.003.0008.

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As a consequence of the obesity epidemic that has developed in the United States over the past few decades, many morbidly obese patients are presenting to the operating room for a variety of procedures, including bariatric surgery. Anesthesiologists must therefore be familiar with the physiologic changes that occur as a consequence of this disease process. Changes in cardiac and respiratory physiology require special consideration as they impact anesthetic management during the perioperative period. Strategies to optimize intraoperative management of the morbidly obese patient presenting for b
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17

Low, Aaron, and Andrew Pittaway. Neonatal Stridor. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0002.

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Stridor is a common pediatric and neonatal sign that can sometimes be associated with life-altering or even life-threatening consequences. In the neonatal population, it is often due to use of an endotracheal tube that is too small, laryngomalacia, and subglottic stenosis. Patients often present with co-existing neonatal comorbidities such as patent ductus arteriosus and bronchopulmonary dysplasia. Management of these patients is often complex, requiring exquisite teamwork by otolaryngology surgeons and pediatric anesthesiologists. This chapter reviews the pathophysiology of neonatal stridor a
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18

Kotsis, Eleni, Jamie M. Zorn, and Grace Lim. Vessels. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0051.

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Acute coronary syndrome (ACS) in pregnancy is generally considered a rare but potentially life-threatening occurrence. Recent societal trends, including improvements in infertility treatments and professional demands, have contributed to many women delaying pregnancy. The rise in average maternal age means that risks for coronary artery disease and subsequent ACS events in pregnancy are likely to be more frequently encountered by the obstetric clinician. A thorough understanding of the risks, pathophysiology, management, and treatment of ACS and its ramifications in the pregnant patient is req
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19

Otis, James A. D. Non-Opioid Pharmacotherapies for Chronic Pain (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190265366.003.0015.

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The objective of chapter 15 is to describe analgesic approaches to chronic pain, excluding opioids. As such, it emphasizes, first, the available pharmacotherapies; and then procedures. The pharmacotherapies divide into analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs); adjuvant analgesics, such as tricyclic antidepressants and anticonvulsants; oral anesthetic agents (cardiotropics); adrenergic agonists; topical agents such as capsaicin and local anesthetic solutions and ointments; and muscle relaxants such as cyclobenzaprine, tizanidine, and baclofen. Interventions include man
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20

Costandi, Andrew J., and Lydia Andras. Achondroplasia. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0030.

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Children with achondroplasia, the most common cause of short stature, pose several challenges for the anesthesiologists who care for them. Although a rare condition, individuals affected with achondroplasia have a normal life span and frequently present to the operating room for much needed otolaryngologic, neurosurgical, and orthopedic procedures. The common clinical features associated with achondroplasia lend a unique set of considerations including difficult airway management, both central and/or obstructive sleep apnea, unstable cervical spines, positioning problems, vascular access chall
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21

Trifa, Mehdi, and Candice Burrier. Anesthetic Management of Anterior Mediastinal Masses in Children. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0052.

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The management of children presenting with an anterior mediastinal mass (AMM) is challenging for anesthesiologists. AMMs are a heterogeneous collection of primary or secondary, benign or malignant tumors. Severe and life-threatening complications related to airway obstruction and/or cardiovascular compression can occur in a patient with an AMM during anesthesia, even in an asymptomatic patient. It is important for the anesthesia provider to understand the pathophysiology of symptoms and complications and the current evidence regarding perioperative management of children with AMM. This chapter
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22

Clavijo, Claudia F., Ronnie Zeidan, and Efrain Riveros-Perez. Crisis Management in the Perioperative Setting. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190885885.003.0006.

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Anesthesiologists play a fundamental role in patient safety, particularly in emergent situations or during a crisis in the perioperative setting. Adequate knowledge and constant preparation is required to manage these events appropriately. This chapter discusses the common intraoperative crises that anesthesia residents encounter, especially during the first few months of residency; these include laryngospasm, oxygen failure, anaphylaxis, local anesthetic systemic toxicity, malignant hyperthermia, surgical site infections, and operating room fires. We also review the presentation and pathophys
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23

Gross, Wendy L., and Richard D. Urman. Challenges of Anesthesia Outside of the Operating Room. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190495756.003.0001.

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As health care bears the simultaneous burdens of rapid technological development and increasing financial constraints, there has been significant increase in the number and types of procedures performed outside of the operating room. The broadening scope and complexity of noninvasive procedures, along with increasing acuity of patients, often make deeper sedation, general anesthesia, and robust hemodynamic monitoring both necessary and challenging. Anesthesiologists are more frequently called upon to provide care for medically complex patients undergoing novel, unfamiliar procedures in nontrad
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24

Desai, Mehul, and Joseph O'Brien, eds. The Spine Handbook. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199350940.001.0001.

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Spinal disorders, especially back pain, are frequent yet challenging for physicians to manage. While most texts are highly subspecialized or focus on only surgical intervention, The Spine Handbook provides a thorough overview, covering the entire spine, of interdisciplinary treatment of common spinal conditions. Sections build from the foundations of history and examination, radiologic imaging, and behavioral assessment through the core topics of both interventional and surgical options, as well as exploring emerging and special conditions and neuromodulation. Chapters are written by experts f
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25

Gupta, Rajnish K., and Alexandria N. Nickless. Nerve Injuries from Positioning and Regional Blocks. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0074.

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Peripheral nerve injury in the perioperative period can have a variety of etiologies, including preexisting patient factors and by surgical and anesthetic complications such as intraoperative positioning and nerve blockade. The actual incidence may be difficult to assess, because most nerve injuries resolve with time and frequently require minimal to no intervention. Injuries often manifest more than 48 hours after surgery and have even been noted in patients who undergo awake procedures and in hospitalized patients who never undergo surgery. This should not negate the fact that close attentio
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26

Rogula, Tomasz G., Philip R. Schauer, and Tammy Fouse, eds. Prevention and Management of Complications in Bariatric Surgery. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190608347.001.0001.

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This book focuses on prevention and management of complications in bariatric surgery. The book will serve as a practical guide for healthcare providers, including bariatric and general surgeons, primary care physicians, nurse practitioners, cardiologists, gastroenterologists, anesthesiologists, psychologists, and dietitians. Chapters describing surgical management of complications should be of special interest to emergency department doctors and surgeons. The book covers most aspects of typical and atypical problems and can be used as a study guide for fellows, residents, and medical students.
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