Clinical Associate Professor, Anesthesiology, Perioperative and Pain Medicine
Fellowship, Stanford University, Perioperative Management Fellowship (2016)
Board Certification, American Board of Anesthesiology, Pediatric Anesthesiology (2014)
Fellowship, Stanford University, Pediatric Anesthesiology (2014)
Residency, Stanford University, Anesthesiology (2012)
Internship, Santa Barbara Cottage Hospital, Internal Medicine (2009)
MD, University of Washington School of Medicine (2008)
BA, Wellesley College, Chemistry (2000)
Novel Utilization of Strand-Specific Reverse Transcription Polymerase Chain Reaction in Perioperative Clinical Decision Making for SARS-CoV-2 Polymerase Chain Reaction Positive Patients.
In order to prevent in-hospital transmission and potential complications related to SARS-CoV-2 in the perioperative patient, most healthcare institutions require preoperative testing for SARS-CoV-2 prior to proceeding with elective surgery. The Centers for Disease Control and Prevention (CDC) recommends a time and symptom-based duration of isolation for the presumed infectious period. The guidance to avoid retesting of asymptomatic patients in the 90days following a positive reverse transcription polymerase chain reaction (RT-PCR) test is because of the possibility of detection of non-infectious viral shedding. When to reschedule asymptomatic patients who test RT-PCR positive for SARS-CoV-2 preoperatively is of considerable debate, both from the perspective of ensuring a patient's full preoperative fitness, as well as reducing the risk of viral transmission within the hospital. We describe the novel perioperative use of a strand-specific assay to detect minus strand ribonucleic acid (RNA) in a clinical decision-making algorithm to determine optimal timing of elective surgery after a patient tests RT-PCR positive for SARS-CoV-2. This is the first description in the literature of an attempt to further stratify patients who repeatedly test positive for SARS-CoV-2 into infectious versus non-infectious for perioperative planning.
View details for DOI 10.1111/pan.14448
View details for PubMedID 35338765
A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry
BRITISH JOURNAL OF ANAESTHESIA
2021; 126 (1): 331-339
The design of a videolaryngoscope blade may affect its efficacy. We classified videolaryngoscope blades as standard and non-standard shapes to compare their efficacy performing tracheal intubation in children enrolled in the Paediatric Difficult Intubation Registry.Cases entered in the Registry from March 2017 to January 2020 were analysed. We compared the success rates of initial and eventual tracheal intubation, complications, and technical difficulties between the two groups and by weight stratification.Videolaryngoscopy was used in 1313 patients. Standard and non-standard blades were used in 529 and 740 patients, respectively. Both types were used in 44 patients. In children weighing <5 kg, standard blades had significantly greater success than non-standard blades at initial (51% vs 26%, P=0.002) and eventual (81% vs 58%, P=0.002) attempts at tracheal intubation. In multivariable logistic regression analysis, standard blades had 3-fold greater odds of success at initial tracheal intubations compared with non-standard blades (adjusted odds ratio 3.0, 95% confidence interval): 1.32-6.86, P=0.0009). Standard blades had 2.6-fold greater odds of success at eventual tracheal intubation compared with non-standard blades in children weighing <5 kg (adjusted odds ratio 2.6, 95% confidence interval: 1.08-6.25, P=0.033). There was no significant difference found in children weighing ≥5 kg.In infants weighing <5 kg, videolaryngoscopy with standard blades was associated with a significantly greater success rate than videolaryngoscopy with non-standard blades. Videolaryngoscopy with a standard blade is a sensible choice for tracheal intubation in children who weigh <5 kg.
View details for DOI 10.1016/j.bja.2020.08.010
View details for Web of Science ID 000617270300069
View details for PubMedID 32950248
Association Between Race and Ethnicity with Intraoperative Analgesic Administration and Initial Recovery Room Pain Scores in Pediatric Patients: a Single-Center Study of 21,229 Surgeries.
Journal of racial and ethnic health disparities
INTRODUCTION: Perioperative pain may have deleterious effects for all patients. We aim to examine disparities in pain management for children in the perioperative period to understand whether any racial and ethnic groups are at increased risk of poor pain control.METHODS: Medical records from children ≤18years of age who underwent surgery from May 2014 to May 2018 were reviewed. The primary outcome was total intraoperative morphine equivalents. The secondary outcomes were intraoperative non-opioid analgesic administration and first conscious pain score. The exposure was race and ethnicity. The associations of race and ethnicity with outcomes of interest were modeled using linear or logistic regression, adjusted for preselected confounders and covariates. Bonferroni corrections were made for multiple comparisons.RESULTS: A total of 21,229 anesthetics were included in analyses. In the adjusted analysis, no racial and ethnic group received significantly more or less opioids intraoperatively than non-Hispanic (NH) whites. Asians, Hispanics, and Pacific Islanders were estimated to have significantly lower odds of receiving non-opioid analgesics than NH whites: odds ratio (OR)=0.83 (95% confidence interval (CI): 0.70, 0.97); OR=0.84 (95% CI: 0.74, 0.97), and OR=0.53 (95% CI: 0.33, 0.84) respectively. Asians were estimated to have significantly lower odds of reporting moderate-to-severe pain on awakening than NH whites: OR=0.80 (95% CI: 0.66, 0.99).CONCLUSIONS: Although children of all races and ethnicities investigated received similar total intraoperative opioid doses, some were less likely to receive non-opioid analgesics intraoperatively. Asians were less likely to report moderate-severe pain upon awakening. Further investigation may delineate how these differences lead to disparate patient outcomes and are influenced by patient, provider, and system factors.
View details for DOI 10.1007/s40615-020-00811-w
View details for PubMedID 32621098
- Technology: The Anesthesia Machine: Managing Exhaled and Waste Gases Anesthesiology Decker Medicine. 2019
- The Most Vulnerable Patients California Society of Anesthesiologists. 2018
- Death Without Dignity California Society of Anesthesiologists. 2016
- Kinked PerifixA (R) FX Springwound epidural catheters CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE 2011; 58 (4): 413-414
- The physician’s role in medication reconciliation: Issues, strategies and safety principles American Medical Association. 2008
- Advanced instrumentation projects for first-year biochemistry laboratory BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION 2003; 31 (2): 115-118