- Pediatric Anesthesia
- Pediatric Cardiac Anesthesia
Clinical Associate Professor, Anesthesiology, Perioperative and Pain Medicine
Boards, Advisory Committees, Professional Organizations
Anesthesia Committee, Re:Surge International (2015 - Present)
Residency: UCSD Dept of Pediatrics (2004) CA
Fellowship: Stanford University Pediatric Anesthesia Fellowship (2009) CA
Residency: Stanford University Anesthesiology Residency (2008) CA
Medical Education: University of Washington School of Medicine (2001) WA
Board Certification: American Board of Anesthesiology, Pediatric Anesthesia (2013)
Board Certification: American Board of Anesthesiology, Anesthesia (2009)
Hydroxocobalamin to treat refractory vasoplegia following phaeochromocytoma resection in a child.
2022; 10 (2): e12201
Phaeochromocytomas and paragangliomas are rare neuroendocrine tumours that often secrete catecholamines, which can cause dramatic swings in blood pressure and end-organ damage. During surgical resection of these tumours, antihypertensive drug infusions are often required, but after resection patients may become vasoplegic, in part due to cessation of catecholamine secretion by the tumour in the context of pre-operative alpha1 adrenoceptor antagonism. Numerous medications have been used to treat vasoplegia in this setting, including noradrenaline, vasopressin and, more recently, angiotensin II. We report the case of a patient who experienced vasoplegia after phaeochromocytoma resection which was refractory to vasopressin and angiotensin II infusions but was successfully treated with high dose hydroxocobalamin.
View details for DOI 10.1002/anr3.12201
View details for PubMedID 36523482
- Clinical Practice Guideline: Maintenance Intravenous Fluids in Children PEDIATRICS 2018; 142 (6)
Clinical Practice Guideline: Maintenance Intravenous Fluids in Children.
Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Despite the common use of maintenance IVFs, there is high variability in fluid prescribing practices and a lack of guidelines for fluid composition administration and electrolyte monitoring. The administration of hypotonic IVFs has been the standard in pediatrics. Concerns have been raised that this approach results in a high incidence of hyponatremia and that isotonic IVFs could prevent the development of hyponatremia. Our goal in this guideline is to provide an evidence-based approach for choosing the tonicity of maintenance IVFs in most patients from 28 days to 18 years of age who require maintenance IVFs. This guideline applies to children in surgical (postoperative) and medical acute-care settings, including critical care and the general inpatient ward. Patients with neurosurgical disorders, congenital or acquired cardiac disease, hepatic disease, cancer, renal dysfunction, diabetes insipidus, voluminous watery diarrhea, or severe burns; neonates who are younger than 28 days old or in the NICU; and adolescents older than 18 years old are excluded. We specifically address the tonicity of maintenance IVFs in children.The Key Action Statement of the subcommittee is as follows:1A: The American Academy of Pediatrics recommends that patients 28 days to 18 years of age requiring maintenance IVFs should receive isotonic solutions with appropriate potassium chloride and dextrose because they significantly decrease the risk of developing hyponatremia (evidence quality: A; recommendation strength: strong).
View details for PubMedID 30478247