Bio


Dr. Leng is an anesthesiologist with fellowship training in regional anesthesiology. She treats patients primarily at the Hospital for Veterans Affairs in Palo Alto.

Clinical Focus


  • Anesthesia
  • Regional Anesthesia

Academic Appointments


Honors & Awards


  • Teaching Excellence Award, Presented annually to a faculty member by the graduating resident class (2016)

Boards, Advisory Committees, Professional Organizations


  • Board Certified, American Board of Anesthesiology (2014 - Present)
  • Member, California Society of Anesthesiologists (2014 - Present)
  • Member, American Society of Anesthesiologists (2009 - Present)

Professional Education


  • Fellowship:Stanford University Anesthesiology FellowshipsCA
  • Fellowship:Stanford University Anesthesiology Fellowships (2014) CA
  • Internship:University of Miami Jackson Memorial Hospital Internal Med Residency (2009) FL
  • Medical Education:University of Miami Miller School of Medicine (2008) FL
  • Residency:Stanford University Anesthesiology Residency (2013) CA
  • Board Certification: Anesthesia, American Board of Anesthesiology (2014)

Projects


  • Regional Anesthesia teaching videos (2015 - Present)

    Instructional videos intended for anesthesiologists trained in regional anesthesia, desiring a short tutorial of a particular nerve block. Posted on www.mereresidency.com.

    Location

    Palo Alto, CA

  • PRIME (Peer support and Resiliency in MEdicine) Facilitator, Stanford Health Care (2016 - Present)

    Faculty facilitator in wellness sessions and annual wellness retreat for anesthesia resident. Training included mindfulness training course.

    Location

    Stanford, CA

Graduate and Fellowship Programs


All Publications


  • A short, sustainable intervention to help reduce day of surgery smoking rates among patients undergoing elective surgery. Journal of clinical anesthesia Coffman, C. R., Howard, S. K., Mariano, E. R., Kou, A., Pollard, J., Boselli, R., Kangas, S., Leng, J. 2019; 58: 35–36

    View details for PubMedID 31059909

  • Preoperative Ultrasound-Guided Botulinum Toxin A Injection Facilitates Closure of a Complex Abdominal Wall Hernia: A Case Report. A&A practice Tamboli, M., Kitamura, R., Ma, W., Kumar, G., Harrison, T. K., Wang, R. R., Mariano, E. R., Leng, J. C. 2019

    Abstract

    Complex abdominal wall hernia repairs can have high failure rates. Many surgical techniques have been proposed with variable success. We report our experience with a new collaborative protocol between general surgery and regional anesthesiology and acute pain medicine services to provide preoperative botulinum toxin A injections to a patient with a large complex ventral hernia to facilitate primary closure. Toxin was administered into the 3 abdominal wall muscle layers under ultrasound guidance at multiple sites 2 weeks before surgery. The resulting flaccid paralysis of the abdominal musculature facilitated a successful primary surgical closure with no postoperative complications.

    View details for DOI 10.1213/XAA.0000000000001033

    View details for PubMedID 31180908

  • Randomized comparison of popliteal-sciatic perineural catheter tip migration and dislocation in a cadaver model using two catheter designs. Korean journal of anesthesiology Steffel, L., Howard, S. K., Borg, L., Mariano, E. R., Leng, J. C., Kim, T. E. 2017; 70 (1): 72-76

    Abstract

    New catheter-over-needle (CON) technology for continuous peripheral nerve blockade has emerged, but its effect on the risk of perineural catheter tip dislocation is unknown. Less flexible catheters may be more likely to migrate away from the nerve with simulated patient movement. In the present study, we evaluated catheter tip migration between CON catheters and traditional catheter-through-needle (CTN) catheters during ultrasound-guided short-axis in-plane (SAX-IP) insertion.We evaluated the migration of popliteal-sciatic catheters in a prone, unembalmed male cadaver. Thirty catheter placement trials were divided randomly into two groups based on the catheter type: CON or CTN. A single anesthesiology resident placed the catheters by SAX-IP insertion, and the catheters were then examined by ultrasound before and after ipsilateral knee range of motion (ROM) exercises (0°-130° flexion). A blinded expert regional anesthesiologist performed caliper measurements on the ultrasound images before and after the ROM exercises. The primary outcome was the change in distance from the catheter tip to the center of the nerve (cm) between before and after the ROM exercises.The change in the tip-to-nerve distance (median [10th-90th percentile]) was 0.06 (-0.16 to 0.23) cm for the CTN catheter and 0.00 (-0.12 to 0.69) for the CON catheter (P = 0.663). However, there was a statistically significant increase in dislocation out of the nerve compartment for the CON catheter (4/15; 0/15 for CTN) (P = 0.043).Although the use of different catheter designs had no effect on the change in the measured migration distance of popliteal-sciatic catheters, 27% of the CON catheters were dislocated out of the nerve compartment. These results may influence the choice of catheter design when using SAX-IP perineural catheter insertion.

    View details for DOI 10.4097/kjae.2017.70.1.72

    View details for PubMedID 28184270

  • Virtual reality distraction decreases routine intravenous sedation and procedure-related pain during preoperative adductor canal catheter insertion: a retrospective study. Korean journal of anesthesiology Pandya, P. G., Kim, T. E., Howard, S. K., Stary, E., Leng, J. C., Hunter, O. O., Mariano, E. R. 2017; 70 (4): 439–45

    Abstract

    Virtual reality (VR) distraction is a nonpharmacological method to prevent acute pain that has not yet been thoroughly explored for anesthesiology. We present our experience using VR distraction to decrease routine intravenous sedation for patients undergoing preoperative perineural catheter insertion.This 1-month quality improvement project involved all elective unilateral primary total knee arthroplasty patients who received a preoperative adductor canal catheter. Clinical data were analyzed retrospectively. For the first half of the month, all patients received usual care; intravenous sedation was administered at the discretion of the regional anesthesiologist. For the second half of the month, patients were offered VR distraction with intravenous sedation upon request. The primary outcome was fentanyl dosage; other outcomes included midazolam dosage, procedure-related pain, procedural time, and blood pressure changes.Seven patients received usual care and seven used VR. In the VR group, 1/7 received intravenous sedation versus 6/7 who received usual care (P = 0.029). The fentanyl dose was lower (median [10th-90th percentiles]) in the VR group (0 [0-20] µg) versus the non-VR group (50 [30-100] µg; P = 0.008). Midazolam use was lower in the VR group (0 [0-0] mg) than in the non-VR group (1 [0-1] mg; P = 0.024). Procedure-related pain was lower in the VR group (1 [1-4] NRS) versus the non-VR group (3 [2-6] NRS; P = 0.032). There was no difference in other outcomes.VR distraction may provide an effective nonpharmacological alternative to intravenous sedation for the ultrasound-guided placement of certain perineural catheters.

    View details for PubMedID 28794840

    View details for PubMedCentralID PMC5548947

  • Comparative Echogenicity of an Epidural Catheter and 2 New Catheters Designed for Ultrasound-Guided Continuous Peripheral Nerve Blocks. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine Moy, D. M., Kim, T. E., Harrison, T. K., Leng, J. C., Carvalho, B., Howard, S. K., Shum, C., Kou, A., Mariano, E. R. 2017

    Abstract

    Visualization of the catheter during ultrasound-guided continuous nerve block performance may be difficult but is an essential skill for regional anesthesiologists. The objective of this in vitro study was to evaluate 2 newer catheters designed for enhanced echogenicity and compare them to a widely used catheter not purposely designed for ultrasound guidance. Outcomes were the numbers of first-place rankings among all 3 catheters and scores on individual echogenicity criteria as assessed by 2 blinded reviewers. Catheters designed for echogenicity are not superior to an older regional anesthesia catheter, and results suggest that catheter preference for ultrasound-guided placement may be subjective.

    View details for PubMedID 28627724

  • A pilot study to assess adductor canal catheter tip migration in a cadaver model JOURNAL OF ANESTHESIA Leng, J. C., Harrison, T. K., Miller, B., Howard, S. K., Conroy, M., Udani, A., Shum, C., Mariano, E. R. 2015; 29 (2): 308-312

    Abstract

    An adductor canal catheter may facilitate early ambulation after total knee arthroplasty, but there is concern over preoperative placement since intraoperative migration of catheters may occur from surgical manipulation and result in ineffective analgesia. We hypothesized that catheter type and subcutaneous tunneling may influence tip migration for preoperatively inserted adductor canal catheters. In a male unembalmed human cadaver, 20 catheter insertion trials were divided randomly into one of four groups: flexible epidural catheter either tunneled or not tunneled; or rigid stimulating catheter either tunneled or not tunneled. Intraoperative patient manipulation was simulated by five range-of-motion exercises of the knee. Distance and length measurements were performed by a blinded regional anesthesiologist. Changes in catheter tip to nerve distance (p = 0.225) and length of catheter within the adductor canal (p = 0.467) were not different between the four groups. Two of five non-tunneled stimulating catheters (40 %) were dislodged compared to 0/5 in all other groups (p = 0.187). A cadaver model may be useful for assessing migration of regional anesthesia catheters; catheter type and subcutaneous tunneling may not affect migration of adductor canal catheters based on this preliminary study. However, future studies involving a larger sample size, actual patients, and other catheter types are warranted.

    View details for DOI 10.1007/s00540-014-1922-7

    View details for Web of Science ID 000352859100026

    View details for PubMedID 25288506

  • Risk factors for respiratory depression in patients undergoing retrobulbar block for vitreoretinal surgery. Ophthalmic surgery, lasers & imaging retina Silva, R. A., Leng, J. C., He, L., Brock-Utne, J. G., Drover, D. R., Leng, T. 2015; 46 (2): 243-247

    Abstract

    To determine the risk factors for respiratory depression during retrobulbar block administration before vitreoretinal surgery.Prospective, observational case series of 113 patients undergoing monitored anesthesia care and retrobulbar block before vitreoretinal surgery at a tertiary medical center.Chin lift, jaw thrust, and bag mask ventilation were performed in eight (7.1%), nine (8%), and six (5.3%) patients, respectively. No patients required intubation. Age, sex, body mass index, history of obstructive sleep apnea, American Society of Anesthesiologists physical status level, and baseline oxygen saturation were not predictive of airway intervention. Of the four anesthetic agents utilized (midazolam, fentanyl, alfentanil, and propofol), only propofol and fentanyl were associated with an increased risk for clinically significant apnea. Use of three medications for sedation was associated with a 5.4-fold increase in the relative risk of requiring a respiratory rescue intervention.During preoperative sedation for retrobulbar block administration, the use of propofol, fentanyl, or a combination of three anesthetics is associated with a statistically significant increase in the risk for respiratory depression requiring resuscitation. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:243-247.].

    View details for DOI 10.3928/23258160-20150213-22

    View details for PubMedID 25707051

  • Risk Factors for Respiratory Depression in Patients Undergoing Retrobulbar Block for Vitreoretinal Surgery OPHTHALMIC SURGERY LASERS & IMAGING RETINA Silva, R. A., Leng, J. C., He, L., Brock-Utne, J. G., Drover, D. R., Leng, T. 2015; 46 (2): 243-247

    Abstract

    To determine the risk factors for respiratory depression during retrobulbar block administration before vitreoretinal surgery.Prospective, observational case series of 113 patients undergoing monitored anesthesia care and retrobulbar block before vitreoretinal surgery at a tertiary medical center.Chin lift, jaw thrust, and bag mask ventilation were performed in eight (7.1%), nine (8%), and six (5.3%) patients, respectively. No patients required intubation. Age, sex, body mass index, history of obstructive sleep apnea, American Society of Anesthesiologists physical status level, and baseline oxygen saturation were not predictive of airway intervention. Of the four anesthetic agents utilized (midazolam, fentanyl, alfentanil, and propofol), only propofol and fentanyl were associated with an increased risk for clinically significant apnea. Use of three medications for sedation was associated with a 5.4-fold increase in the relative risk of requiring a respiratory rescue intervention.During preoperative sedation for retrobulbar block administration, the use of propofol, fentanyl, or a combination of three anesthetics is associated with a statistically significant increase in the risk for respiratory depression requiring resuscitation. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:243-247.].

    View details for DOI 10.3928/23258160-20150213-22

    View details for Web of Science ID 000353360100013

    View details for PubMedID 25707051

  • An Anesthesia Resident's Prayer. Anesthesiology Leng, J. C. 2013; 119 (2): 483-?

    View details for DOI 10.1097/ALN.0b013e31829b36c2

    View details for PubMedID 23719614

  • Correlation of anesthetic medications with required airway interventions during retrobulbar anesthesia He, L., Leng, J., Silva, R., Leng, T. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2013