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.

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)

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


  • Patient experiences following botulinum toxin A injection for complex abdominal wall hernia repair. Journal of clinical anesthesia Hunter, O. O., Pratt, J. S., Bandle, J., Leng, J., Mariano, E. R. 2020; 66: 109956

    View details for DOI 10.1016/j.jclinane.2020.109956

    View details for PubMedID 32516679

  • Implementation of a patient-specific tapering protocol at discharge decreases total opioid dose prescribed for 6 weeks after elective primary spine surgery. Regional anesthesia and pain medicine Joo, S. S., Hunter, O. O., Tamboli, M., Leng, J. C., Harrison, T. K., Kassab, K., Keeton, J. D., Skirboll, S., Tharin, S., Saleh, E., Mudumbai, S. C., Wang, R. R., Kou, A., Mariano, E. R. 2020

    Abstract

    BACKGROUND AND OBJECTIVES: At our institution, we developed an individualized discharge opioid prescribing and tapering protocol for joint replacement patients and implemented the same protocol for neurosurgical spine patients. We then tested the hypothesis that this protocol will decrease the oral morphine milligram equivalent (MME) dose of opioid prescribed postdischarge after elective primary spine surgery.METHODS: In this retrospective cohort study, we identified all consecutive elective primary spine surgery cases 1year before and after introduction of the protocol. This protocol used the patient's prior 24-hour inpatient opioid consumption to determine discharge opioid pill count and tapering schedule. The primary outcome was total opioid dose prescribed in oral MME from discharge through 6 weeks. Secondary outcomes included in-hospital opioid consumption in MME, hospital length of stay, MME prescribed at discharge, opioid refills, and rates of minor and major adverse events.RESULTS: Eighty-three cases comprised the final sample (45 preintervention and 38 postintervention). There were no differences in baseline characteristics. The total oral MME (median (IQR)) from discharge through 6 weeks postoperatively was 900 (420-1440) preintervention compared with 300 (112-806) postintervention (p<0.01, Mann-Whitney U test), and opioid refill rates were not different between groups. There were no differences in other outcomes.CONCLUSIONS: This patient-specific prescribing and tapering protocol effectively decreases the total opioid dose prescribed for 6 weeks postdischarge after elective primary spine surgery. Our experience also demonstrates the potential generalizability of this protocol, which was originally designed for joint replacement patients, to other surgical populations.

    View details for DOI 10.1136/rapm-2020-101324

    View details for PubMedID 32238478

  • Replacement of Fascia Iliaca Catheters with Continuous Erector Spinae Plane Blocks Within a Clinical Pathway Facilitates Early Ambulation After Total Hip Arthroplasty. Pain medicine (Malden, Mass.) Xu, L., Leng, J. C., Elsharkawy, H., Hunter, O. O., Harrison, T. K., Vokach-Brodsky, L., Kumar, G., Funck, N., Hill, J. N., Giori, N. J., Indelli, P. F., Kou, A., Mariano, E. R. 2020

    Abstract

    The optimal continuous peripheral nerve block (CPNB) technique for total hip arthroplasty (THA) that maximizes both analgesia and mobility is unknown. Continuous erector spinae plane (ESP) blocks were implemented at our institution as a replacement for fascia iliaca (FI) catheters to improve our THA clinical pathway. We designed this study to test the hypothesis that this change will increase early postoperative ambulation for elective primary THA patients.We identified all consecutive primary unilateral THA cases six months before and six months after the clinical pathway change to ESP catheters. All other aspects of the THA clinical pathway and multimodal analgesic regimen including perineural infusion protocol did not change. The primary outcome was total ambulation distance (meters) on postoperative day 1. Other outcomes included total ambulation on postoperative day 2, combined two-day ambulation distance, pain scores, opioid consumption, inpatient length of stay, and minor and major adverse events.Eighty-eight patients comprised the final sample (43 FI and 45 ESP). Postoperative day 1 total ambulation distance was greater for the ESP group compared with the FI group (median [10th-90th percentiles] = 24.4 [0.0-54.9] vs 9.1 [0.7-45.7] meters, respectively, P = 0.036), and two-day ambulation distance was greater for the ESP group compared with the FI group (median [10th-90th percentiles] = 68.6 [9.0-128.0] vs 46.6 [3.7-104.2] meters, respectively, P = 0.038). There were no differences in pain scores, opioid use, or other outcomes.Replacing FI catheters with continuous ESP blocks within a clinical pathway results in increased early ambulation by elective primary THA patients.

    View details for DOI 10.1093/pm/pnaa243

    View details for PubMedID 32869079

  • A little better is still better: using marginal gains to enhance 'enhanced recovery' after surgery. Regional anesthesia and pain medicine Leng, J. C., Mariano, E. R. 2020

    View details for DOI 10.1136/rapm-2019-101239

    View details for PubMedID 31932489

  • 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
  • Erector spinae plane: a collapsible potential space. Regional anesthesia and pain medicine Xu, L., Leng, J. C., Mariano, E., Tsui, B. C. 2019

    View details for DOI 10.1136/rapm-2019-101107

    View details for PubMedID 31748425

  • 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

  • Five-year follow-up to assess long-term sustainability of changing clinical practice regarding anesthesia and regional analgesia for lower extremity arthroplasty. Korean journal of anesthesiology Tamboli, M., Leng, J. C., Hunter, O. O., Kou, A., Mudumbai, S. C., Memtsoudis, S. G., Walters, T. L., Lochbaum, G. M., Mariano, E. R. 2019

    Abstract

    Long-term sustainability of clinical practice changes in anesthesia has not been previously reported. Therefore, we performed a 5-year audit following implementation of a clinical pathway change to favor spinal anesthesia for total knee arthroplasty (TKA). We similarly evaluated a parallel cohort of patients undergoing total hip arthroplasty (THA) which did not undergo clinical pathway change as well as the utilization of regional analgesia.We identified all primary unilateral TKA and THA cases performed from January 2013 through December 2018 to include data from one-year pre-implementation and 5-years post-implementation of the clinical pathway change. Our primary outcome was the overall rate of spinal anesthesia usage. Secondary outcomes included rate of nerve block utilization, 30-day postoperative complications, and resource utilization variables such as hospital readmission, emergency department visits, and blood transfusions.The sample consisted of 1859 cases (1250 TKAs, 609 THAs). In the first year post-implementation, 174/221 (78.7%) TKAs received spinal anesthesia compared to 23/186 (12.4%) in the year before implementation (p<0.001). In the subsequent 4-year period, 647/843 (77.2%) TKAs received spinal anesthesia (p=0.532 vs. year 1). For THA, 78/124 (62.9%) received spinal anesthesia in the year after implementation compared to 48/116 (41.4%) pre-implementation (p=0.001), but this rate decreased in the subsequent 4-year period to 193/369 (52.3%) (p=0.040 vs. year 1). Utilization of regional analgesia was high in both groups, and there were no differences in other outcomes.A clinical pathway change promoting spinal anesthesia for TKA can be effectively implemented and sustained over a 5-year period.

    View details for DOI 10.4097/kja.19400

    View details for PubMedID 31865661

  • 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