Clinical Focus

  • Anesthesia
  • Anesthesia, Pediatric
  • Mobile (In-situ) simulation
  • Global Healthcare
  • Pharmeceuticals

Academic Appointments

Administrative Appointments

  • Chair, OR Medication Safety Committee (2015 - Present)
  • Co-Medical Director and Co-Founder, REVIVE (2015 - 2017)
  • Director, Stanford Children's Joint Venture Simulation, REVIVE (2017 - Present)
  • Executive Co-Director, Solutions @StanfordMedicine (2018 - Present)
  • Co-Chair of Pharmacy & Therapeutics Committee, Stanford Children's (2010 - Present)
  • Director, Pediatric Neuroanesthesia (2008 - Present)

Professional Education

  • Residency: Stanford University Anesthesiology Residency (2001) CA
  • Internship: University of Hawaii General Surgery Residency (1997) HI
  • Medical Education: Tulane University School of Medicine Registrar (1995) LA
  • Board Certification: American Board of Anesthesiology, Pediatric Anesthesia (2013)
  • Board Certification: American Board of Anesthesiology, Anesthesia (2002)

2021-22 Courses

Graduate and Fellowship Programs

All Publications

  • Anesthesia for the Pediatric Patient With Epilepsy and Minimally Invasive Surgery for Epilepsy CURRENT ANESTHESIOLOGY REPORTS Wong, B. J., Agarwal, R., Chen, M. I. 2021
  • Operating Room Codes Redefined: A Highly Reliable Model Integrating the Core Hospital Code Team. Pediatric quality & safety Caruso, T. J., Rama, A. n., Knight, L. J., Gonzales, R. n., Munshey, F. n., Darling, C. n., Chen, M. n., Sharek, P. J. 2019; 4 (3): e172


    Typically, multidisciplinary teams manage cardiac arrests occurring outside of the operating room (OR). This approach results in reduced morbidity. However, arrests that occur in the OR are usually managed by OR personnel alone, missing the benefits of out-of-OR hospital code teams. At our institution, there were multiple pathways to activate codes, each having different respondents, depending on time and day of the week. This improvement initiative aimed to create a reliable intraoperative emergency response system with standardized respondents and predefined roles.A multidisciplinary improvement team led this project at an academic pediatric hospital in California. After simulations performed in the OR (in situ), the team identified a valuable key driver-a consistent activation process that initiated standard respondents, 24 hours a day, 7 days a week. By utilizing core hospital code members routinely available outside of the OR during days, nights, and weekends, respondents were identified to augment OR personnel. Code roles were preassigned. After education, we conducted in situ simulations that included the perioperative and out-of-OR code team members. We administered a knowledge assessment to perioperative staff.The knowledge assessment for perioperative staff (n = 52) had an average score of 96%. Review of subsequent OR codes reflects an improved initiation process and management.The process for activating the emergency response system and roles for intraoperative code respondents were standardized to ensure a predictable code response, regardless of time or day of the week. Ongoing simulations with perioperative personnel continue to optimize the process.

    View details for DOI 10.1097/pq9.0000000000000172

    View details for PubMedID 31579871

    View details for PubMedCentralID PMC6594783

  • Affordable Simulation for Small-Scale Training and Assessment SIMULATION IN HEALTHCARE Edler, A. A., Chen, M., Honkanen, A., Hackel, A., Golianu, B. 2010; 5 (2): 112-115


    High-fidelity patient simulation is increasingly recognized as an effective means of team training, acquisition and maintenance of technical and professional skills, and reliable performance assessment; however, finding a cost effective solution to providing such instruction can be difficult. This report describes the rationale, design, and appropriateness of a portable simulation model and example of its successful use at national meetings.The Stanford Simulation Group, in association with several other centers, developed a portable Pediatric Simulation Training and Assessment Program (Pediatric Anesthesia in-Situ Simulation) and presented it at two national meetings. The technical challenges and costs of development are outlined, and a satisfaction survey was conducted at the completion of the program.All respondents (100%) either agreed or strongly agreed that the course was useful, met expectations, was enjoyable, and that the scenarios were realistic.The Portable Simulation Training and Assessment Program (Pediatric Anesthesia in-Situ Simulation) presents innovative educational and financial opportunities to assist in both training and assessment of critical emergency response skills at smaller institutions and allows specialized instruction in an in situ setting.

    View details for DOI 10.1097/SIH.0b013e3181c76332

    View details for PubMedID 20661010

  • Determination of the pharmacodynamic interaction of propofol and dexmedetomidine during esophagogastroduodenoscopy in children PEDIATRIC ANESTHESIA Hammer, G. B., Sam, W. J., Chen, M. I., Golianu, B., Drover, D. R. 2009; 19 (2): 138-144


    Propofol is a sedative-hypnotic drug commonly used to anesthetize children undergoing esophagogastroduodenoscopy (EGD). Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist that has been utilized in combination with propofol to provide anesthesia. There is currently no information regarding the effect of intravenous dexmedetomidine on the propofol plasma concentration-response relationship during EGD in children. This study aimed to investigate the pharmacodynamic interaction of propofol and dexmedetomidine when used in combination for children undergoing EGD.A total of 24 children undergoing EGD, ages 3-10 years, were enrolled in this study. Twelve children received dexmedetomidine 1 microg x kg(-1) given over 10 min as well as a continuous infusion of propofol delivered by a computer-assisted target-controlled infusion (TCI) system with target plasma concentrations ranging from 2.8 to 4.0 microg x ml(-1) (DEX group). Another group of 12 children undergoing EGD also received propofol administered by TCI targeting comparable plasma concentrations without dexmedetomidine (control group). We used logistic regression to predict plasma propofol concentrations at which 50% of the patients exhibited minimal response to stimuli (EC50 for anesthesia).The EC50 +/- SE values in the control and DEX groups were 3.7 +/- 0.4 microg x ml(-1) and 3.5 +/- 0.2 microg x ml(-1), respectively. There was no significant shift in the propofol concentration-response curve in the presence of dexmedetomidine.The EC50 of propofol required to produce adequate anesthesia for EGD in children was unaffected by a concomitant infusion of dexmedetomidine 1 microg x kg(-1) given over 10 min.

    View details for DOI 10.1111/j.1460-9592.2008.02823.x

    View details for PubMedID 19207899

  • Patient simulation: a literary synthesis of assessment tools in anesthesiology. Journal of educational evaluation for health professions Edler, A. A., Fanning, R. G., Chen, M. I., Claure, R., Almazan, D., Struyk, B., Seiden, S. C. 2009; 6: 3-?


    High-fidelity patient simulation (HFPS) has been hypothesized as a modality for assessing competency of knowledge and skill in patient simulation, but uniform methods for HFPS performance assessment (PA) have not yet been completely achieved. Anesthesiology as a field founded the HFPS discipline and also leads in its PA. This project reviews the types, quality, and designated purpose of HFPS PA tools in anesthesiology. We used the systematic review method and systematically reviewed anesthesiology literature referenced in PubMed to assess the quality and reliability of available PA tools in HFPS. Of 412 articles identified, 50 met our inclusion criteria. Seventy seven percent of studies have been published since 2000; more recent studies demonstrated higher quality. Investigators reported a variety of test construction and validation methods. The most commonly reported test construction methods included "modified Delphi Techniques" for item selection, reliability measurement using inter-rater agreement, and intra-class correlations between test items or subtests. Modern test theory, in particular generalizability theory, was used in nine (18%) of studies. Test score validity has been addressed in multiple investigations and shown a significant improvement in reporting accuracy. However the assessment of predicative has been low across the majority of studies. Usability and practicality of testing occasions and tools was only anecdotally reported. To more completely comply with the gold standards for PA design, both shared experience of experts and recognition of test construction standards, including reliability and validity measurements, instrument piloting, rater training, and explicit identification of the purpose and proposed use of the assessment tool, are required.

    View details for DOI 10.3352/jeehp.2009.6.3

    View details for PubMedID 20046456

    View details for PubMedCentralID PMC2796725

  • Scenario and checklist for airway rescue during pediatric sedation. Simulation in healthcare Chen, M. I., Edler, A., Wald, S., Dubois, J., Huang, Y. M. 2007; 2 (3): 194-198

    View details for DOI 10.1097/SIH.0b013e3181461b60

    View details for PubMedID 19088623

  • Flexor tendon suture methods: A quantitative analysis of suture material within the repair site ORTHOPEDICS Norris, S. R., Ellis, F. D., Chen, M. I., Seller, J. C. 1999; 22 (4): 413-416


    This study compared the cross-sectional area and volume occupied by suture material at the repair site in three common methods of flexor tendon repair. A total of 51 human cadaveric tendons were studied. Zone II flexor digitorum profundus tendon lacerations were created and then repaired using the techniques described by Kessler, Tajima, and Savage. Quantitative cross-sectional area and volumetric measurements of suture material within each repair site were determined using a digital image analysis system. The Tajima repair occupied 27% of the tendon area at the repair site, while the Savage and Kessler repairs occupied 18% and 2%, respectively.

    View details for Web of Science ID 000079967600010

    View details for PubMedID 10220056

  • 1995 Volvo Award in basic sciences. The use of an osteoinductive growth factor for lumbar spinal fusion. Part I: Biology of spinal fusion. Spine Boden, S. D., Schimandle, J. H., Hutton, W. C., Chen, M. I. 1995; 20 (24): 2626-2632


    The histology of lumbar intertransverse process spinal fusion was studied in an experimental model in rabbits.To qualitatively and quantitatively analyze the sequential histology of spinal fusion using a previously validated animal model.Few previous studies have described the sequential histology during the posterolateral spinal fusion healing process using autogenous bone, and a basic understanding of the biology of this repair process is lacking.Fourteen adult New Zealand white rabbits underwent single-level posterolateral lumbar intertransverse process arthrodesis with autogenous iliac bone graft. Animals were killed 1-10 weeks after surgery, and the fusion masses were analyzed histologically and quantitated using a semiautomated image analysis system.Three distinct phases of healing were identified (inflammatory, reparative, and remodeling) and occurred in sequence but in a delayed fashion in the central zone of the fusion mass compared with the outer transverse process zones. Membraneous bone formation, evident first at the ends of the fusion eminating from the decorticated transverse processes, was the predominant mechanism of healing. The central zone was somewhat different in that there was a period of endochondral bone formation during weeks 3 and 4 in this zone where cartilage formed and was converted to bone. Remodeling in the central zone had equilibrated with the transverse process zones by 10 weeks.Lumbar intertransverse process spinal fusion is a complex process from a spatial and temporal standpoint. When autogenous bone is used as the graft material, this process critically depends on a variety of factors from the decorticated host bone and exposed marrow. The persistence of a central cartilage zone may be related to some types of nonunions and deserves future investigation. This enhanced understanding of the biology of spinal fusion with autogenous bone graft will provide a foundation for optimizing the use of osteoinductive bone growth factors in this healing process.

    View details for PubMedID 8747240