Bio

Dr. Esfahanian is a clinical assistant professor of pediatric anesthesiology at Lucile Packard Children's Hospital Stanford. He is board certified in pediatrics, anesthesiology, and pediatric anesthesiology and practices as a pediatric regional anesthesiologist. He has an interest in utilizing regional techniques to enhance postoperative recovery and has presented nationally on the effectiveness of head and neck blocks, particularly for cleft palate repair.

Clinical Focus

  • pediatric regional anesthesiology
  • Pediatric Anesthesia

Academic Appointments

Honors & Awards

  • Recent Alumni Award, Michigan State University College of Natural Science (2024)
  • Teacher of the Year, Stanford Pediatric Anesthesiology Fellowship Program (2022)
  • Cynthia T. Anderson Award: Outstanding performance in the acquisition of medical knowledge., UC Irvine, Dept. of Anesthesiology and Perioperative Care (2018)

Boards, Advisory Committees, Professional Organizations

  • Member, Stanford Medicine Children's Health Cleft and Craniofacial Care Team (2022 - Present)
  • Member, Stanford Pediatric Anesthesia Fellowship Program Education Committee (2018 - Present)
  • Member, Stanford Pediatric Anesthesia Fellowship Program Evaluation Committee (2018 - Present)
  • Diplomate, American Board of Anesthesiology (2019 - Present)
  • Member, American Society of Regional Anesthesia and Pain Medicine (ASRA) (2019 - Present)
  • Member, Society for Pediatric Anesthesia (2018 - Present)
  • Member, American Society of Anesthesiologists (2014 - Present)
  • Member, American Academy of Pediatrics (2013 - Present)

Professional Education

  • Board Certification: American Board of Pediatrics, Pediatrics (2020)
  • Board Certification: American Board of Anesthesiology, Pediatric Anesthesia (2019)
  • Board Certification: American Board of Anesthesiology, Anesthesia (2019)
  • Clinical Scholar, Stanford University Dept. of Anesthesiology, Division of Pediatric Anesthesiology, Pediatric Regional Anesthesia (2020)
  • Fellowship: Stanford University Anesthesiology Fellowships (2019) CA
  • Fellowship, Stanford, Pediatric Anesthesiology (2019)
  • Residency: UC Irvine Combined Anesthesiology/Pediatric Residency (2018) CA
  • Medical Education: Wayne State University School of Medicine (2013) MI
  • Bachelor of Science, Michigan State University, Physics (2008)
  • Bachelor of Science, Michigan State University, Physiology (2008)

Contact

  • Clinical (Primary)  Center for Academic Medicine Pediatric Anesthesiology 453 Quarry Rd MC 5663 Stanford, CA 94305 (650) 725-8544 (fax)

Additional Clinical Info

Links

Current Research and Scholarly Interests

My current interests include the suprazygomatic maxillary nerve block and its role in enhanced recovery after cleft palate surgery and the development of a high-fidelity ultrasound phantom model to teach this regional anesthesia technique. I am also investigating the role of erector spinae plane blockade in the post-operative recovery of adolescent idiopathic scoliosis patients undergoing posterior spinal fusion.

All Publications

  • Postoperative analgesia for Kasai portoenterostomy using external oblique intercostal blocks. Regional anesthesia and pain medicine Wilkinson-Maitland, N., Cunningham, A. J., Esfahanian, M. 2023

    Abstract

    External Oblique Intercostal (EOI) fascial plane blockade is a relatively new regional anesthetic technique used for a variety of upper abdominal surgical procedures. Proponents of this block praise its simple sonoanatomy, extensive local anesthetic (LA) spread, and ease of catheter placement, while avoiding encroachment into the surgical field or dressing sites; nevertheless, it is underutilized in pediatric surgery. Kasai portoenterostomy is a common pediatric surgical procedure for biliary atresia typically done via an open abdominal approach with an extended subcostal incision. Postoperative analgesic management with epidural anesthetic techniques are considered but may be limited by periprocedural coagulopathy concerns.We present a case of a neonate who underwent successful analgesic management of Kasai portoenterostomy with bilateral EOI block catheters. Opioid consumption and other postoperative outcomes were comparative to previously reported literature of epidural analgesia in this patient population.The purpose of this report is to describe the outcomes and technical approach in a neonate who received EOI blocks as an alternative to epidural anesthetic management. Further studies are needed to compare the efficacy and complication rate of EOI blockade to epidural analgesia for Kasai portoenterostomy surgery.

    View details for DOI 10.1136/rapm-2023-104510

    View details for PubMedID 37474282

  • Enhanced Recovery After Cleft Palate Repair: A Quality Improvement Project. Paediatric anaesthesia Esfahanian, M., Marcott, S. C., Hopkins, E., Burkart, B., Khosla, R., Lorenz, H. P., Wang, E., De Souza, E., Algaze-Yojay, C., Caruso, T. J. 2022

    Abstract

    BACKGROUND: Children undergoing cleft palate repair present challenges to postoperative management due to several factors that can complicate recovery. Utilization of multimodal analgesic protocols can improve outcomes in this population. We report experience designing and implementing an enhanced recovery after surgery (ERAS) pathway for cleft palate repair to optimize postoperative recovery.AIMS: The primary aim was to implement an ERAS pathway with >70% bundle adherence to achieve a 30% reduction in postoperative opioid consumption within 12 months. Our secondary aims assessed intraoperative opioid consumption, length of stay (LOS), timeliness of oral intake, and respiratory recovery.METHODS: A multidisciplinary team of perioperative providers developed an ERAS pathway for cleft palate patients. Key drivers included patient and provider education, formal pathway creation and implementation, multimodal pain therapy, and target-based care. Interventions included maxillary nerve blockade and enhanced intra- and postoperative medication regimens. Outcomes were displayed as statistical process control charts.RESULTS: Pathway compliance was 77.0%. Patients during the intervention period (n=39) experienced a 49% reduction in postoperative opioid consumption (p<0.0001) relative to our historical cohort (n=63), with a mean difference of -0.33 ±0.11 mg/kg (95% CI -0.55 to -0.12 mg/kg). Intraoperative opioid consumption was reduced by 36% (p=0.002), with a mean difference of -0.27 ±0.09 mg/kg (95% CI -0.45 to -0.09 mg/kg). Additionally, patients in the intervention group had a 45% reduction in time to first oral intake (p=0.02) relative to our historical cohort, with a mean difference of -3.81 ±1.56 hours (95% CI -6.9 to -0.70). There was no difference in PACU or hospital LOS, but there was a significant reduction in variance of all secondary outcomes.CONCLUSION: Opioid reduction and improved timeliness of oral intake is possible with an ERAS protocol for cleft palate repair, but our protocol did not alter PACU or hospital LOS.

    View details for DOI 10.1111/pan.14541

    View details for PubMedID 35929340

  • Toward Opioid-Free Fast Track for Pediatric Congenital Cardiac Surgery. Journal of cardiothoracic and vascular anesthesia Esfahanian, M., Caruso, T. J., Lin, C., Kuan, C., Purkey, N. J., Maeda, K., Tsui, B. C. 2019

    View details for DOI 10.1053/j.jvca.2019.02.003

    View details for PubMedID 30852093

  • Moving toward patients being pain- and spasm-free after pediatric scoliosis surgery by using bilateral surgically-placed erector spinae plane catheters. Canadian journal of anaesthesia = Journal canadien d'anesthesie Tsui, B. C., Esfahanian, M. n., Lin, C. n., Policy, J. n., Vorhies, J. n. 2019

    View details for DOI 10.1007/s12630-019-01543-0

    View details for PubMedID 31776896

  • Regional changes in cardiac and stellate ganglion norepinephrine transporter in DOCA-salt hypertension. Autonomic neuroscience : basic & clinical Wehrwein, E. A., Novotny, M., Swain, G. M., Parker, L. M., Esfahanian, M., Spitsbergen, J. M., Habecker, B. A., Kreulen, D. L. 2013; 179 (1-2): 99-107

    Abstract

    Uptake of norepinephrine via the neuronal norepinephrine transporter is reduced in the heart during deoxycorticosterone (DOCA)-salt hypertension. We hypothesized that this was due to reduced norepinephrine transporter mRNA and/or protein expression in the stellate ganglia and heart. After 4 weeks of DOCA-salt treatment there was no change in norepinephrine transporter mRNA in either the right or the left stellate ganglia from hypertensive rats (n=5-7, p>0.05). Norepinephrine transporter immunoreactivity in the left stellate ganglion was significantly increased (n=4, p<0.05) while the right stellate ganglion was unchanged (n=4, p>0.05). Whole heart norepinephrine content was significantly reduced in DOCA rats consistent with reduced uptake function; however, when norepinephrine was assessed by chamber, a significant decrease was noted only in the right atrium and right ventricle (n=6, p<0.05). Cardiac norepinephrine transport binding by chamber revealed that it was only reduced in the left atrium (n=5-7, p>0.05). Therefore, 1) contrary to our hypothesis reduced reuptake in the hypertensive heart is not exclusively due to an overall reduction in norepinephrine transporter mRNA or protein in the stellate ganglion or heart, and 2) norepinephrine transporter regulation occurs regionally in the heart and stellate ganglion in the hypertensive rat heart.

    View details for DOI 10.1016/j.autneu.2013.08.070

    View details for PubMedID 24075956

    View details for PubMedCentralID PMC3883044