Mo Esfahanian, MD, D. ABA, FAAP

All Publications

• Clinical Effectiveness Strategies to Improve Patient Outcomes After Pectus Excavatum Repair JOURNAL FOR HEALTHCARE QUALITY Schwab, M. E., Cohen, S., Bassett, H. K., Michel, D., Algaze, C. A., Esfahanian, M., Good, J., Chao, S. D. 2026; 48 (2)

  Abstract

  Target-based care (TBC) uses institutional data to create a shared mental model of anticipated postoperative milestones. This study evaluated the impact of a clinical effectiveness strategy, combining TBC with a clinical pathway and decision support, on outcomes in patients undergoing pectus excavatum repair.This was a prospective study at a quaternary children's hospital between 2022 and 2024. Patients undergoing repair from 2018 to 2021 were historical controls. Target-based care included displaying bedside targets for length of stay (LOS) (outcome metric), Foley catheter and patient-controlled analgesia (PCA) discontinuation (process metrics), and a multidisciplinary evidence-based clinical pathway with an electronic order set.Overall, 91 patients were included: 52 preintervention and 39 postintervention. Median LOS decreased from 3 to 1.8 days (95% confidence interval [CI] 0.8-1.6, p < .05). The proportion of patients who met the LOS target of 2 days increased from 44.2% to 91.8% ( p < .05). The mean time to PCA discontinuation decreased from 1.6 to 0.8 days (95% CI 34.8-118.7, p < .05). The time to Foley catheter removal diminished from 22.2 to 17.1 hour (95% CI 0.6-9.6, p < .05).A data-driven TBC with a clinical pathway had an immediate and sustained impact on patient care. Length of stay, PCA discontinuation, and time to Foley discontinuation decreased after TBC.

  View details for DOI 10.1097/JHQ.0000000000000508

  View details for Web of Science ID 001755683800001

  View details for PubMedID 41355141

• 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