Bio


Dr Agarwal is a Pediatric Anesthesiologist who went to medical school and completed her anesthesia residency at Baylor College of Medicine, with a fellowship in pediatric anesthesiology at Denver Children's Hospital. Her interests include pediatric acute pain management, regional anesthesia, ambulatory anesthesia and neuro-anesthesia and medical student, reisident fellow education. She was the Pediatric Anesthesia Program Director at the University of Colorado for 18 years and the Course Director for the Colorado Review of Anesthesiology for Surgicenters and Hospitals for 17. She has served as the Editor for the Society for Pediatric Anesthesia Newsletter, Communication Chair and member of the Board Of Directors. She is immediate past Chair for the American Academy of Pediatrics:Section on Anesthesiology and Pain Management, and the Vice President for the Society of Pediatric Pain Management. She is delighted to be at Stanford and Lucille Packard Children's Hospital

Clinical Focus


  • Anesthesia

Academic Appointments


Administrative Appointments


  • Chair, American Academy of Pediatrics Section on Anesthsiology (2015 - 2017)
  • Treasurer, Society for Pediatric Pain Medicine (2014 - 2017)
  • Pediatric Anesthesia Trauma Liaison, Stanford (2015 - Present)
  • Associate Director Pediatric Anesthesia Education, Stanford (2014 - Present)

Boards, Advisory Committees, Professional Organizations


  • Junior Editor, American Board of Anesthesiology: Pediatric Anesthesiology Examination (2009 - Present)
  • Senior Editor, American Board of Anesthesiology (2011 - Present)
  • Director -At -Large, Pediatric Anesthesia Program Directors (2010 - 2014)
  • Course and Program Director, Colorado Review of Anesthesiology for Surgicenters and Hospitals (CRASH) (1997 - 2015)
  • Treasurer, Society for Pediatric Pain Medicine (2014 - Present)
  • At-large Director, Society for Pediatric Anesthesia (2006 - 2014)
  • Chair-Elect, American Academy of Pediatrics:Section on Anesthesiology and Pain Management (2013 - Present)

Professional Education


  • Fellowship:Childrens Hospital of Colorado Pediatric Anesthesiology Fellowship (1991) CO
  • Residency:Baylor College of Medicine Registrar (1990) TX
  • Internship:Baylor College of Medicine Registrar (1987) TX
  • Medical Education:Baylor College of Medicine Registrar (1986) TX
  • Board Certification: Pediatric Anesthesia, American Board of Anesthesiology (2013)
  • Pediatric ANEsthesiology, Denver Children's Hospital, Pediatric Anesthesiology (1991)
  • Anesthesiology, Baylor College of Medicine, Anesthesiology (1990)
  • Board Certification: Anesthesia, American Board of Anesthesiology (1992)
  • MD, Baylor College of Medicine, Medicine (1986)
  • BA, Texas A&M, Biology (1982)

Current Research and Scholarly Interests


Part of a multi=institutional national group comparing various techniques of analgesia used in the management of surgical repairs. The first surgical procedure we are studying is Pecturs Excavatum repair. Each institution follows its usual protocols and data is collected on a variety of outcomes, including length of stay, pain scores, opioid consumption, time to start walking and any long term issues.
Once data collection and analysis of that procedure is complete we will start looking at Spinal Fusion

All Publications


  • Perioperative Management and In-Hospital Outcomes After Minimally Invasive Repair of Pectus Excavatum: A Multicenter Registry Report From the Society for Pediatric Anesthesia Improvement Network. Anesthesia and analgesia Muhly, W. T., Beltran, R. J., Bielsky, A., Bryskin, R. B., Chinn, C., Choudhry, D. K., Cucchiaro, G., Fernandez, A., Glover, C. D., Haile, D. T., Kost-Byerly, S., Schnepper, G. D., Zurakowski, D., Agarwal, R., Bhalla, T., Eisdorfer, S., Huang, H., Maxwell, L. G., Thomas, J. J., Tjia, I., Wilder, R. T., Cravero, J. P. 2018

    Abstract

    BACKGROUND: There are few comparative data on the analgesic options used to manage patients undergoing minimally invasive repair of pectus excavatum (MIRPE). The Society for Pediatric Anesthesia Improvement Network was established to investigate outcomes for procedures where there is significant management variability. For our first study, we established a multicenter observational database to characterize the analgesic strategies used to manage pediatric patients undergoing MIRPE. Outcome data from the participating centers were used to assess the association between analgesic strategy and pain outcomes.METHODS: Fourteen institutions enrolled patients from June 2014 through August 2015. Network members agreed to an observational methodology where each institution managed patients based on their institutional standards and protocols. There was no requirement to standardize care. Patients were categorized based on analgesic strategy: epidural catheter (EC), paravertebral catheter (PVC), wound catheter (WC), no regional (NR) analgesia, and intrathecal morphine techniques. Primary outcomes, pain score and opioid consumption by postoperative day (POD), for each technique were compared while adjusting for confounders using multivariable modeling that included 5 covariates: age, sex, number of bars, Haller index, and use of preoperative pain medication. Pain scores were analyzed using repeated-measures analysis of variance with Bonferroni correction. Opioid consumption was analyzed using a multivariable quantile regression.RESULTS: Data were collected on 348 patients and categorized based on primary analgesic strategy: EC (122), PVC (57), WC (41), NR (120), and intrathecal morphine (8). Compared to EC, daily median pain scores were higher in patients managed with PVC (POD 0), WC (POD 0, 1, 2, 3), and NR (POD 0, 1, 2), respectively (P < .001-.024 depending on group). Daily opioid requirements were higher in patients managed with PVC (POD 0, 1), WC (POD 0, 1, 2), and NR (POD 0, 1, 2) when compared to patients managed with EC (P < .001).CONCLUSIONS: Our data indicate variation in pain management strategies for patients undergoing MIRPE within our network. The results indicate that most patients have mild-to-moderate pain postoperatively regardless of analgesic management. Patients managed with EC had lower pain scores and opioid consumption in the early recovery period compared to other treatment strategies.

    View details for DOI 10.1213/ANE.0000000000003829

    View details for PubMedID 30346358

  • Concerns Regarding the Single Operator Model of Sedation in Young Children PEDIATRICS Agarwal, R., Kaplan, A., Brown, R., Cote, C. J. 2018; 141 (4)

    View details for DOI 10.1542/peds.2017-2344

    View details for Web of Science ID 000429276200014

    View details for PubMedID 29500294

  • The Pediatric Anesthesiology Workforce: Projecting Supply and Trends 2015-2035 ANESTHESIA AND ANALGESIA Muffly, M. K., Singleton, M., Agarwal, R., Scheinker, D., Miller, D., Muffly, T. M., Honkanen, A. 2018; 126 (2): 568–78

    Abstract

    A workforce analysis was conducted to predict whether the projected future supply of pediatric anesthesiologists is balanced with the requirements of the inpatient pediatric population. The specific aims of our analysis were to (1) project the number of pediatric anesthesiologists in the future workforce; (2) project pediatric anesthesiologist-to-pediatric population ratios (0-17 years); (3) project the mean number of inpatient pediatric procedures per pediatric anesthesiologist; and (4) evaluate the effect of alternative projections of individual variables on the model projections through 2035.The future number of pediatric anesthesiologists is determined by the current supply, additions to the workforce, and departures from the workforce. We previously compiled a database of US pediatric anesthesiologists in the base year of 2015. The historical linear growth rate for pediatric anesthesiology fellowship positions was determined using the Accreditation Council for Graduate Medical Education Data Resource Books from 2002 to 2016. The future number of pediatric anesthesiologists in the workforce was projected given growth of pediatric anesthesiology fellowship positions at the historical linear growth rate, modeling that 75% of graduating fellows remain in the pediatric anesthesiology workforce, and anesthesiologists retire at the current mean retirement age of 64 years old. The baseline model projections were accompanied by age- and gender-adjusted anesthesiologist supply, and sensitivity analyses of potential variations in fellowship position growth, retirement, pediatric population, inpatient surgery, and market share to evaluate the effect of each model variable on the baseline model. The projected ratio of pediatric anesthesiologists to pediatric population was determined using the 2012 US Census pediatric population projections. The projected number of inpatient pediatric procedures per pediatric anesthesiologist was determined using the Kids' Inpatient Database historical data to project the future number of inpatient procedures (including out of operating room procedures).In 2015, there were 5.4 pediatric anesthesiologists per 100,000 pediatric population and a mean (±standard deviation [SD]) of 262 ±8 inpatient procedures per pediatric anesthesiologist. If historical trends continue, there will be an estimated 7.4 pediatric anesthesiologists per 100,000 pediatric population and a mean (±SD) 193 ±6 inpatient procedures per pediatric anesthesiologist in 2035. If pediatric anesthesiology fellowship positions plateau at 2015 levels, there will be an estimated 5.7 pediatric anesthesiologists per 100,000 pediatric population and a mean (±SD) 248 ±7 inpatient procedures per pediatric anesthesiologist in 2035.If historical trends continue, the growth in pediatric anesthesiologist supply may exceed the growth in both the pediatric population and inpatient procedures in the 20-year period from 2015 to 2035.

    View details for DOI 10.1213/ANE.0000000000002535

    View details for Web of Science ID 000425664900030

    View details for PubMedID 29116973

  • Fifty years of the American Academy of Pediatrics Section on Anesthesiology: a history of our specialty. Paediatric anaesthesia Agarwal, R., Riefe, J., Houck, C. S. 2017; 27 (6): 560-570

    Abstract

    The American Academy of Pediatrics Section on Anesthesiology and Pain Medicine celebrated its 50th Anniversary in 2015. The Section was one of the first and only subspecialty organizations in anesthesiology at the time. This special article will focus on the contributions of the Section to the practice of pediatric anesthesiology in the areas of advocacy, education and member contributions. In 1986, the Section created the Robert M. Smith Award to honor those members who had made significant advances in the practice of pediatric anesthesiology. It is named after one of the Section founders, an influential educator, inventor, and researcher in our field. We will focus the latter part of the article on the Robert M. Smith award winners to illustrate the contributions of the Section and its members to the development of the field of pediatric anesthesiology.

    View details for DOI 10.1111/pan.13121

    View details for PubMedID 28332249

  • Airway management in laryngotracheal injuries from blunt neck trauma in children PEDIATRIC ANESTHESIA Chatterjee, D., Agarwal, R., Bajaj, L., Teng, S. N., Prager, J. D. 2016; 26 (2): 132-138

    View details for DOI 10.1111/pan.12791

    View details for Web of Science ID 000367788700003

  • Pain and Pain Relief Handbook of Neonatal Intensive Care Gardner, S. L., Hagedorn, M. E., Agarwal, R. 2015
  • Educate parents on benefits of smoking cessation before child’s surgery AAP: News Teng, S. N., Agarwal, R. 2015; 36 (13)
  • Use of oral opioids during tonsillectomy re-evalauted AAP News Agarwal, R. 2014; 35 (13): 13
  • Neonatal Anesthesia Anesthesia Secrets Agarwal, R. Elsevier. 2013
  • A practical Approach to the Pediatric Neurosurgical Patient A practical Approach ot Neuroanesthesia Dean, K., Agarwal, R. 2013
  • Pediatric Anesthesia Anesthesia Secrets Agarwal, R. Elsevier. 2013
  • Acute Pain Services Pediatric Anesthesia: Basic Principles, State of the Art, Future – Update Agarwal, R., Polaner, D. PMPH-USA. 2011
  • Improvement of intraoperative samatosensory evoked potentials by ketamine PAEDIATRIC ANAESTHESIA Agarwal, R., Roitman, K. J., Stokes, M. 1998; 8 (3): 263-266

    Abstract

    Many anaesthetics effect the latency and amplitude of somatosensory evoked potentials (SSEP). We present a patient who underwent two anterior/posterior spine fusions (A/PSF) at age 11 and 12 years old after resection of a spinal astrocytoma. She did have residual neurologic deficits of her lower extremities. SSEPs were unobtainable during the first surgery using an opioid-based anaesthetic. A ketamine-based anaesthetic was used for the second surgery and SSEPs were easily monitored. No other factors seem to have changed between the two surgeries. The anaesthetic management during each procedure is reviewed and the contributions of other factors to SSEP monitoring discussed.

    View details for Web of Science ID 000073673600017

    View details for PubMedID 9608975