- Pediatric Anesthesiology
- Regional Anesthesiology
- Pediatric Regional Anesthesiology
- Perioperative Point of Care Ultrasound (POCUS)
Clinical Assistant Professor, Anesthesiology, Perioperative and Pain Medicine
Residency: University of Washington Dept of Anesthesiology (2017) WA
Fellowship: UPMC Hospital Regional Anesthesiology Fellowship (2019) PA
Board Certification: American Board of Anesthesiology, Anesthesia (2018)
Board Certification: American Board of Anesthesiology, Pediatric Anesthesia (2018)
Fellowship: UPMC Children's Hospital of Pittsburgh Pediatric Anesthesiology (2018) PA
Medical Education: Dartmouth Geisel School of Medicine Office of the Registrar (2013) NH
Dexmedetomidine Use in SZMN Blocks for Pediatric T&A Pain Control
The suprazygomatic maxillary nerve (SZMN) block is a well-established, safe and effective regional technique for pain management following cleft palate procedures. However, it has not been studied for patients undergoing tonsillectomy and adenoidectomy (T&A) procedures. The goal of this study is to determine whether the SZMN block can be utilized to improve pain control and decrease morbidity in pediatric patients undergoing T&A. An additional goal will be to determine whether the use of dexmedetomidine as a local anesthetic adjunct can prolong the analgesic effects of the SZMN block to cover the entire duration of pain experienced.
Stanford is currently not accepting patients for this trial. For more information, please contact Ban CH Tsui, MD, (650) 200-9107.
- Perioperative Methadone: Perilous or Pain Panacea? Anesthesia and analgesia 2023; 137 (1): 72-75
Neonatal and paediatric point-of-care ultrasound review.
Australasian journal of ultrasound in medicine
2023; 26 (1): 46-58
Point-of-care ultrasound (POCUS) examinations for children and newborns are different from POCUS exams for adults due to dissimilarities in size and body composition, as well as distinct surgical procedures and pathologies in the paediatric patient. This review describes the major paediatric POCUS exams and how to perform them and summarizes the current evidence-based perioperative applications of POCUS in paediatric and neonatal patients.Literature searches using PubMed and Google Scholar databases for the period from January 2000 to November 2021 that included MeSH headings of [ultrasonography] and [point of care systems] and keywords including "ultrasound" for studies involving children aged 0 to 18 years.Paediatric and neonatal POCUS exams can evaluate airway, gastric, pulmonary, cardiac, abdominal, vascular, and cerebral systems.POCUS is rapidly expanding in its utility and presence in the perioperative care of paediatric and neonatal patients as their anatomy and pathophysiology are uniquely suited for ultrasound imaging applications that extend beyond the standard adult POCUS exams.Paediatric POCUS is a powerful adjunct that complements and augments clinical diagnostic evaluation and treatment.
View details for DOI 10.1002/ajum.12322
View details for PubMedID 36960139
View details for PubMedCentralID PMC10030095
The effect of intraoperative lidocaine administration in a disrupted erector spinae fascial plane on intercostal transcranial motor evoked potentials.
Journal of clinical anesthesia
2022; 82: 110956
Erector spinae plane (ESP) blocks have been recently described for postoperative pain management following spine surgery but their effects on intraoperative neuromonitoring are unknown.Retrospective cohort study.Pediatric patients at a tertiary care center.26 pediatric patients who received bilateral surgically-placed ESP catheters for single-stage posterior spine fusion (PSF) from August 2020 to June 2021.Patients in this study did not receive any special interventions as part of this observational retrospective study.This retrospective study investigated the effects of local anesthesia administration through bilateral surgically-placed ESP catheters on intraoperative intercostal transcranial motor evoked potentials (tcMEPs) in the setting of a disrupted erector spinae fascial plane in pediatric patients undergoing single-stage posterior spine fusion.Of the 26 patients that received bilateral surgically-placed ESP catheters for pediatric posterior spine fusion surgery, none exhibited any changes in intercostal tcMEPs attributable to intraoperative lidocaine administration through the ESP catheters.The administration of a local anesthetic into a disrupted erector spinae fascial plane does not appear to interfere with intraoperative neuromonitoring of posterior spine fusion surgeries.
View details for DOI 10.1016/j.jclinane.2022.110956
View details for PubMedID 36029703
- Suprazygomatic infratemporal pterygopalatine fossa block with adjuvant low-dose dexmedetomidine for adenotonsillectomy. Canadian journal of anaesthesia = Journal canadien d'anesthesie 1800
- Systemic lidocaine absorption from continuous erector spinae plane catheters after paediatric posterior spine fusion surgery. Regional anesthesia and pain medicine 2022
Opioid-Free Postoperative Pain Management After Adenotonsillectomy With Nasal Turbinate Reduction Using Bilateral Suprazygomatic Infratemporal-Pterygopalatine Fossa Injections: A Case Report.
2021; 15 (8): e01502
Adenotonsillectomies are one of the most common otolaryngologic surgeries performed to alleviate obstructive sleep-disordered breathing and apnea in children. The pain management following adenotonsillectomy continues to be a challenge for both pediatric anesthesiologists and otolaryngologists due to the mortality that stems from the use of opioid pain medications in children who have an increased baseline risk airway obstruction and apnea that is exacerbated by any exposure to opioids. We present a case utilizing bilateral suprazygomatic maxillary nerve (SZMN) blocks or, more accurately, suprazygomatic infratemporal-pterygopalatine fossa injections to achieve opioid-free perioperative analgesia for pediatric adenotonsillectomy with nasal turbinate reduction.
View details for DOI 10.1213/XAA.0000000000001502
View details for PubMedID 34403375
- Opioid-Free Tonsillectomy With and Without Adenoidectomy: The Role of Regional Anesthesia in the "New Era". Anesthesia and analgesia 2021; 133 (1): e7-e9
- Suprazygomatic maxillary (SZM) nerve blocks for perioperative pain control in pediatric tonsillectomy and adenoidectomy. Journal of clinical anesthesia 2021; 71: 110240
- Alternating Side Programmed Intermittent Repeated (ASPIRe) Bolus Regimen for Delivering Local Anesthetic via Bilateral Interfascial Plane Catheters. Journal of cardiothoracic and vascular anesthesia 2021
Transesophageal probe placement increases endotracheal tube cuff pressure but is not associated with postoperative extubation failure after congenital cardiac surgery.
Annals of cardiac anaesthesia
2020; 23 (4): 447-452
The concomitant use of cuffed endotracheal tubes (ETT) and transesophageal echocardiography (TEE) probes increases ETT cuff pressures (CP), which may contribute to mucosal ischemia and perioperative complications such as failed extubation.To assess changes in ETT CP after TEE insertion in patients of different age groups undergoing congenital heart surgery and examine the relationship between ETT CP and postoperative extubation failure.Single-center quality improvement project.ETT CP was measured with a manometer following intubation and again after TEE insertion. Tracheal perfusion pressure was then calculated and postoperative extubation failures were recorded.Chi-square testing, Fisher's-exact testing, one-way analysis of variance testing or Kruskal-Wallis testing with Dunn's pairwise, and student's t-test or Wilcoxon rank-sum testing were used to analyze the data.Median ETT CP increased significantly after TEE insertion in each age group, with infants showing a smaller magnitude of increase (+2 [1-6] cm H2O, P < 0.001) than adults (+12 [8-14] cm H2O, P = 0.008) (intergroup comparison P = 0.002). Five patients (9%) failed extubation, all of which were infants. Within the infant subgroup, no significant difference existed between failed vs successful extubation regarding ETT CP during bypass (15 ± 1 vs 16 ± 2 mmHg, P = 0.206) or tracheal perfusion pressure pre-bypass (34 ± 9 vs 38 ± 11 mmHg, P = 0.518), during bypass (20 ± 9 vs 22 ± 6 mmHg, P = 0.697), or post-bypass (42 ± 9 vs 41 ± 9 mmHg, P = 0.923). There was a significant difference in cardiopulmonary bypass duration (151 ± 29 vs 85 ± 32 min, P < 0.001).Factors beyond intraoperative ETT CP likely play a larger role in postoperative extubation failure.
View details for DOI 10.4103/aca.ACA_143_19
View details for PubMedID 33109802
View details for PubMedCentralID PMC7879897
- Distanced-based dynamic behaviour of aerosol particles during aerosol-generating medical procedures. British journal of anaesthesia 2020
- Droplet evacuation strategy for simulated coughing during aerosol-generating procedures in COVID-19 patients. British journal of anaesthesia 2020
- COVID-19: Epidemiological factors during aerosol generating medical procedures. Anesthesia and analgesia 2020
- Are aerosol-generating procedures safer in an airborne infection isolation room or operating room? British journal of anaesthesia 2020
Quadratus lumborum blocks: Two cases of associated hematoma.
2019; 29 (3): 286-288
A quadratus lumborum block associated complication is a rare event. We report two cases of hematoma following the performance of quadratus lumorum blocks in two patients. Performing this block requires additional consideration of abdominal wall anatomy and patient coagulation status.
View details for DOI 10.1111/pan.13588
View details for PubMedID 30664311
Immune responses in infants whose mothers received Tdap vaccine during pregnancy.
The Pediatric infectious disease journal
2013; 32 (11): 1257-60
The effect of maternal Tdap vaccination on infant immunologic responses to routine pediatric vaccines is unknown.This was a cohort study of infants whose mothers received or did not receive Tdap vaccine during pregnancy. Maternal and cord blood samples were collected at delivery; infant blood samples were collected before and after primary series and booster dose of diphtheria, tetanus, and acellular pertussis (DTaP) and other vaccines. Geometric mean antibody concentrations or titers to pertussis, hepatitis B, tetanus, diphtheria, Haemophilus influenzae type b and polio antigens were measured. Mean maternal-to-cord blood antibody ratios were calculated.At delivery, maternal and cord antibody concentrations to pertussis antigens were higher in the Tdap group (n=16) than control group (n=54; maternal: 1.9- to 20.4-fold greater; cord: 2.7- to 35.5-fold greater). Increased antibody concentrations persisted for infants at first DTaP (3.2- to 22.8-fold greater). After primary series, antibody concentrations to pertussis antigens were lower in Tdap group (0.7- to 0.8-fold lower), except for fimbriae types 2 and 3 (FIM) (1.5-fold greater). Antibody concentrations to pertussis antigens before and after booster dose were comparable (prebooster: Tdap group 1.0- to 1.2-fold higher than controls; postbooster: 0.9- to 1.0-fold lower). Differences in FIM values at these time points are difficult to interpret, due to varying FIM content among DTaP vaccines administered to infants in both groups.Maternal Tdap immunization resulted in higher pertussis antibody concentrations during the period between birth and the first vaccine dose. Although slightly decreased immune responses following the primary series were seen compared with controls, differences did not persist following the booster.
View details for DOI 10.1097/INF.0b013e3182a09b6a
View details for PubMedID 23799518