Clinical Associate Professor, Anesthesiology, Perioperative and Pain Medicine
Fellowship: Lucile Packard Children's Hospital at Stanford University Medical Center (2014) CA
Board Certification: American Board of Anesthesiology, Pediatric Anesthesia (2013)
Board Certification: American Board of Anesthesiology, Anesthesia (2013)
Fellowship: Stanford University Pediatric Anesthesia Fellowship (2013) CA
Residency: UC Davis Medical Center (2012) CA
Internship: UCSF Dept of General Surgery (2009) CA
Medical Education: University of California at San Francisco School of Medicine (2008) CA
- Alternative to heart-lung transplantation for end-stage tetralogy of Fallot with major aortopulmonary collaterals: Simultaneous heart transplantation and pulmonary artery reconstruction. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2021
Transfusion Outcomes in Patients Undergoing Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals.
World journal for pediatric & congenital heart surgery
2020; 11 (2): 159–65
Surgical repair of tetralogy of Fallot and major aortopulmonary collaterals (TOF/MAPCAs) involves unifocalization of MAPCAs and reconstruction of the pulmonary arterial circulation. Surgical and cardiopulmonary bypass (CPB) times are long and suture lines are extensive. Maintaining patency of the newly anastomosed vessels while achieving hemostasis is important, and assessment of transfusion practices is critical to successful outcomes.Clinical, surgical, and transfusion data in patients with TOF/MAPCAs repaired at our institution (2013-2018) were reviewed. Types and volumes of blood products used in the perioperative period, in addition to the use of antifibrinolytics and/or procoagulants (factor VIII inhibitor bypassing activity [FEIBA]; anti-inhibitor coagulant complex), were assessed. Outcome measures included days on mechanical ventilation (DOMV), postoperative intensive care unit and hospital length of stay (LoS), and incidence of thrombosis.Perioperative transfusion data from 279 patients were analyzed. Surgical (879 ± 175 minutes vs 684 ± 257 minutes) and CPB times (376 ± 124 minutes vs 234 ± 122 minutes) were longer in patients who received FEIBA than those who did not. Although the indexed volume of packed red blood cells (128.4 ± 82.2 mL/kg) and fresh frozen plasma (64.2 ± 41.1 mL/kg) was similar in patients who did and did not receive FEIBA, the amounts of cryoprecipitate (5.5 ± 5.2 mL/kg vs 5.8 ± 4.8 mL/kg) and platelets (19.5 ± 20.7 mL/kg vs 20.8 ± 13 mL/kg) transfused were more in those who did receive FEIBA.Perioperative transfusion is an important component in the overall surgical and anesthetic management of patients with TOF/MAPCAs. The intraoperative use of FEIBA was not associated with a decrease in the amount of blood products transfused, DOMV, or LoS or with an increase in thrombotic complications.
View details for DOI 10.1177/2150135119892192
View details for PubMedID 32093560
- Developmental Physiology of the Central Nervous System Gregory’s Pediatric Anesthesia John Wiley & Sons Ltd. 2020; 6: 143–63
- Analgesia and Sedation in the Cardiac Intensive Care Unit Texas Children's Hospital Handbook of Congenital Heart Disease 2020: 412–426
- Acute Postoperative Pain Management Case Studies in Pediatric Anesthesia Cambridge University Press. 2019: 249–53
- Transitional Circulation Case Studies in Pediatric Anesthesia Cambridge University Press. 2019: 264–68
Anesthetic Management During Surgery for Tetralogy of Fallot With Pulmonary Atresia and Major Aortopulmonary Collateral Arteries
WORLD JOURNAL FOR PEDIATRIC AND CONGENITAL HEART SURGERY
2018; 9 (2): 236–41
Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collaterals (TOF/PA/MAPCAs) is a heterogeneous disease with varying degrees of severity, requiring complex anesthetic management. Our institution has adopted the approach of early complete repair with incorporation of all lung segments, extensive lobar and branch segmental pulmonary artery reconstruction, and ventricular septal defect closure. While the surgical management of TOF/PA/MAPCAs has been extensively described and varies depending on the institution, there is a paucity of literature on the anesthetic management for such procedures. Herein, we describe our anesthetic management based on our own institution's surgical approach at Lucile Packard Children's Hospital/Stanford University.
View details for PubMedID 29544416
Selected 2016 Highlights in Congenital Cardiac Anesthesia
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
2017; 31 (6): 1927–33
View details for PubMedID 29074129
- Double-Outlet Right Ventricle Congenital Heart Disease in Pediatric and Adult Patients Springer. 2016: 671–84
- Double-Outlet Left Ventricle Congenital Heart Disease in Pediatric and Adult Patients Springer. 2016: 685–96
- Perioperative Pain Management in Patients with Congenital Heart Disease Congenital Heart Disease in Pediatric and Adult Patients Springer. 2016: 871–88
Effect of General Anesthesia in Infancy on Long-Term Recognition Memory in Humans and Rats
2014; 39 (10): 2275-2287
Anesthesia in infancy impairs performance in recognition memory tasks in mammalian animals, but it is unknown if this occurs in humans. Successful recognition can be based on stimulus familiarity or recollection of event details. Several brain structures involved in recollection are affected by anesthesia-induced neurodegeneration in animals. Therefore, we hypothesized that anesthesia in infancy impairs recollection later in life in humans and rats. Twenty eight children ages 6-11 who had undergone a procedure requiring general anesthesia before age 1 were compared with 28 age- and gender-matched children who had not undergone anesthesia. Recollection and familiarity were assessed in an object recognition memory test using receiver operator characteristic analysis. In addition, IQ and Child Behavior Checklist scores were assessed. In parallel, thirty three 7-day-old rats were randomized to receive anesthesia or sham anesthesia. Over 10 months, recollection and familiarity were assessed using an odor recognition test. We found that anesthetized children had significantly lower recollection scores and were impaired at recollecting associative information compared with controls. Familiarity, IQ, and Child Behavior Checklist scores were not different between groups. In rats, anesthetized subjects had significantly lower recollection scores than controls while familiarity was unaffected. Rats that had undergone tissue injury during anesthesia had similar recollection indices as rats that had been anesthetized without tissue injury. These findings suggest that general anesthesia in infancy impairs recollection later in life in humans and rats. In rats, this effect is independent of underlying disease or tissue injury.
View details for DOI 10.1038/npp.2014.134
View details for Web of Science ID 000340308400002
View details for PubMedID 24910347
Anesthesia and the developing brain: relevance to the pediatric cardiac surgery.
2014; 4 (2): 295-310
Anesthetic neurotoxicity has been a hot topic in anesthesia for the past decade. It is of special interest to pediatric anesthesiologists. A subgroup of children potentially at greater risk for anesthetic neurotoxicity, based on a prolonged anesthetic exposure early in development, are those children receiving anesthesia for surgical repair of congenital heart disease. These children have a known risk of neurologic deficit after cardiopulmonary bypass for surgical repair of congenital heart disease. Yet, the type of anesthesia used has not been considered as a potential etiology for their neurologic deficits. These children not only receive prolonged anesthetic exposure during surgical repair, but also receive repeated anesthetic exposures during a critical period of brain development. Their propensity to abnormal brain development, as a result of congenital heart disease, may modify their risk of anesthetic neurotoxicity. This review article provides an overview of anesthetic neurotoxicity from the perspective of a pediatric cardiac anesthesiologist and provides insight into basic science and clinical investigations as it relates to this unique group of children who have been studied over several decades for their risk of neurologic injury.
View details for DOI 10.3390/brainsci4020295
View details for PubMedID 24961762
Anisocoria in a 10-month old girl in the immediate preoperative setting: can you proceed with surgery?
Journal of biomedical research
2011; 25 (3): 224-226
We report the case of a 10-month old girl with a significant past medical history who presented for elective surgery with a new-onset fixed, dilated pupil. We briefly review the diagnostic approach to such patients and provide guidelines for managing these patients in the immediate preoperative setting.
View details for DOI 10.1016/S1674-8301(11)60030-4
View details for PubMedID 23554694