Zoel A. Quiñónez

All Publications

• The Hemodynamic Effects of Protamine in Pediatric Patients Undergoing Pulmonary Artery Reconstruction and Unifocalization Surgery: A Pilot StudyHemodynamic Effects of Protamine in Children. Journal of cardiothoracic and vascular anesthesia Li, X., Fang, Z. A., Lennig, M. M., Klein, A., Char, D., Giustini, A. J., Boltz, M. G., Quiñónez, Z. A. 2024

  Abstract

  To determine protamine administration increases pulmonary artery pressures (PAPs) in patients undergoing unifocalization or pulmonary artery reconstruction surgeries.Retrospective database study.A large pediatric heart center within an academic quaternary care facility.All patients undergoing pulmonary artery reconstruction or a unifocalization procedure identifiable within the data warehouse.We collected data from Stanford University's data repository, formatted it, and analyzed it using RStudio (v 2023.06.1+524).Our primary outcome is the change in PAP after the administration of protamine. Secondary outcomes include changes in the mean arterial pressure, the ratio of systolic pulmonary artery to systemic artery pressure, right-sided filling pressure, and left atrial pressure. After a protamine bolus, we found a difference in PAP (Friedman χ2 = 49.46; p < 0.001). When compared with 2 minutes before its administration, the PAP was higher at 2 minutes (29.00 mmHg versus 25.00 mmHg; p < 0.001), 5 minutes (30.00 mmHg versus 25.00 mmHg; p < 0.001) and 10 minutes (31 mmHg versus 25 mmHg; p < 0.001). When coadministered with calcium, there was also a significant increase in PAP (Friedman χ2 = 28.11; p < 0.001), with a higher PAP 10 minutes after calcium administration when compared with 2 minutes before (32 mmHg versus 26 mmHg; p < 0.001).Protamine administration led to a small increase in PAP after separation from cardiopulmonary bypass in patients undergoing pulmonary artery reconstruction or unifocalization surgeries. Calcium coadministration did not lead to a greater increase in PAP.

  View details for DOI 10.1053/j.jvca.2024.11.001

  View details for PubMedID 39592272

• The Hemodynamic Effects of Bolus Dose Calcium in Patients Undergoing Pulmonary Artery Reconstruction and Unifocalization Surgery: A Pilot Study. Journal of cardiothoracic and vascular anesthesia Quiñónez, Z. A., Klein, A., Li, X., Lennig, M. A., Giustini, A. J., Boltz, M. G., Char, D. 2024

  Abstract

  To determine if bolus administration of calcium increases pulmonary artery pressures after unifocalization procedures or pulmonary artery reconstruction surgery.Retrospective cohort study using Stanford University's data warehouse.A large pediatric heart center within an academic quaternary care facility.All patients undergoing pulmonary artery reconstruction or unifocalization procedures identifiable in the data warehouse.Data were collected from Stanford University's data repository and formatted and analyzed using RStudio (v 2023.06.1+524).The primary outcome was the change in pulmonary artery systolic pressure (PASP) after a bolus administration of calcium. Secondary endpoints include changes in pulmonary arterial-to-systemic arterial pressure ratio, mean arterial pressure, right-sided filling pressure, and left atrial pressure. The Friedman test was used to assess differences and the Durbin-Conover rank-sum for pairwise comparisons. A difference in PASP after a bolus dose of calcium was found (Friedman X2 = 13.67, p = 0.003), with a higher PASP 5 minutes after calcium administration compared with 2 minutes before administration (35 mmHg v 33 mmHg, p = 0.01), and a higher PASP 10 minutes after calcium administration compared with2 minutes before administration (35 mmHg v 33 mmHg, p = 0.008).Calcium bolus administration led to an increase in pulmonary arterial pressure in patients after pulmonary artery reconstruction or unifocalization surgeries. It may be prudent to avoid bolus administration in this patient population immediately after repair or in patients with right ventricular dysfunction.

  View details for DOI 10.1053/j.jvca.2024.08.008

  View details for PubMedID 39227189

• Artificial Intelligence in Perioperative Care: Opportunities and Challenges. Anesthesiology Han, L., Char, D. S., Aghaeepour, N. 2024; 141 (2): 379-387

  View details for DOI 10.1097/ALN.0000000000005013

  View details for PubMedID 38980160

• Geospatial Analysis of the Proportion of Persons Defined as Underrepresented in Medicine for Each Medical School and Their Surrounding Core-Based Statistical Area. Health equity Quiñónez, Z. A., Benitez-Melo, A., Diaz, L. M., Lennig, M., Char, D., Smith, C. 2024; 8 (1): 132-137

  Abstract

  The current approach to increasing diversity in medical education fails to consider local community demographics when determining medical school matriculation.We propose that medical schools better reflect their surrounding community, both because racially/ethnically concordant physicians have been shown to provide better care and to repair the historical and current racist impacts of these institutions that have criminalized, displaced, and excluded local Black and Brown communities.In this study, we used geospatial analysis to determine that medical school enrollments generally fail to reflect their surrounding community, represented as their core-based statistical area, within which the individual medical schools reside.

  View details for DOI 10.1089/heq.2023.0221

  View details for PubMedID 38435025

  View details for PubMedCentralID PMC10908325

• Case Report: Parental Separation by Proxy Using Video Conference Between Patient and Parent for Induction of Anesthesia. A&A practice Quinonez, Z. A., Brandford, E., Char, D. 2023; 17 (7): e01696

  Abstract

  Anesthetic induction in children can have significant psychological and behavioral impacts. Strategies like premedication or parental presence for induction may reduce distress. In children who require ongoing procedural care into adulthood, like those who receive heart transplants, transitioning from these strategies toward independence may require intermediate steps. The use of parental presence by video may aid in this transition. It might also be a reasonable approach for those children who have adverse reactions to medications commonly used for anxiolysis before procedures.

  View details for DOI 10.1213/XAA.0000000000001696

  View details for PubMedID 37409741

• In Response. Anesthesia and analgesia Quiñónez, Z. A., Pyke-Grimm, K. A., Char, D. 2023; 136 (6): e29-e30

  View details for DOI 10.1213/ANE.0000000000006361

  View details for PubMedID 37205812

• Tetralogy of Fallot Congenital Heart Disease in Pediatric and Adult Patients: Anesthetic and Perioperative Management Vo, C. H., Bushman, G. A., Kleiman, Z. I., Quiñónez, Z. A. Springer. 2023; 2: 437–468

  View details for DOI https://doi-org.laneproxy.stanford.edu/10.1007/978-3-031-10442-8_22

• Double Outlet Left Ventricle Congenital Heart Disease in Pediatric and Adult Patients: Anesthetic and Perioperative Management Quiñónez, Z. A., Sinton, J. W. Springer. 2023; 2: 633-640

  View details for DOI https://doi-org.laneproxy.stanford.edu/10.1007/978-3-031-10442-8_32

• Double Outlet Right Ventricle Congenital Heart Disease in Pediatric and Adult Patients: Anesthetic and Perioperative Management Quiñónez, Z. A., Kleiman, Z. I. Springer. 2023; 2: 619–631

  View details for DOI https://doi-org.laneproxy.stanford.edu/10.1007/978-3-031-10442-8_31

• Could, Should Families Watch Their Loved One's Surgeries and, If So, When? Anesthesia and analgesia Quinonez, Z. A., Pyke-Grimm, K. A., Char, D. 2022; 135 (4): 704-707

  View details for DOI 10.1213/ANE.0000000000005801

  View details for PubMedID 36108184

• Enhanced Recovery after Pediatric Congenital Heart Repair with Erector Spinae Plane Blockade: An Ongoing Prospective, Randomized Controlled Trial Lee, C. K., Caruso, T., Lawrence, K., Fonseca, A., Boltz, G., Quinonez, Z., Maeda, K., Tsui, B. LIPPINCOTT WILLIAMS & WILKINS. 2021: 722-724

  View details for Web of Science ID 000752526600315

• 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 Adamson, G. T., Profita, E. L., Quinonez, Z. A., McElhinney, D. B., Rosenthal, D. N., Ma, M. n. 2021

  View details for DOI 10.1016/j.healun.2021.02.003

  View details for PubMedID 33674153

• Transfusion Outcomes in Patients Undergoing Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals. World journal for pediatric & congenital heart surgery Wise-Faberowski, L. n., Irvin, M. n., Quinonez, Z. A., Long, J. n., Asija, R. n., Margetson, T. D., Hanley, F. L., McElhinney, D. B. 2020; 11 (2): 159–65

  Abstract

  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 Quinonez, Z. A., Easley, R. B., Bissonnette, B., Brady, K. M. 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 Achuff, B., Resheidat, A., Quinonez, Z. A., Shekerdemian, L. S. 2020: 412–426
• Acute Postoperative Pain Management Case Studies in Pediatric Anesthesia Quiñónez, Z. A., Sinton, J. W. Cambridge University Press. 2019: 249–53
• Transitional Circulation Case Studies in Pediatric Anesthesia Vu, E. L., Quiñónez, Z. A. 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 Quinonez, Z. A., Downey, L., Abbasi, R. K., Kuan, C., Asija, R., McElhinney, D. B., Hanley, F. L., Mainwaring, R. D., Wise-Faberowski, L. 2018; 9 (2): 236–41

  Abstract

  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 Resheidat, A., Quinonez, Z. A., Mossad, E. B., Wise-Faberowski, L., Mittnacht, A. C. 2017; 31 (6): 1927–33

  View details for PubMedID 29074129

• Double-Outlet Right Ventricle Congenital Heart Disease in Pediatric and Adult Patients Quiñónez, Z. A. Springer. 2016: 671–84
• Perioperative Pain Management in Patients with Congenital Heart Disease Congenital Heart Disease in Pediatric and Adult Patients Mónico, E. C., Quiñónez, Z. A. Springer. 2016: 871–88
• Double-Outlet Left Ventricle Congenital Heart Disease in Pediatric and Adult Patients Quiñónez, Z. A., Sinton, J. W. Springer. 2016: 685–96
• Effect of General Anesthesia in Infancy on Long-Term Recognition Memory in Humans and Rats NEUROPSYCHOPHARMACOLOGY Stratmann, G., Lee, J., Sall, J. W., Lee, B. H., Alvi, R. S., Shih, J., Rowe, A. M., Ramage, T. M., Chang, F. L., Alexander, T. G., Lempert, D. K., Lin, N., Siu, K. H., Elphick, S. A., Wong, A., Schnair, C. I., Vu, A. F., Chan, J. T., Zai, H., Wong, M. K., Anthony, A. M., Barbour, K. C., Ben-Tzur, D., Kazarian, N. E., Lee, J. Y., Shen, J. R., Liu, E., Behniwal, G. S., Lammers, C. R., Quinones, Z., Aggarwal, A., Cedars, E., Yonelinas, A. P., Ghetti, S. 2014; 39 (10): 2275-2287

  Abstract

  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. Brain sciences Wise-Faberowski, L., Quinonez, Z. A., Hammer, G. B. 2014; 4 (2): 295-310

  Abstract

  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 Quinonez, Z. A., Ravula, N. R. 2011; 25 (3): 224-226

  Abstract

  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