Gas Pipeline Spring 2016

A Message from the Chairman

Planning Our Future

By Ron Pearl, MD, PhD

This month we had our departmental retreat—only our second one in the past decade. The theme of the retreat was “Planning for our Future,” an important topic to consider as the pace of change at Stanford continues to accelerate in response to changes throughout medicine. Academic medical centers are rapidly transforming into health care systems, a change with profound implications for clinical care, teaching, research, finances, and leadership. Our department has had multiple years of success in all our missions, but during the next several years we will face unprecedented challenges.

One consequence of the transformation of academic medical centers is dramatic clinical expansion, both at their core hospitals and also into the community. Over the next several years, we will open major new adult and pediatric towers, expand our activity at the existing satellite locations (Outpatient Surgery Center in Redwood City, Byers Outpatient Eye Surgery Center, and South Bay Cancer Center), open additional locations such as the ambulatory surgery center in Emeryville, and become increasingly involved in more distant locations such as ValleyCare in Pleasanton. As a result, in another four years we may provide anesthesia for an incremental 40-50 locations per day, many distant from the main campus.  

The resulting dramatic expansion of clinical faculty will occur with at most a minor increase in the number of residents and fellows, so the retreat provided us the opportunity to discuss options such as increased use of nurse anesthetists, creation of a pure clinical faculty track, and various hybrid approaches. Each of these options has significant implications for departmental culture, education, clinical care, and finances, and we need to find a solution where all faculty are valued members of a department which itself has multiple missions. In preparation for the retreat, Harry Lemmens led a working group on this topic with broad faculty representation.

Clinical expansion provides opportunities to expand clinical research, especially with the resources of our electronic anesthesia and medical records. Since laboratory space will continue to be limited at a time of clinical expansion, department research will increasingly shift towards clinical research. Stanford as an institution has impressive resources for clinical research, and there are multiple opportunities to collaborate with departments such as Health Research and Policy, Medicine, Surgery, Psychology, Statistics, and the newly created Department of Biomedical Data Science.

Many of our faculty already have formal training in clinical research, ranging from one week intensive courses in clinical research to master’s degrees offered at Stanford, and many are successful as individual investigators. However, as a department we can be more successful with an organized departmental approach. Therefore, a workgroup chaired by Sean Mackey has been examining issues related to clinical research, including topics such as creating a robust clinical research infrastructure, allocation of non-clinical time for research, enhancing collaborations throughout the institution, recruitment of faculty, and impact on existing faculty lines. The recommendations from the retreat have been referred to our Research Executive Committee for implementation, with leadership from Dave Clark, our vice-chair for research, and Hui Wang, our new Director of Strategic Research Development.

Nationally, the specialty of anesthesiology is transforming into perioperative medicine, and Stanford, with its history in preoperative assessment and optimization, intraoperative care, critical care, and regional anesthesia and acute pain medicine, has been a leader. We have leveraged our close collaborations with surgeons and hospitalists to create complex care pathways consistent with the concept of the perioperative surgical home. However, there remain significant opportunities and challenges in patient care, trainee education and clinical research related to perioperative medicine.

For example, I have been co-chairing a joint ABA-ASA committee charged with developing recommendations on changes in residency training required to prepare anesthesiology graduates for a career that includes perioperative medicine. Our recommendations will include significant expansion of knowledge (e.g., management and leadership training), skills (e.g., transthoracic echocardiography), and experience such as a defined perioperative rotation that includes collaborative management of surgical patients until or even after the time of discharge. The third workgroup for the retreat was chaired by Cliff Schmiesing and discussed issues related to expansion of perioperative medicine, including impact on resident and fellow education, expansion of current preoperative programs into new areas, expansion of our role in postoperative care, and the associated financial implications for the department.

Finally, one underlying concern which is a factor in all our discussions is the financial challenges for anesthesiology and for academic medicine. A recent article in the Washington Post titled “The nation’s teaching hospitals are under threat” noted that academic hospitals currently are facing a fiscal crisis where they need to be cost-competitive with private hospitals while also fulfilling multiple missions. The article asks, “How, then, can we save our academic medical centers, cutting costs and improving efficiency, without compromising the high caliber of care, patient safety, workforce development and discovery?” Our department has had a net overall profit in 6 of the past 7 years, which has allowed us to build departmental reserves to a healthy level while remaining a leader in all our departmental missions. However, our goal to support increased educational and research activities at the same time we increase faculty compensation must be balanced against the potential for decreased revenue if anesthesia unit compensation decreases across the country.

The retreat was an opportunity for us as a department to plan our future together and thereby create a future where the department as a whole and each faculty member will be successful in accomplishing their goals. I hope you were as energized by the discussions as I was, and I look forward to working together to implement the changes we talked about.

ASA Reception

Handling Large-Volume Liposuction as an Anesthesiologist in Private Practice

By Dr. Rick Novak

Case Presentation: It’s your first week in private practice, and you’re scheduled to do a large-volume liposuction on a 60-year-old woman. She has stable asthma and hypertension, weighs 90 kg, and has a BMI of 30. The surgeon is also new to private practice. In the last hour of a 4-hour procedure, the patient’s blood pressure drops to 70/40, her heart rate rises to 120 beats per minute, and her abdominal girth increases markedly. What do you do?

Discussion:  Most academic anesthesia training programs have a paucity of cosmetic plastic surgery cases. As a resident or a fellow, your initial experience with large-volume liposuction will likely occur in community practice after your formal training concludes.

I work in a private practice setting in Palo Alto, California, and liposuction is one of the most common plastic surgery procedures performed. The accepted definition of a “large-volume” liposuction is a total aspirate of greater than 4 liters. Seventy percent of the total aspirate is fat, so if a total volume of 4 liters is harvested, the total volume of fat is 0.7 x 4, or 2.8 liters. Each liter of liposuction fat weighs approximately 2 pounds, so the weight removed in a 4-liter total-aspirate liposuction is 2.8 liters x 2 pounds/liter, or 5.6 pounds.

The current accepted upper limit for fat removed in an outpatient liposuction is 5 liters, so the maximum weight of fat removed would be 5 liters x 2 pounds/liter, which equals 10 pounds.

Early in my career, in the late 1980s, liposuction was a bloody procedure. Prior to surgery, healthy outpatients donated autologous blood, which they received intraoperatively to treat the expected hemorrhage which accompanied liposuction. In the late 1980s, American dermatologist Jeffery Klein introduced the tumescent technique for liposuction, in which dilute solutions of epinephrine and lidocaine were injected into the subcutaneous tissues prior to liposuction. This technique induced vasoconstriction and resulted in decreased blood loss, and made transfusion and post-operative anemia rare.

The volume of tumescent solution injected by the surgeon is roughly equivalent to the total volume expected to be aspirated from the patient. For a large-volume liposuction, 4 – 7 liters of tumescent solution may be injected into the body areas to be suctioned. The tumescent solution includes 1 mg of epinephrine and 20 ml of 1% lidocaine (200 mg lidocaine) per 1 liter of Lactated Ringers. The complication of local anesthetic toxicity from lidocaine is rare. The maximum dose of lidocaine should be kept to < 35 mg/kg, or < 2450 mg for a 70 kg (154 pound) patient. If the surgeon injects 6 liters, this will total only 1,200 mg of lidocaine. Symptoms of epinephrine toxicity are also rare.

Preanesthetic assessment and patient selection are key for safe large-volume liposuction procedures. All patients are ASA I or II and have stable medical histories. Our facility, the Plastic Surgery Center in Palo Alto, requires each patient to weigh less than 250 pounds or to have a BMI < 36. Preoperative labs and ECGs are done only as needed, per standard Ambulatory Surgery Center policies. The procedures are done under general endotracheal anesthesia, and can last from 3 to 8 hours. Our facility has two operating rooms. At times the second room is not occupied, and so a solo anesthesiologist is the only anesthesia professional present on site and must be prepared to handle any and all emergencies.

A protocol for large-volume liposuction at our facility is as follows:

  1. General anesthesia is induced. An endotracheal tube rather than a supraglottic airway is used. Many procedures involve both supine and prone positioning because anterior and posterior parts of the body are liposuctioned. A Foley catheter is inserted.
  2. After prepping and draping, the surgeon injects the tumescent solution into the areas to be liposuctioned. The total volume of the injectate must not exceed 10 liters. In most cases, the total volume of the injectate does not exceed 6 liters.
  3. The liposuction proceeds. The typical aspirate is a mixture of fat and tumescent fluid, with minimal bloody or reddish tinge. The total volume of fat aspirated is not to exceed 5 liters. The ratio of fat/total aspirate in each container is 0.7. If a total of 7 liters of liposuction aspirate is harvested, the total volume of fat is 7 x 0.7, or 4.9 liters.
  4. Fluid intake and output must be balanced. The total intake includes 6 liters of tumescent Lactated Ringers, plus intravenous fluids. Usually the volume of intravenous fluid is kept to less than 1 liter. The output equals the total aspirate volume of 7 liters in this case, plus the urine output. If the urine output is less than 0.5 ml/kg/hour, the diuretic furosemide 10 mg can be administered by IV.
  5. Maintaining normothermia is challenging. Large-volume liposuction usually requires exposure of the patient’s body surface from the lower thorax to the knees to room air temperature. Twin Bair Huggers are used to warm both the lower and upper non-operative fields of the patient’s body.
  6. At the conclusion of surgery, constricting garments are applied to reduce edema and bleeding. General anesthesia is continued until these garments are applied.
  7. Patients are discharged home after a typical PACU time of 75–120 minutes.

Let’s return to the Case Presentation above: It’s clear from the history and vital signs that the patient is bleeding acutely into her abdomen. Reports of liver hemorrhage or retroperitoneal bleeding in large-volume liposuction cases have been published, and the mechanism of injury is traumatic damage done by the blunt tip of the liposuction catheter. In a freestanding plastic surgery center, there are inadequate resources to manage acute hemorrhagic shock. You inform the surgeon of the change in vital signs, and the nurses immediately call 911 for an Emergency Medical Transport ambulance to take you and the patient to the nearest hospital. You start a second large bore IV line, discontinue anesthetic agents, paralyze the patient, and administer IV scopolamine for amnesia. The ambulance arrives, and you ventilate the patient with an Ambu bag as you ride to the hospital with the EMTs. You communicate by phone with the Emergency Room and inform the attending that urgent transfusion and a trip to the operating room with a general surgeon are indicated immediately.

The good news is that this scenario should be very rare in your anesthesia career. How safe is large-volume liposuction? Palo Alto plastic surgeon George Commons and anesthesiologist Bruce Halperin published a retrospective review on 631 consecutive patients from 1986–1998 who underwent liposuction procedures of at least 3 liters total aspirate (1). Total aspirate volumes ranged from 3 to 17 liters. Complications consisted of minor skin injuries and burns, allergic reactions to garments, and postoperative seromas. Only 4 patients of 631 (0.6%) developed serious complications, including 4 patients with mild pulmonary edema and 1 patient who developed pneumonia postoperatively. These patients were treated appropriately and had uneventful recoveries.

On the other hand, a retrospective study from Germany reported on 2,275 large-volume liposuction patients from 1998–2002 in which there were 72 cases of severe complications (3.1%), including 23 deaths(2). The most frequent complications were bacterial infections (necrotizing fasciitis, gas gangrene, and sepsis), hemorrhage, perforation of abdominal viscera, and pulmonary embolism. Fifty-seven of the 72 complications were clinically evident within the first 24 postoperative hours. Risk factors for the development of severe complications were insufficient standards of hygiene, infiltration of multiple liters of tumescent solution, permissive postoperative discharge, selection of unfit patients, and lack of surgical experience, especially regarding the identification of complications. The striking 1% mortality rate of this series documents that liposuction was dangerous in Germany between 1998 and 2002.

A review of 127,961 cosmetic surgery cases of all types in the U.S. in 2016 showed a 0.9% complication rate in liposuction patients (3). Being overweight (BMI = 25-29.9) and obese (BMI ≥ 30) were both independent risk factors for post-operative infection and venous thromboembolism. In contrast to the German study, there were no deaths in this series.

In a series from Illinois, 69 of 4,534 (1.5%) of liposuction patients experienced a postoperative complication (4). Both the liposuction volume and the patient’s BMI were significant independent risk factors. Liposuction volumes in excess of 100 ml per unit of body mass index were an independent predictor of complications (p < 0.001).

In experienced hands, the major morbidity of large-volume liposuction should be low—no more than the complication rates of 0.6 – 1.5% reported from the United States above. The striking 1% mortality rate of the German series between 1998 and 2002 demonstrates that liposuction can be dangerous. In present day Palo Alto, with excellent plastic surgeons and vigilant perioperative medical care, the rate of major complications in large-volume liposuction should approach zero. Strong demand for liposuction exists. Large-volume liposuction requires an anesthesia professional who’s comfortable managing the perioperative medicine for the procedure. In the future, that anesthesia professional could be you.

References:

(1) Commons GW, Halperin B, Large-volume liposuction: a review of 631 consecutive cases over 12 years. Plast Reconstr Surg. 2001 Nov;108(6):1753-63.

(2) Lehnhardt M et al, Major and lethal complications of liposuction: a review of 72 cases in Germany between 1998 and 2002. Plast Reconstr Surg. 2008 Jun;121(6):396e-403e.

(3) Gupta V et al, Safety of Aesthetic Surgery in the Overweight Patient: Analysis of 127,961 Patients. Aesthet Surg J. 2016 Feb 9. pii: sjv268.

(4) Chow I et al, Is There a Safe Lipoaspirate Volume? A Risk Assessment Model of Liposuction Volume as a Function of Body Mass Index. Plast Reconstr Surg. 2015 Sep;136(3):474-83.

Success in Clinical Research: Case Discussions

As a researcher, you may find yourself asking: Should I stop a clinical trial early if the results indicate quickly and definitively that one of the treatments being tested is better than the other? What should I do if I worked with 8 other researchers on a study, but the journal where I want to publish caps the number of authors at 5? Or what about if editors of a journal say they like my submission, but want me to cut it down so it can be published as a letter-to-the-editor, not a research article?

         These questions and many more, about the pitfalls and triumphs of clinical research, fill the latest book by Dr. John G. Brock-Utne: Clinical Research: Case Studies of Success and Failures (Springer 2015, ISBN 978-1-4939-2516-2). Of course the most important parts of the book are the answers that accompany the questions, often straight from Dr. Brock-Utne’s clinical and laboratory experience. “I’ve been doing research since 1968,” says Dr. Brock-Utne. “I got bit by the bug and got involved, very luckily, with some very enthusiastic people. We did a lot of research together over the years. Now, when I sit back and look at all of what has been produced, I know I’ve made a lot of mistakes,” he says, modestly. “The idea was to collect some of the cases, both successes and failures, so the next generation of researchers will avoid the sometimes elementary mistakes I made.”

This intention comes through in the tone of the answers; they read as letters of advice from a trusted mentor. For example, in Case 22, Dr. Brock-Utne writes about a “hypothetical” case where “You have submitted a paper to a large North American Medical Journal. It is the opinion of you and your coworkers that it is a great paper…But the paper is not accepted. The criticisms are vague; the tone of the review is disrespectful and the language damning. In short, you are told that the results would be of very little interest to practicing clinicians. You do not agree but feel the editor and the reviewers must be correct. Based on the above you do not attempt to resubmit it to another journal. Less than 2 years later, a paper dealing with the same question is published in the same journal.… What did you do wrong?” The answer? “You should have resubmitted to another journal. Never give up, especially if you think it’s a worthwhile paper.” Dr. Brock-Utne goes on to explain that this happened to him and his colleague in the ’80s, and states exactly how they (mis)handled it, and what he would suggest other researchers do differently.

Dr. Brock-Utne is not new to writing case studies—he has published a large number of case reports in journals, and also has four books entitled: Case Studies of Near Misses in Clinical Anesthesia, Clinical Anesthesia: Near Misses and Lessons Learned, and Near Misses in Pediatric Anesthesia 1st and 2nd edition. Many of these books have been translated into Polish, Chinese and French. This latest book concerning research was his idea, which he proposed to the publisher with whom he had worked on his other Near Misses books. There had never been anything like this, analyzing cases of both successes and failures of clinical research.  Luckily for Dr. Brock-Utne, the publisher reacted with excitement. 

The ultimate lesson that Dr. Brock-Utne has taken from his clinical career also probably helps with large projects of other natures, like writing a book: “Planning is absolutely everything. Without it, you can get yourself into big doodoo, and waste a lot of time…. For a researcher, getting published makes your career, and a lack of planning could be the end of you,” he said.  

In addition to planning, Dr. Brock-Utne emphasizes the importance of forming a community of research-enthusiastic people around you:  “All those people I worked with over the years, I learned from them, and hopefully they learned from me. It’s been a lot of fun,” he says.  

As for the questions posed at the beginning of this article—what do you do in those situations? You’ll have to read the book to find out.

by Christine Junge

Writer and editor with experience focused in science and medicine.

Grants and Awards this Quarter

Congratulations to the following members of the department:

  • Dr. Ed Bertaccini received a grant from the Stanford Innovation Program as part of the Office of Technology and Licensing to continue the development of a new class of anesthetic agents.
  • Dr. Alex Butwick received a CHRI grant for a study investigating the association between maternal obesity and postpartum hemorrhage.
  • Dr. Louise Wen received a Stanford Society of Physician Scholars (SSPS) collaborative research grant for "Online-Based Resilience Curriculum for Anesthesia Residents, a Randomized Controlled Trial.”
  • Dr. Ed Mariano received the John D. Chase Award for Executive Excellence from the VA’s Under Secretary for Health for sustained Executive Leadership by a Veterans Hospital individual from any healthcare discipline. 
  • The first World Airway Management Meeting was held in Dublin in November and involved a large number of Stanford faculty. There were over 1,200 anesthesiologists attending. The case report by Lena Scotto with Vladimir Nekhendzy was selected as one of the top 5 clinical cases for presentation at the plenary session.
  • Dr. Eric Gross was elected to membership in the Association of University Anesthesiologists (AUA). Drs. Vivianne Tawfik, Stary Creed, and Boris Heifets were elected to Associate Membership in the AUA.

Publications

In the last quarter, Anesthesia faculty published the following:

Articles

  • Zhang H, Zheng M, Wu M, Xu D, Nishimura T, Nishimura Y, Giffard R, Xiong X, Xu LJ, Clark JD, Sahbaie P, Dill DL, Peltz G. A Pharmacogenetic Discovery: Cystamine Protects against Haloperidol-Induced Toxicity and Ischemic Brain Injury. Genetics. 2016 Mar 18. pii: genetics.115.184648. [Epub ahead of print] PubMed PMID: 26993135.
  • Smith JD, Suresh S, Schlecht U, Wu M, Wagih O, Peltz G, Davis RW, Steinmetz LM, Parts L, St Onge RP. Quantitative CRISPR interference screens in yeast identify chemical-genetic interactions and new rules for guide RNA design. Genome Biol. 2016 Mar 8;17(1):45. doi: 10.1186/s13059-016-0900-9. PubMed PMID: 26956608.
  • Stary CM, Hogan MC. Cytosolic Calcium Transients are a Determinant of Contraction-Induced HSP72 Transcription in Single Skeletal Muscle Fibers. J Appl Physiol (1985). 2016 Feb 11:jap.01060.2015. doi: 10.1152/japplphysiol.01060.2015. [Epub ahead of print] PubMed PMID: 26869714.
  • Wagner NM, Gross ER, Patel HH. A Slick Way Volatile Anesthetics Reduce Myocardial Injury. Anesthesiology. 2016 Feb 4. [Epub ahead of print] PubMed PMID: 26845142.
  • Wagner NM, Lu Y, Gross ER. Remote Ischemic Preconditioning and Cardiac Surgery. N Engl J Med. 2016 Feb 4;374(5):490. doi: 10.1056/NEJMc1514509#SA3. PubMed PMID: 26840143.
  • Andrews NA, Latrémolière A, Basbaum AI, Mogil JS, Porreca F, Rice AS, Woolf CJ, Currie GL, Dworkin RH, Eisenach JC, Evans S, Gewandter JS, Gover TD, Handwerker H, Huang W, Iyengar S, Jensen MP, Kennedy JD, Lee N, Levine J, Lidster K, Machin I, McDermott MP, McMahon SB, Price TJ, Ross SE, Scherrer G, Seal RP, Sena ES, Silva E, Stone L, Svensson CI, Turk DC, Whiteside G. Ensuring transparency and minimization of methodologic bias in preclinical pain research: PPRECISE considerations. Pain. 2016 Apr;157(4):901-9. doi: 10.1097/j.pain.0000000000000458. PubMed PMID: 26683237.
  • MacIver MB. Mind and Brain: Consciousness in Unresponsive Subjects. Curr Biol. 2015 Dec 7;25(23):R1140-2. doi: 10.1016/j.cub.2015.10.036. PubMed PMID: 26654376.
  • Zambelli VO, Chen CH, Gross ER. Reactive aldehydes: an initial path to develop precision medicine for pain control. Ann Transl Med. 2015 Oct;3(17):258. doi: 10.3978/j.issn.2305-5839.2015.10.02. PubMed PMID: 26605304; PubMed Central PMCID: PMC4620088.
  • Tzabazis A, Mechanic J, Miller J, Klukinov M, Pascual C, Manering N, Carson DS, Jacobs A, Qiao Y, Cuellar J, Frey WH 2nd, Jacobs D, Angst M, Yeomans DC. Oxytocin receptor: Expression in the trigeminal nociceptive system and potential role in the treatment of headache disorders. Cephalalgia. 2015 Nov 20. pii: 0333102415618615. [Epub ahead of print] PubMed PMID: 26590611.
  • Mudumbai SC, Barr J, Scott J, Mariano ER, Bertaccini E, Nguyen H, Memtsoudis SG, Cason B, Phibbs CS, Wagner T. Invasive Mechanical Ventilation in California Over 2000-2009: Implications for Emergency Medicine. West J Emerg Med. 2015 Sep;16(5):696-706. doi: 10.5811/westjem.2015.6.25736. Epub 2015 Oct 20. PubMed PMID: 26587094; PubMed Central PMCID: PMC4644038.
  • Borghese CM, Ruiz CI, Lee US, Cullins MA, Bertaccini EJ, Trudell JR, Harris RA. Identification of an Inhibitory Alcohol Binding Site in GABAA ρ1 Receptors. ACS Chem Neurosci. 2016 Jan 20;7(1):100-8. doi: 10.1021/acschemneuro.5b00246. Epub 2015 Nov 25. PubMed PMID: 26571107.
  • Xu D, Peltz G. Can Humanized Mice Predict Drug "Behavior" in Humans? Annu Rev Pharmacol Toxicol. 2016 Jan 6;56:323-38. doi: 10.1146/annurev-pharmtox-010715-103644. Epub 2015 Oct 22. PubMed PMID: 26514208.
  • Peltz G, Anand KJ. Long-Acting Opioids for Treating Neonatal Abstinence Syndrome: A High Price for a Short Stay? JAMA. 2015 Nov 17;314(19):2023-4. doi: 10.1001/jama.2015.13537. PubMed PMID: 26469386.
  • Small BA, Lu Y, Hsu AK, Gross GJ, Gross ER. Morphine Reduces Myocardial Infarct Size via Heat Shock Protein 90 in Rodents. Biomed Res Int. 2015;2015:129612. doi: 10.1155/2015/129612. Epub 2015 Aug 27. PubMed PMID: 26413502; PubMed Central PMCID: PMC4564588.
  • Walters TL, Howard SK, Kou A, Bertaccini EJ, Harrison TK, Kim TE, Shafer A, Brun C, Funck N, Siegel LC, Stary E, Mariano ER. Design and Implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital. Semin Cardiothorac Vasc Anesth. 2015 Sep 21. pii: 1089253215607066. [Epub ahead of print] Review. PubMed PMID: 26392388.
  • Qiu L, Lin J, Bertaccini EJ. Insights into the Nature of Anesthetic-Protein Interactions: An ONIOM Study. J Phys Chem B. 2015 Oct 8;119(40):12771-82. doi: 10.1021/acs.jpcb.5b05897. Epub 2015 Sep 30. PubMed PMID: 26388288.
  • Bland BH, Bland CE, MacIver MB. Median raphe stimulation-induced motor inhibition concurrent with suppression of type 1 and type 2 hippocampal theta. Hippocampus. 2016 Mar;26(3):289-300. doi: 10.1002/hipo.22521. Epub 2015 Oct 1. PubMed PMID: 26314691.
  • Ozawa A, Brunori G, Mercatelli D, Wu J, Cippitelli A, Zou B, Xie XS, Williams M, Zaveri NT, Low S, Scherrer G, Kieffer BL, Toll L. Knock-In Mice with NOP-eGFP Receptors Identify Receptor Cellular and Regional Localization. J Neurosci. 2015 Aug 19;35(33):11682-93. doi: 10.1523/JNEUROSCI.5122-14.2015. PubMed PMID: 26290245; PubMed Central PMCID: PMC4540802.
  • Stary CM, Sun X, Giffard RG. Astrocytes Protect against Isoflurane Neurotoxicity by Buffering pro-brain-derived Neurotrophic Factor. Anesthesiology. 2015 Oct;123(4):810-9. doi: 10.1097/ALN.0000000000000824. PubMed PMID: 26270940; PubMed Central PMCID: PMC4573311.
  • Stary CM, Patel HH, Roth DM. Epigenetics: The Epicenter for Future Anesthesia Research? Anesthesiology. 2015 Oct;123(4):743-4. doi: 10.1097/ALN.0000000000000808. PubMed PMID: 26259141.
  • Darnall BD. "Compassion Cultivation in Chronic Pain May Reduce Anger, Pain, and Increase Acceptance: Study Review and Brief Commentary". Health Care Curr Rev. 2015 Dec;3(2). pii: 142. Epub 2015 Oct 20. PubMed PMID: 26985456; PubMed Central PMCID: PMC4791068.
  • Sun EC, Miller TR, Halzack NM. In the United States, "Opt-Out" States Show No Increase in Access to Anesthesia Services for Medicare Beneficiaries Compared with Non-"Opt-Out" States. A A Case Rep. 2016 Feb 18. [Epub ahead of print] PubMed PMID: 26895523.
  • Schatman ME, Darnall BD. Ethics Forum: Conflict of Interest, Part II: Pain Society Leadership and Industry. Pain Med. 2016 Jan 8. pii: pnv041. [Epub ahead of print] PubMed PMID: 26814304.
  • Darnall BD, Scheman J, Davin S, Burns JW, Murphy JL, Wilson AC, Kerns RD, Mackey SC. Pain Psychology: A Global Needs Assessment and National Call to Action. Pain Med. 2016 Jan 23. pii: pnv095. [Epub ahead of print] PubMed PMID: 26803844.
  • Darnall BD. Pain Psychology and Pain Catastrophizing in the Perioperative Setting: A Review of Impacts, Interventions, and Unmet Needs. Hand Clin. 2016 Feb;32(1):33-9. doi: 10.1016/j.hcl.2015.08.005. Review. PubMed PMID: 26611387; PubMed Central PMCID: PMC4662774.
  • Sturgeon JA, Dixon EA, Darnall BD, Mackey SC. Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study. Pain. 2015 Dec;156(12):2627-33. doi: 10.1097/j.pain.0000000000000313. PubMed PMID: 26230739.
  • Udani AD, Harrison TK, Mariano ER, Derby R, Kan J, Ganaway T, Shum C, Gaba DM, Tanaka P, Kou A, Howard SK; ADAPT (Anesthesiology-Directed Advanced Procedural Training) Research Group. Comparative-Effectiveness of Simulation-Based Deliberate Practice Versus Self-Guided Practice on Resident Anesthesiologists' Acquisition of Ultrasound-Guided Regional Anesthesia Skills. Reg Anesth Pain Med. 2016 Mar-Apr;41(2):151-7. doi: 10.1097/AAP.0000000000000361. PubMed PMID: 26866296.
  • Mariano ER, Harrison TK, Kim TE, Kan J, Shum C, Gaba DM, Ganaway T, Kou A, Udani AD, Howard SK; ADAPT (Anesthesiology-Directed Advanced Procedural Training) Research Group. Evaluation of a Standardized Program for Training Practicing Anesthesiologists in Ultrasound-Guided Regional Anesthesia Skills. J Ultrasound Med. 2015 Oct;34(10):1883-93. doi: 10.7863/ultra.14.12035. Epub 2015 Sep 18. PubMed PMID: 26384608.
  • McKenzie CP, Carvalho B, Riley ET. The Wiley Spinal Catheter-Over-Needle System for Continuous Spinal Anesthesia: A Case Series of 5 Cesarean Deliveries Complicated by Paresthesias and Headaches. Reg Anesth Pain Med. 2016 Feb 24. [Epub ahead of print] PubMed PMID: 26909488.
  • Cobb B, Cho Y, Hilton G, Ting V, Carvalho B. Active Warming Utilizing Combined IV Fluid and Forced-Air Warming Decreases Hypothermia and Improves Maternal Comfort During Cesarean Delivery: A Randomized Control Trial. Anesth Analg. 2016 Feb 18. [Epub ahead of print] PubMed PMID: 26895002.
  • Ansari J, Carvalho B, Shafer SL, Flood P. Pharmacokinetics and Pharmacodynamics of Drugs Commonly Used in Pregnancy and Parturition. Anesth Analg. 2016 Mar;122(3):786-804. doi: 10.1213/ANE.0000000000001143. PubMed PMID: 26891392.
  • Carvalho B, Granot M, Sultan P, Wilson H, Landau R. A Longitudinal Study to Evaluate Pregnancy-Induced Endogenous Analgesia and Pain Modulation. Reg Anesth Pain Med. 2016 Mar-Apr;41(2):175-80. doi: 10.1097/AAP.0000000000000359. PubMed PMID: 26866295.
  • Hilton G, Daniels K, Carvalho B. Simulation Study Assessing Healthcare Provider's Knowledge of Pre-Eclampsia and Eclampsia in a Tertiary Referral Center. Simul Healthc. 2016 Feb;11(1):25-31. doi: 10.1097/SIH.0000000000000125. PubMed PMID: 26836465.
  • Lin JC, Chu LF, Stringer EA, Baker KS, Sayyid ZN, Sun J, Campbell KA, Younger JW. One Month of Oral Morphine Decreases Gray Matter Volume in the Right Amygdala of Individuals with Low Back Pain: Confirmation of Previously Reported Magnetic Resonance Imaging Results. Pain Med. 2015 Dec 26. pii: pnv047. [Epub ahead of print] PubMed PMID: 26814280.
  • Brookfield KF, Su F, Elkomy MH, Drover DR, Lyell DJ, Carvalho B. Pharmacokinetics and placental transfer of magnesium sulfate in pregnant women. Am J Obstet Gynecol. 2016 Jan 6. pii: S0002-9378(15)02664-2. doi: 10.1016/j.ajog.2015.12.060. [Epub ahead of print] PubMed PMID: 26767791.
  • Lam KK, Kunder S, Wong J, Doufas AG, Chung F. Obstructive sleep apnea, pain, and opioids: is the riddle solved? Curr Opin Anaesthesiol. 2016 Feb;29(1):134-40. doi: 10.1097/ACO.0000000000000265. PubMed PMID: 26545144.
  • Anast N, Olejniczak M, Ingrande J, Brock-Utne J. The impact of blood pressure cuff location on the accuracy of noninvasive blood pressure measurements in obese patients: an observational study. Can J Anaesth. 2016 Mar;63(3):298-306. Epub 2015 Oct 16. PubMed PMID: 26475165.
  • Jeejeebhoy FM, Zelop CM, Lipman S, Carvalho B, Joglar J, Mhyre JM, Katz VL, Lapinsky SE, Einav S, Warnes CA, Page RL, Griffin RE, Jain A, Dainty KN, Arafeh J, Windrim R, Koren G, Callaway CW; American Heart Association Emergency Cardiovascular Care Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Diseases in the Young, and Council on Clinical Cardiology. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association. Circulation. 2015 Nov 3;132(18):1747-73. doi: 10.1161/CIR.0000000000000300. Epub 2015 Oct 6. Review. PubMed PMID: 26443610.
  • Downey L, Blaine K, Sliwa J, Macario A, Brock-Utne J. In Response. Anesth Analg. 2015 Oct;121(4):1113. doi: 10.1213/ANE.0000000000000827. PubMed PMID: 26378711.
  • Tanaka P, Yanez D, Lemmens H, Djurdjulov A, Scotto L, Borg L, Walker K, Bereknyei Merrell S, Macario A. Impact of an Innovative Classroom-Based Lecture Series on Residents' Evaluations of an Anesthesiology Rotation. Anesthesiol Res Pract. 2016;2016:8543809. doi: 10.1155/2016/8543809. Epub 2016 Feb 17. PubMed PMID: 26989407; PubMed Central PMCID: PMC4773520.
  • Sun EC, Miller TR, Halzack NM. In the United States, "Opt-Out" States Show No Increase in Access to Anesthesia Services for Medicare Beneficiaries Compared with Non-"Opt-Out" States. A A Case Rep. 2016 Feb 18. [Epub ahead of print] PubMed PMID: 26895523.
  • Hah JM, Sharifzadeh Y, Wang BM, Gillespie MJ, Goodman SB, Mackey SC, Carroll IR. Factors Associated with Opioid Use in a Cohort of Patients Presenting for Surgery. Pain Res Treat. 2015;2015:829696. doi: 10.1155/2015/829696. Epub 2015 Dec 31. PubMed PMID: 26881072; PubMed Central PMCID: PMC4736213.
  • Dixon EA, Benham G, Sturgeon JA, Mackey S, Johnson KA, Younger J. Development of the Sensory Hypersensitivity Scale (SHS): a self-report tool for assessing sensitivity to sensory stimuli. J Behav Med. 2016 Feb 12. [Epub ahead of print] PubMed PMID: 26873609.
  • Udani AD, Harrison TK, Mariano ER, Derby R, Kan J, Ganaway T, Shum C, Gaba DM, Tanaka P, Kou A, Howard SK; ADAPT (Anesthesiology-Directed Advanced Procedural Training) Research Group. Comparative-Effectiveness of Simulation-Based Deliberate Practice Versus Self-Guided Practice on Resident Anesthesiologists' Acquisition of Ultrasound-Guided Regional Anesthesia Skills. Reg Anesth Pain Med. 2016 Mar-Apr;41(2) :151-7. doi: 10.1097/AAP.0000000000000361. PubMed PMID: 26866296.
  • Hamilton JP, Glover GH, Bagarinao E, Chang C, Mackey S, Sacchet MD, Gotlib IH. Effects of salience-network-node neurofeedback training on affective biases in major depressive disorder. Psychiatry Res. 2016 Mar 30;249:91-6. doi: 10.1016/j.pscychresns.2016.01.016. Epub 2016 Jan 19. PubMed PMID: 26862057; PubMed Central PMCID: PMC4803612.
  • Tanaka P. Response from author to the editor. J Clin Monit Comput. 2016 Feb;30(1):127-8. doi: 10.1007/s10877-016-9825-9. Epub 2016 Jan 29. PubMed PMID: 26823287.
  • Darnall BD, Scheman J, Davin S, Burns JW, Murphy JL, Wilson AC, Kerns RD, Mackey SC. Pain Psychology: A Global Needs Assessment and National Call to Action. Pain Med. 2016 Jan 23. pii: pnv095. [Epub ahead of print] PubMed PMID: 26803844.
  • Mackey S. Future Directions for Pain Management: Lessons from the Institute of Medicine Pain Report and the National Pain Strategy. Hand Clin. 2016 Feb;32(1):91-8. doi: 10.1016/j.hcl.2015.08.012. Review. PubMed PMID: 26611393.
  • Yamamoto S, Tanaka P, Madsen MV, Macario A. Analysis of Resident Case Logs in an Anesthesiology Residency Program. A A Case Rep. 2015 Oct 29. [Epub ahead of print] PubMed PMID: 26517235.
  • Woodworth D, Mayer E, Leu K, Ashe-McNalley C, Naliboff BD, Labus JS, Tillisch K, Kutch JJ, Farmer MA, Apkarian AV, Johnson KA, Mackey SC, Ness TJ, Landis JR, Deutsch G, Harris RE, Clauw DJ, Mullins C, Ellingson BM; MAPP Research Network. Unique Microstructural Changes in the Brain Associated with Urological Chronic Pelvic Pain Syndrome (UCPPS) Revealed by Diffusion Tensor MRI, Super-Resolution Track Density Imaging, and Statistical Parameter Mapping: A MAPP Network Neuroimaging Study. PLoS One. 2015 Oct 13;10(10):e0140250. doi: 10.1371/journal.pone.0140250. eCollection 2015. PubMed PMID: 26460744; PubMed Central PMCID: PMC4604194.
  • Sturgeon JA, Dixon EA, Darnall BD, Mackey SC. Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study. Pain. 2015 Dec;156(12):2627-33. doi: 10.1097/j.pain.0000000000000313. PubMed PMID: 26230739.
  • Carroll IR, Hah JM, Barelka PL, Wang CK, Wang BM, Gillespie MJ, McCue R, Younger JW, Trafton J, Humphreys K, Goodman SB, Dirbas FM, Mackey SC. Pain Duration and Resolution following Surgery: An Inception Cohort Study. Pain Med. 2015 Dec;16(12):2386-96. doi: 10.1111/pme.12842. Epub 2015 Jul 14. PubMed PMID: 26179223; PubMed Central PMCID: PMC4706803.
  • Harle CA, Listhaus A, Covarrubias CM, Schmidt SO, Mackey S, Carek PJ, Fillingim RB, Hurley RW. Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report. J Am Med Inform Assoc. 2016 Jan;23(1):74-9. doi: 10.1093/jamia/ocv085. Epub 2015 Jul 9. PubMed PMID: 26159464.
  • Bond RL, Downey LE, Weston PS, Slattery CF, Clark CN, Macpherson K, Mummery CJ, Warren JD. Processing of Self versus Non-Self in Alzheimer's Disease. Front Hum Neurosci. 2016 Mar 8;10:97. doi: 10.3389/fnhum.2016.00097. eCollection 2016. PubMed PMID: 27014028; PubMed Central PMCID: PMC4781858.
  • Yudi MB, Clark DJ, Farouque O, Eccleston D, Andrianopoulos N, Duffy SJ, Brennan A, Lefkovits J, Ramchand J, Yip T, Oqueli E, Reid CM, Ajani AE; Melbourne Interventional Group. Clopidogrel, Prasugrel or Ticagrelor in Patients with Acute Coronary Syndromes undergoing Percutaneous Coronary Intervention. Intern Med J. 2016 Feb 23. doi: 10.1111/imj.13041. [Epub ahead of print] PubMed PMID: 26909472.
  • Fletcher PD, Nicholas JM, Downey LE, Golden HL, Clark CN, Pires C, Agustus JL, Mummery CJ, Schott JM, Rohrer JD, Crutch SJ, Warren JD. A physiological signature of sound meaning in dementia. Cortex. 2016 Apr;77:13-23. doi: 10.1016/j.cortex.2016.01.007. Epub 2016 Jan 23. PubMed PMID: 26889604.
  • Ocampo J, Chereji RV, Eriksson PR, Clark DJ. The ISW1 and CHD1 ATP-dependent chromatin remodelers compete to set nucleosome spacing in vivo. Nucleic Acids Res. 2016 Feb 9. pii: gkw068. [Epub ahead of print] PubMed PMID: 26861626.
  • Clark DJ. Composite Versus Ceramics, Part I: Young Patients and Fractures. Dent Today. 2016 Jan;35(1):132, 134-5. PubMed PMID: 26846063.
  • Capasso R, Rosa T, Tsou DY, Nekhendzy V, Drover D, Collins J, Zaghi S, Camacho M. Variable Findings for Drug-Induced Sleep Endoscopy in Obstructive Sleep Apnea with Propofol versus Dexmedetomidine. Otolaryngol Head Neck Surg. 2016 Jan 26. pii: 0194599815625972. [Epub ahead of print] PubMed PMID: 26814208.
  • Brookfield KF, Su F, Elkomy MH, Drover DR, Lyell DJ, Carvalho B. Pharmacokinetics and placental transfer of magnesium sulfate in pregnant women. Am J Obstet Gynecol. 2016 Jan 6. pii: S0002-9378(15)02664-2. doi: 10.1016/j.ajog.2015.12.060. [Epub ahead of print] PubMed PMID: 26767791.
  • Clark DJ, Fondrie WE, Yang A, Mao L. Triple SILAC quantitative proteomic analysis reveals differential abundance of cell signaling proteins between normal and lung cancer-derived exosomes. J Proteomics. 2016 Feb 5;133:161-9. doi: 10.1016/j.jprot.2015.12.023. Epub 2015 Dec 29. PubMed PMID: 26739763.
  • Clark DJ, Mei Y, Sun S, Zhang H, Yang AJ, Mao L. Glycoproteomic Approach Identifies KRAS as a Positive Regulator of CREG1 in Non-small Cell Lung Cancer Cells. Theranostics. 2016 Jan 1;6(1):65-77. doi: 10.7150/thno.12350. eCollection 2016. PubMed PMID: 26722374; PubMed Central PMCID: PMC4679355.
  • Clark DJ, Kolias AG, Garnett MR, Trivedi RA, Price SJ, Hutchinson PJ. Student-selected components in neurosurgery. Br J Neurosurg. 2016 Feb;30(1):4-6. doi: 10.3109/02688697.2015.1114590. Epub 2015 Nov 26. PubMed PMID: 26610147.
  • Qiu H, Chereji RV, Hu C, Cole HA, Rawal Y, Clark DJ, Hinnebusch AG. Genome-wide cooperation by HAT Gcn5, remodeler SWI/SNF, and chaperone Ydj1 in promoter nucleosome eviction and transcriptional activation. Genome Res. 2016 Feb;26(2):211-25. doi: 10.1101/gr.196337.115. Epub 2015 Nov 24. PubMed PMID: 26602697; PubMed Central PMCID: PMC4728374.
  • Tzabazis A, Mechanic J, Miller J, Klukinov M, Pascual C, Manering N, Carson DS, Jacobs A, Qiao Y, Cuellar J, Frey WH 2nd, Jacobs D, Angst M, Yeomans DC. Oxytocin receptor: Expression in the trigeminal nociceptive system and potential role in the treatment of headache disorders. Cephalalgia. 2015 Nov 20. pii: 0333102415618615. [Epub ahead of print] PubMed PMID: 26590611.
  • Clark DJ, Neptune RR, Behrman AL, Kautz SA. Locomotor Adaptability Task Promotes Intense and Task-Appropriate Output From the Paretic Leg During Walking. Arch Phys Med Rehabil. 2016 Mar;97(3):493-6. doi: 10.1016/j.apmr.2015.10.081. Epub 2015 Oct 23. PubMed PMID: 26525528; PubMed Central PMCID: PMC4769939.
  • Ocampo J, Clark DJ. A Positive Twist to the Centromeric Nucleosome. Cell Rep. 2015 Oct 27;13(4):645-6. doi: 10.1016/j.celrep.2015.10.007. PubMed PMID: 26510160.
  • Fletcher PD, Downey LE, Golden HL, Clark CN, Slattery CF, Paterson RW, Rohrer JD, Schott JM, Rossor MN, Warren JD. Pain and temperature processing in dementia: a clinical and neuroanatomical analysis. Brain. 2015 Nov;138(Pt 11):3360-72. doi: 10.1093/brain/awv276. Epub 2015 Oct 12. PubMed PMID: 26463677; PubMed Central PMCID: PMC4620514.
  • Anton SD, Woods AJ, Ashizawa T, Barb D, Buford TW, Carter CS, Clark DJ, Cohen RA, Corbett DB, Cruz-Almeida Y, Dotson V, Ebner N, Efron PA, Fillingim RB, Foster TC, Gundermann DM, Joseph AM, Karabetian C, Leeuwenburgh C, Manini TM, Marsiske M, Mankowski RT, Mutchie HL, Perri MG, Ranka S, Rashidi P, Sandesara B, Scarpace PJ, Sibille KT, Solberg LM, Someya S, Uphold C, Wohlgemuth S, Wu SS, Pahor M. Successful aging: Advancing the science of physical independence in older adults. Ageing Res Rev. 2015 Nov;24(Pt B):304-27. doi: 10.1016/j.arr.2015.09.005. Epub 2015 Oct 14. Review. PubMed PMID: 26462882; PubMed Central PMCID: PMC4661112.
  • Sorond FA, Cruz-Almeida Y, Clark DJ, Viswanathan A, Scherzer CR, De Jager P, Csiszar A, Laurienti PJ, Hausdorff JM, Chen WG, Ferrucci L, Rosano C, Studenski SA, Black SE, Lipsitz LA. Aging, the Central Nervous System, and Mobility in Older Adults: Neural Mechanisms of Mobility Impairment. J Gerontol A Biol Sci Med Sci. 2015 Dec;70(12):1526-32. doi: 10.1093/gerona/glv130. Epub 2015 Sep 18. PubMed PMID: 26386013; PubMed Central PMCID: PMC4643615.
  • Clark DJ, Fondrie WE, Liao Z, Hanson PI, Fulton A, Mao L, Yang AJ. Redefining the Breast Cancer Exosome Proteome by Tandem Mass Tag Quantitative Proteomics and Multivariate Cluster Analysis. Anal Chem. 2015 Oct 20;87(20):10462-9. doi: 10.1021/acs.analchem.5b02586. Epub 2015 Sep 29. PubMed PMID: 26378940.
  • Downey L, Blaine K, Sliwa J, Macario A, Brock-Utne J. In Response. Anesth Analg. 2015 Oct;121(4):1113. doi: 10.1213/ANE.0000000000000827. PubMed PMID: 26378711.
  • Couper LT, Loane P, Andrianopoulos N, Brennan A, Nanayakkara S, Nerlekar N, Scott P, Walton AS, Clark DJ, Duffy SJ, Ajani AE, Reid C, Shaw JA; Melbourne Interventional Group (MIG) Investigators. Utility of rotational atherectomy and outcomes over an eight-year period. Catheter Cardiovasc Interv. 2015 Oct;86(4):626-31. doi: 10.1002/ccd.26077. Epub 2015 Jul 8. PubMed PMID: 26152449.
  • Shi X, Guo TZ, Wei T, Li WW, Clark DJ, Kingery WS. Facilitated spinal neuropeptide signaling and upregulated inflammatory mediator expression contribute to postfracture nociceptive sensitization. Pain. 2015 Oct;156(10):1852-63. doi: 10.1097/j.pain.0000000000000204. PubMed PMID: 25932690; PubMed Central PMCID: PMC4578973.
  • Sun E. Does the Modifier "QZ" Accurately Reflect Independent Nurse Anesthetist Practice: And Why Does It Matter? A A Case Rep. 2016 Apr 1;6(7):220-1.
  • Bruehl S, Maihöfner C, Stanton-Hicks M, Perez RS, Vatine JJ, Brunner F, Birklein F, Schlereth T, Mackey S, Mailis-Gagnon A, Livshitz A, Harden RN. Complex regional pain syndrome (CRPS): evidence for warm and cold subtypes in a large prospective clinical sample. Pain. 2016 Mar 25. [Epub ahead of print]

Book Chapters

  • Clark DJ, Leblanc BP. Analysis of DNA Supercoiling Induced by DNA-Protein Interactions. Methods Mol Biol. 2015;1334:161-72. doi: 10.1007/978-1-4939-2877-4_10. PubMed PMID: 26404149.

Global Health Activities and Updates

Global anesthesia faculty, Denise Chan, Ana Crawford, Rebecca McGoldrick; program manager, Michelle Duperrault; and CA-3 resident Ann Ng hosting academic partners from University of Zimbabwe (Aug. ‘15)

  • Congratulations to Drs. Adam Was and Anna Harter on their acceptance to the ASA-GHO Resident International Anesthesia Scholarship in Ethiopia.  Drs. Christina Staucher and Anna Swenson received the award last year and will be sharing their experiences at Grand Rounds on May 9, 2016, along with Ann Ng, Lauren Steffel, and Chris Miller, who also participated in international electives this year. 
  • Director Rebecca McGoldrick presented on “Blended Learning in a Low-Resource Environment” at the Consortium of Universities for Global Health (CUGH) annual conference in April 2016.
  • The Office of International Affairs (OIA) awarded us a grant and published an article on our efforts to bring one of our academic partners from the University of Zimbabwe College of Health Sciences (UZCHS) to Stanford.
  • The resident rotation in Rwanda will take place during block 9, February 20-March 3, 2017 with Ana Crawford.  The Zimbabwe rotation will occur block 10, March 13-April 9, 2017 with Rebecca McGoldrick.  We are currently accepting applications for both electives.  The deadline is December 1. Requirements for applications were emailed previously, but email mduperrault@stanford.edu with any questions. 
  • Upcoming global health conferences include:
    • Bethune Round Table – Building Collaborative Teams to Strengthen Global Surgery (June 3-4, 2016 in Halifax, Canada)
    • The World Congress of Anaesthesiologists – held every 4 years (August 28-September 2, 2016 in Hong Kong).
    • Anesthesia for Global Outreach Course will be hosted at Boston Children’s Hospital, October 7-9, 2016. For more information, please visit http://anesthesiaglobaloutreach.com
  • We are accepting rolling applications for the global health in anesthesia fellowship. Please contact us at mduperrault@stanford.edu for further information.
  • Don’t forget to check out the new website: globalanesthesia.stanford.edu. Follow us on Instagram too: instagram.com/stanfordglobalanesthesia.

Laura Steffel Receives 2016 ASRA Resident/Fellow of the Year Award

Dr. Lauren Steffel has been named 2016 Resident/Fellow of the Year by ASRA.  Lauren is a fourth year (CA-3) Stanford anesthesiology resident. She earned her MD at Harvard Medical School and completed her internship at Stanford University Medical Center.

In his nomination letter, Dr. Edward Mariano, MD, MAS, chief of Anesthesiology and Perioperative Care Service at the Veterans Affairs Palo Alto Health Care System, wrote, "Lauren is as well-rounded as they come.” Among her many interests and accomplishments: she is fluent in German, has eight years of chamber music and orchestra experience as a harpist, is a former varsity collegiate swimmer and has traveled outside the country five times in the past year, including three global health trips to Guatemala, Rwanda, and Vietnam. “She is incredibly hard- working, eager to learn, and enthusiastic, and I am confident that she will accomplish great things in her career,” Mariano wrote.

ASRA’s Resident/Fellow of the Year Award is given annually to a resident or fellow member of ASRA who has demonstrated outstanding contributions to regional anesthesia or pain medicine; has contributed to the advancement of the profession, welfare of residents, or quality of residency education; serves as a role model and mentor to his or her peers; and embodies the values of ASRA. Lauren will be going to Virginia Mason Medical Center to do her regional anesthesiology and acute pain medicine fellowship.

APS Honors Resident Louise Wen

Award presentation at the 2015 American Society of Anesthesiologists meeting. From left to right: David Gaba, MD, Louise Wen, CA-3, Robert Stoelting, MD (APSF President), and Steven Howard, MD

Louise Wen, MD, CA-3, mentored by Steven Howard, MD, (Palo Alto VA), and Ruth Fanning, MD, (Stanford), was recognized by the Anesthesia Patient Safety Foundation (APSF) for her quality improvement work on sharps safety for anesthesia residents. After a contaminated needle stick injury at the end of her CA-1 year, Louise became very interested in this subject. In March 2015, she surveyed her class when they were halfway through their anesthesia training (middle of CA-2 year) and found that 68% of her class had suffered from contaminated sharps injuries. Three residents had completed antiretroviral prophylaxis for HIV exposure and 2 residents had been exposed to patients with Hepatitis C. Stanford occupational health data showed that anesthesia residents were exposed to contaminated sharps injuries at a higher rate than any other residency department at Stanford Hospital. Using these findings, Louise developed a simulation-based sharps training module taught to the incoming CA-1’s during their orientation week.

Then, in summer of 2015, the APSF hosted its first national resident quality improvement video competition. The competition was announced to the residents at Stanford shortly before submission deadline. Louise was on her surgical intensive care unit rotation and had no experience at video editing. She shot the video on her smartphone at night after work, motivated to bring awareness to the issue of contaminated sharps injuries among residents. At the 2015 ASA meeting, the APSF awarded Louise’s video second place out of 22 video submissions from anesthesia programs across the country. 

The training module and video have already made a difference. In the first half of the 2015-2016 academic year, the rate of contaminated sharps injuries as reported to occupational health dropped over 90% compared to the previous academic year.

New Faculty

Welcome to the following new faculty, who were hired this past quarter:

  • Kevin Blackney, 85% Clinical Instructor MSD (2/1/2016-6/30/16)
    Dr. Kevin A. Blackney, from Clovis, California, graduated from Saint Louis University School of Medicine and then served 4 years in the U.S. Air Force as both a Flight Surgeon/Flight Commander and a Public Health Emergency Officer. After completing his service, he did his Anesthesia residency at Massachusetts General Hospital in Boston where he was involved in several Quality Improvement and resiliency projects. After residency, he stayed at MGH as Chief Resident and a staff anesthesiologist. Dr. Blackney arrived at Stanford as a Clinical Instructor and will start his Critical Care fellowship in July. He is excited to get started, and has an interest in public health and disaster management.
  • Alyssa Burgart, 100% Clinical Instructor Pediatric Anesthesia
    Dr. Alyssa Burgart graduated from Loyola University Chicago's Stritch School of Medicine, where she concurrently earned her Master’s in Bioethics and Health Policy. She also completed her residency and internship at Loyola, and served as chief resident. She joined Stanford in pursuit of pediatric anesthesia fellowship training at Lucile Packard Children's Hospital. She has a joint appointment in the Stanford Center for Bioethics, serves as the Co-Chair of the LPCH Ethics Committee and as a member of the SHC Ethics Committee. Her interests include research on the practice of medicine, organ transplantation, end-of-life care, ethics education, and ethics consultation.
  • Worasak Keeyapaj, 100% Clinical Assistant Professor Cardiac Anesthesia (2/1/16-1/31/20)
    Dr. Worasak Keeyapaj graduated from Faculty of Medicine, Chulalongkorn University in Thailand, where he also completed his anesthesia residency and served as an attending anesthesiologist. To receive training in cardiothoracic anesthesiology, he then pursued internship, residency and adult cardiothoracic anesthesiology fellowship at the Cleveland Clinic. Before coming to Stanford, he held an appointment as an Instructor in Anesthesia at Harvard Medical School. In Boston, he worked as a cardiac and general anesthesiologist at Massachusetts General Hospital, where he also served as a Director of Cardiac Anesthesia Resident Education. He was also heavily involved in residency and fellowship recruitment as well as an anesthesia simulation for residents. He enjoys traveling, especially in the San Francisco/Bay Area, and he likes cooking Thai cuisine. He is very much enjoying the growing cardiac surgery/anesthesia program as well as the advanced technology and surgical procedures at Stanford University Hospital. He said it’s been a privilege to become a part of Department of Anesthesia at Stanford University.
  • Gunjan Kumar, 10% Clinical Instructor MSD (2/1/16-1/31/19)
    Dr. Gunjan Kumar received her medical education at Virginia Commonwealth University. She did her residency at Loma Linda Medical Center, and her internship at Arrowhead Medical Center, both in California. She worked as an anesthesiologist at the VA and then did a fellowship here in Stanford’s Anesthesia Department.
  • Amy Lu, 100% Clinical Assistant Professor MSD (2/1/16-1/31/20)
    Dr. Amy Lu received her medical education at the University of California, San Francisco. She did her internship at Beth Israel Deaconess and residency at Massachusetts General Hospital.
  • Sarah Madison, 100% Assistant Professor MSD/Regional (2/1/16-1/31/20)
    Dr. Sarah Madison got her medical education at the University of California San Diego School of Medicine. She went on to do her internship at Banner Good Samaritan in Phoenix, AZ, her residency at UC Irvine, and her fellowship at UC San Diego in regional anesthesia. She then worked as an assistant professor of anesthesiology at UC San Diego. At UCSD, she was on the department promotions committee, the QI committee, and the P&T committee for the hospital. She has also worked as an editor for STARTprep, and for an oral boards prep course giving practice exams. She also teaches many workshops and currently serves on the ASRA newsletter committee. Her clinical research interests are regional anesthesia and acute pain. She has published on persistent post-mastectomy pain in the Annals of Surgical Oncology. Dr. Madison spends most of her free time with her husband and two kids (ages 2 and 4). She also enjoys cooking and eating good food. A graduate of Stanford for her undergraduate degree, Dr. Madison is happy to be back on campus. She loves being in the Bay Area because of all the natural beauty and great hikes around here.
  • Kathleen McGinn, Clinical Instructor, per diem, Pediatric Anesthesia (5/1/2016)
    Dr. Kathleen McGinn did her medical education at New York Medical College. She did her residency and internship at Virginia Mason Medical Center in WA. She did fellowships at Boston Children’s Hospital and Harvard in pediatric anesthesia and pain. Her research interests include pediatric pain, palliative care, regional anesthesia, and acupuncture. She has published on these topics, and she has also participated in several international medical service trips. In her free time, she enjoys playing soccer and hiking with her husband and three kids.
  • Jessica Patterson, Clinical Instructor, 100% FTE, MSD, (3/16/2016)
    Dr. Jessica Patterson did her medical education at Texas A&M College of Medicine, followed by an internship and residency at Brigham & Women's Hospital in Boston, MA. She then did a fellowship in Critical Care Medicine here at Stanford and went on to practice as an anesthesiologist with medical anesthesia consultants at John Muir Hospital and ValleyCare Medical Center. Her research interests include perioperative quality improvement, and outside of work she enjoys rock climbing, yoga/pilates, cooking, and adventures with her labradoodle.
  • Isobel Russell, Clinical Professor, per diem, Cardiac Anesthesia (5/16/2016)
    Dr. Isobel Russell did her medical education and a Ph.D. in biochemistry concurrently at Tulane University. She then did an internship, residency, and fellowship in cardiac anesthesia at the University of California, San Francisco. During residency, she served one year as Chief Resident. She stayed on at UCSF, becoming an Assistant Professor in Residence of Anesthesia, and then an Associate Professor in Residence of Anesthesia, and then a Professor. At different points she was Chief of Cardiac Anesthesia at UCSF’s Department of Anesthesia and Perioperative Care at Moffitt-Long Hospital; Director of the Adult and Pediatric Cardiac Anesthesia Fellowships at UCSF; and Director of Adult and Pediatric Cardiac Anesthesia Resident Rotations at UCSF. She has also been a contract physician in anesthesia for Kaiser Permanente in San Francisco and San Francisco’s VA Medical Center. Her clinical interests include cardiac anesthesia and global health. Her non-clinical interests include masters swimming, cooking, and her two teenage boys.

New Staff

Some New Faces

Make sure to say hello to these five new staff members of the department:

Hui Wang, M.D., Ph.D. is the new Director of Strategic Research Development (replacing Michael Helms). Dr. Wang comes to us from the National University of Singapore, where he was most recently the Director of Research Administration. He received his medical degree from Peking University in China and a DPhil from Oxford. He then carried out postdoctoral research in neuroscience and neurological diseases at Johns Hopkins University School of Medicine and Harvard Medical School, and subsequently headed an independent research group at Hamburg University Hospital in Germany.

In 2001, Dr. Wang switched careers to research administration and scientific publishing at the international level. During the past 15 years, he has served as Associate Editor of Nature; Scientific Secretary of European Medical Research Councils and to the Standing Committee for Life and Environmental Sciences at the European Science Foundation; Editorial Director of John Wiley and Sons, the world’s 2nd largest scholarly publisher; and Deputy Director and Head of Administration of the International Neuroinformatics Coordinating Facility, a global institution established by the Organization for Economic Co-operation and Development (OECD) and hosted by Karolinska Institutet and Royal Institute of Technology (KTH) in Sweden.

Dr. Wang has received several prizes for research and editorial contributions. He is currently an expert consultant to the UK Medical Research Council and on an evaluation panel of OECD.

Kevin Duong has joined our Division as our new Peds Scheduler. He will be responsible for producing and managing the Peds schedules.

Kevin graduated Deans Honor Roll, Cum Laude in 2014 from University of San Francisco with a BS in Organizational Behavior and Leadership. He comes with an extensive background in scheduling (including Amion experience!), finance, coordination of CME courses, and administrative support. He was born and raised in San Francisco, and now lives in Daly City.

He is located in the Business Office, 3rd floor—stop by and say hello if you’re in the area!

Keith Patti is a new research administrator 1 for the department and will be functioning as a point-of-contact for PIs and helping to monitor the department’s research funding. He has worked for Stanford in its Financial Management Services (FMS), Procurement Division, auditing expense requests and was a part of its transition from iOU in Oracle to ERS and PRS in 2015. Keith served in the Air Force from 2009 to 2011 at Ellsworth AFB in South Dakota, where he primarily audited travel for Air Force Reserve members.

He attended graduate school at Arizona State University and received an M.Ed. in Higher Education Administration. Originally from Akron, OH, he came to California to begin his assignment with FMS in 2014 and has resided in Redwood City ever since.

Sadly, Keith recently lost his father to cancer. His hiring date coincided with his father’s admission to hospice and he was very proud of Keith’s new job. A fun fact about Keith: He went to high school with LeBron James and LeBron asked Keith to rap for him once.

Wendy Schadle has joined the Pain Division as an Administrator. Before this, she was juggling the demands of her family as a stay-at-home mom. She has two children; one has graduated from college and works in San Francisco, and the other is still in college and, Wendy jokes, still causing a strain on the family budget. She likes hiking, reading, and living vicariously through her kids. She has also very much enjoyed her experience so far working and learning in the Pain Lab, and looks forward to many more positive experiences here at Stanford.

The Art of Anesthesia

Dr. Sam Rodriguez

Dr. Sam Rodriguez displays his paintings in LKSC

Not everyone sees an obvious connection between being an artist and being an anesthesiologist. Dr. Sam Rodriguez, Clinical Assistant Professor in the Anesthesia Department, though, can find a plethora of ways the two fields are linked.

It’s not surprising that Dr. Rodriguez thinks about the similarities between these two fields—both have been a major part of his life since college. He started taking art classes when he was a junior at Washington University in St. Louis. He says he wasn’t a very good artist at first, but he stuck with it because he enjoyed it—and now he’s good enough to be getting his work published on the cover of Academic Medicine journal, getting commissions for medical illustrations and portraits, and to have an exhibit up at the Li Ka Shing Center (LKS).

He also teaches classes here at Stanford focusing on intersections of art and medicine, both for medical students and for undergraduates. Dr. Rodriguez explains that the classes are fun, get the students to the Cantor Art Museum, which many have never visited even though it’s right on campus, and, most importantly, teach students “to be comfortable juggling multiple possibilities in [their] head at the same time…. Usually there are multiple interpretations of a piece of art, and it’s the same with clinical findings: a change in blood pressure or oxygen saturation can be signs of many different things.”

A photograph of Dr. Rodriguez’s “Transfer of Care,” which hangs in Boston Children’s Hospital. 

Another similarity between art and anesthesia is that they both require the skill of deducing a conclusion from limited information: “As anesthesiologists, our interaction with patients and their families in an average case is very brief—we may only have 10 or 15 minutes to get the patient’s background, explain the procedure, and review the consent. We have to decide based on this interaction, what is the best way to get that child to sleep?... We have to extract information in a short period of time that will impact our decision. That’s the same thing we do when we come upon a work of art. What is going on in this painting? If it’s a portrait, who is this person? What are they doing in the scene? What were they doing right beforehand, and what will they do after? How do you know? Or if you’re interpreting an abstract piece of art, what does this mean, and why?” he says.

Yet another thread running through both of Dr. Rodriguez’s passions is that both painting and practicing anesthesia require fine motor skills. Plus, since Dr. Rodriguez does medical illustrations, he often studies the same anatomy for his artwork that he does for his patient care. In those ways, plus the aforementioned sharpening of the ability to observe, “Being a doctor makes me a better artist, and making art makes me a better doctor,” he said.

Then there’s the fact that key step for both is practice and planning—most of the time, at least. “I do a write-up and multiple sketches before starting a large painting to work out the main focal points and secondary focal points. Since I started doing that type of planning, I’ve been more consistently successful…. The planning aspect is similar to medicine—there is lots of planning in anesthesia. Normally we discuss cases with residents the night before; with more complicated cases, we might have meetings with the surgical and medical teams sometimes weeks before the procedure. Though of course sometimes there are emergencies and we don’t have time to plan; just like with painting—sometimes you have to be spontaneous and just react,” he explains.  

Some of the larger pieces hanging in the LKS exhibit were not commissioned to illustrate journal articles, but are scenes he decided to illustrate simply because they emotionally impacted him. For example, one large oil painting, “Anatomy Lab 2005,” illustrates the first time he dissected a cadaver during medical school. “It’s an intense experience for all medical students, so painting it was an outlet for me,” he said. The scene for another painting—“The Transfer of Care,” which hangs in Boston Children’s Hospital, where Dr. Rodriguez did his fellowship—depicts the moment when a mother passes her child to the doctor. “I wanted to display what we do in pediatric anesthesia in a single image. That’s what I chose,” he said.

For those larger pieces, he can spend 100 or more hours doing research, sketching, and painting. “You become immersed in the topic. Even spending a couple of hours staring at the same landscape, the same beach, you see much more about the scene over time. You leave seeing that landscape or person or medical procedure differently,” he said. Probably not unlike the way you might see a patient differently after treating them.

by Christine Junge

Writer and editor with experience focused in science and medicine.

Research Awards Dinner May 26

The Department of Anesthesia’s annual Research Awards Dinner will take place on Thursday, May 26, at the Sheraton in Palo Alto. Dr. Jim Rathmell from Brigham and Women’s Hospital will be attending as the guest evaluator.  

Please RSVP to chynnav@stanford.edu if you plan to attend.

Abstracts will be evaluated by the department’s Research Committee, and several will be selected for awards and oral presentation at the dinner. Award categories include:

  • Best Basic Science Abstract
  • Best Clinical Abstract
  • Best Case Study
  • Best Educational Abstract
  • Best Abstract by a FARM Fellow
  • Best Abstract by a T32 Fellow

The schedule for the evening is as follows:

  • 5:00pm to 6:30pm: Reception and abstract viewing
  • 6:30pm to 7:30pm: Dinner
  • 7:30pm to 9:00pm: Presentation and awards

Selected Press Mentions

Fourth Annual Arts & Anesthesia Soiree

The Arts and Anesthesia Committee invites you to share your artistic creations, explorations and performances with the rest of the Department at the 4th Annual Arts & Anesthesia Soiree on Thursday, June 2 from 5:00 pm - 7:30 pm in LKSC 101/102. We will serve beer, wine, hors d’Oeuvres, and desserts. The evening is a casual, yet meaningful way to connect with those you know and don’t know in the department, as well as their families and partners!

The evening typically includes: art, literature, crafts, print photography, digital image slideshow, music, dance, martial art, short readings of original writing and poetry, video – all by you. Also welcome is Nerd Art: anything made from or resembling the tools and clean discards of the anesthesia trade, like vial cap art.

Anyone affiliated with Stanford Anesthesiology, Perioperative and Pain Medicine in some way can attend the event or present. This includes staff, residents, fellows, faculty, attendings, perioperative staff from all affiliated hospitals, alumni and family members.

Department Golf Tournament Coming Up

The 14th Department of Anesthesia Golf Tournament will be on Sunday June 19, 2016 at noon.

The format will be as it has always been—a scramble—so there is no significant pressure on the individual golfer. It is open to all members of the Department of Anesthesia. You may bring 1 golfer who is not associated with the department. This means that 2 of the 4 players should be a department member either current or alumni. You must have your own golf bag; no sharing of clubs is allowed. You can walk or drive. If you drive, the cost for the cart is $35.00 for 2 players.

Residents who are interested in playing should try to get onto the Ann Dohn’s list for June 2016. If you are on that list you only pay $20.00 per round; all others pay $110.00 per person, except University Faculty who pay $60.00.

At the end of the tournament there, will be a prize-giving ceremony on the patio overlooking the 18th green. A finger supper with drinks will be provided courtesy of our department.

New Books in the Lane Library

Look for the following new books in the Anesthesia library:

Anesthesia and perioperative care of the high-risk patient, 3e, McConachie

RD 82.5 A53 2014

Atlas of peripheral regional anesthesia: Anatomy and techniques, 3e, Meier

RD 84 M45 2016

Current medical diagnosis & treatment, 2016, 55e, Papadakis, Ed.

RC 71 C92 2016

Essential clinical anesthesia review: Keywords, questions and answers for the boards, 1e, Aglio, Ed. RD 82.3 E74 2015

Handbook of clinical anesthesia procedures of the Massachusetts General Hospital, 9e, Pino, Ed.(fulltext available at https://www.inkling.com/read)

RD 82.2 C54  2016

Lippincott’s anesthesia review: 1,001 questions and answers, 1e, Sikka

(fulltext available at http://solution.lww.com)

RD 82.3 S29 2015

Atlas of pain medicine procedures, 1e, Diwan

RB 127 D64 2015

Clinical anesthesia fundamentals, 1e, Barash, Ed.(fulltext available at https://www.inkling.com/read) RD 81 C58f 2015

Delirium in critical care: Core critical care, 2e, Page

RC 520.7 P14 2015

Goldman-Cecil medicine, 25e, Goldman, Ed., volumes 1 & 2 (fulltext available at https://www.inkling.com/read)

RC 46 C43 2016

Handbook of pediatric anesthesia, 1e, Houck

RD 139 H20 2015

Neurocritical care essentials: A practical guide, 1e, Sekhon

RC 361 N39 2015

Anesthesiology: Examination & Board Review, 7e
edited by Mark Dershwitz & J. Matthias Walz
RD 82.3 A532014

Anesthesia Holiday Party

Welcome to the World!

Becky Wong happily welcomed her son, Clark, at the end of April. He was 7 lbs, 8 oz and 20 inches long. His big sister, Clara, is adjusting to a new role, and they are all settling into being a family of four. Clark is looking forward to meeting his Stanford family, and Becky offers her deepest thanks to everyone for supporting her throughout her pregnancy.

Quynh Dierickx welcomed baby Nina Josephine Dierickx, born on 4/25/16. Her birthday is special in a mathematical way, as Quynh’s engineer husband pointed out: all of the numbers in the date are squares.

Nina Josephine weighed 7lb 11oz, 20.5 inch at birth. Quynh would like to thank everyone who encouraged, supported and helped her through her pregnancy, especially Drs. Collins, Butwick, Ann Ng, and Glorilee Harper for the fantastic care during her labor and C-section. 

Happy News! On March 16, Ru He, from the Anesthesia IT department, and his wife welcomed their first child, Alexander Carter He. Alexander arrived at 2:21 p.m., weighing 6 lb, 3 oz, and measuring 19” long… Everyone is healthy and doing great.  

Dr. Lindsey Bergman and her husband Grant wrote to announce the new addition to their family, Dodson Hart Bergman, born 1/27/15, weighing 8lb 0oz and 55cm long.

Dr. Bergman says, “Thank you so much for the amazing care we received from Drs. Ann Ng and Naola Austin in the early morning hours of that day. I have a new appreciation for what we do as anesthesiologists....epidurals ROCK!!!!” 

Dr. Luke McCage says: “We are pleased to welcome our daughter, Eden Izmir McCage, to the world on January 27, 2016 weighing 8 lb 9 ou. Mom and Eden are healthy and big brother (Nolan) couldn't be happier! Much appreciation for the wonderful care from our own Drs. Schwab, Ng, and Austin!” 

Dr. Liz Koch wrote on January 11: “So looks like I will go on maternity leave as planned after all. Our little girl came just a couple hours after we got to the hospital -- she couldn't wait to see the world! Josephine Juno Koch was born at 9:19, weighed 7 lb 4 oz, and measured 20 inches.” 

Dr. Jessica Brodt and her husband Chad welcomed a new baby on December 9. She said, “Kate arrived on Wednesday morning, and came home to 3 very excited big sisters today. Deepest thanks to Sarah Stone for an amazing epidural (very slick, and timed perfectly between contractions!), and Gillian Abir for the expert oversight.” 

Dr. Eric Sun said: “My wife and I are happy to announce that Linnea Summer Sun was born on Tuesday, November 17th.  Many thanks to Drs. Abir, McDonald, Sullivan, Sutton, and Stone for excellent anesthesia care! Mother and child are at home and doing well. Mom states that the baby is better behaved than her father, which is an impressive feat given the high bar involved.”  

Dr. Rachel Outterson said that she and her husband, Jay Saleh, “are delighted to share the news of the arrival of our son, Charlie David Saleh, last Monday, 10/26/2015. We've been home almost a week and are all doing well. We are exceptionally grateful to the whole team at LPCH and most especially to Dr.'s Gillian Hilton and Erin Crawford for their kindness, expertise, and one genuinely exquisite spinal anesthetic.” 

On October 30, Dr. Naola Austin wrote to say that she and her husband Erik were excited to introduce Elise Viola Frey, born a little over a week earlier.

She said, “E.V. and I couldn’t be more pleased with the level of care and compassion we received at LPCH, especially the perfect anesthesia care of Drs. Hilton & Seligman. We are home, doing well, and can’t believe the joy that such a little package can bring to the world.”  

Dr. Ryan Mountjoy wrote: “Have great news to share with you. I want to introduce you to baby girl Quinn Iris Mountjoy, born 10/14 after a 31 hour labor, 3 hours of pushing, and a c-section to boot...best things are worth waiting for though!”

In September, Dr. Jordan Newmark and his wife Rachna welcomed twins, Eli and Sahana. Mother, father, and babies are all doing well.