Bio

Clinical Focus


  • Anesthesia
  • Pediatric Anesthesia

Academic Appointments


Administrative Appointments


  • Clinical Professor of Anesthesia, Stanford University (2011 - Present)
  • Co-Director Operating Rooms, Lucile Packard Children's Hospital (2007 - Present)
  • Chief of Pediatric Anesthesia, Stanford University (2006 - Present)
  • Clinical Associate Professor in Anesthesia, Stanford Medical School (2006 - 2011)
  • Clinical Assistant Professor in Anesthesia, Stanford Medical School (2003 - 2006)
  • Instructor in Anesthesia, Harvard Medical School (1995 - 1999)

Boards, Advisory Committees, Professional Organizations


  • Section on Anesthesiology and Pain Medicine, Executive Committee, American Academy of Pediatrics (2013 - Present)

Professional Education


  • Medical Education:Tufts University (1987) MA
  • Board Certification: Pediatric Anesthesia, American Board of Anesthesiology
  • Board Re-Certification, American Board of Anesthesiology, Anesthesia (2009)
  • MS, Stanford University, Health Services Research (2012)
  • Fellowship:Children's Hospital Boston (1994) MA
  • Board Certification: Anesthesia, American Board of Anesthesiology (1996)
  • Residency:Massachusetts General Hospital (1994) MA
  • Internship:Walter Reed Army Medical Center (1988) DC
  • Anesthesia, Massachusetts General Hospital, Anesthesiology (1994)
  • Pediatric Anesthesia, Children's Hospital Boston, Pediatric Anesthesia (1994)
  • Aviation Medicine, US Army Medical Corp, Aviation Medicine (1988)
  • MD, Tufts University, Medicine (1987)
  • BS, M.I.T., Biology (1983)

Research & Scholarship

Current Research and Scholarly Interests


Developing educational and system testing models for team OR environment using high fidelity simulation
Studying Pediatric Perioperative Outcomes and Cost-effectiveness for Pediatric Surgical and Anesthetic Care

Teaching

2013-14 Courses


Graduate and Fellowship Programs


Publications

Journal Articles


  • Simulation in pediatric anesthesiology PEDIATRIC ANESTHESIA Fehr, J. J., Honkanen, A., Murray, D. J. 2012; 22 (10): 988-994

    Abstract

    Simulation-based training, research and quality initiatives are expanding in pediatric anesthesiology just as in other medical specialties. Various modalities are available, from task trainers to standardized patients, and from computer-based simulations to mannequins. Computer-controlled mannequins can simulate pediatric vital signs with reasonable reliability; however the fidelity of skin temperature and color change, airway reflexes and breath and heart sounds remains rudimentary. Current pediatric mannequins are utilized in simulation centers, throughout hospitals in-situ, at national meetings for continuing medical education and in research into individual and team performance. Ongoing efforts by pediatric anesthesiologists dedicated to using simulation to improve patient care and educational delivery will result in further dissemination of this technology. Health care professionals who provide complex, subspecialty care to children require a curriculum supported by an active learning environment where skills directly relevant to pediatric care can be developed. The approach is not only the most effective method to educate adult learners, but meets calls for education reform and offers the potential to guide efforts toward evaluating competence. Simulation addresses patient safety imperatives by providing a method for trainees to develop skills and experience in various management strategies, without risk to the health and life of a child. A curriculum that provides pediatric anesthesiologists with the range of skills required in clinical practice settings must include a relatively broad range of task-training devises and electromechanical mannequins. Challenges remain in defining the best integration of this modality into training and clinical practice to meet the needs of pediatric patients.

    View details for DOI 10.1111/pan.12001

    View details for Web of Science ID 000308638300009

    View details for PubMedID 22967157

  • Cost-effectiveness Analysis of Adjunct VSL#3 Therapy Versus Standard Medical Therapy in Pediatric Ulcerative Colitis JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Park, K. T., Perez, F., Tsai, R., Honkanen, A., Bass, D., Garber, A. 2011; 53 (5): 489-496

    Abstract

    Inflammatory bowel diseases (IBDs) are costly chronic gastrointestinal diseases, with pediatric IBD representing increased costs per patient compared to adult disease. Health care expenditures for ulcerative colitis (UC) are >$2 billion annually. It is not clear whether the addition of VSL#3 to standard medical therapy in UC induction and maintenance of remission is a cost-effective strategy.We performed a systematic review of the literature and created a Markov model simulating a cohort of 10-year-old patients with severe UC, studying them until 100 years of age or death. We compared 2 strategies: standard medical therapy versus medical therapy + VSL#3. For both strategies, we assumed that patients progressed through escalating therapies--mesalamine, azathioprine, and infliximab--before receiving a colectomy + ileal pouch anal anastamosis (IPAA) if the 3 medical therapy options were exhausted. The primary outcome measure was the incremental cost-effectiveness ratio (ICER), defined as the difference of costs between strategies for each quality-adjusted life-year (QALY) gained. One-way sensitivity analyses were performed on variables to determine the key variables affecting cost-effectiveness.Standard medical care accrued a lifetime cost of $203,317 per patient, compared to $212,582 per patient for medical therapy + VSL#3. Lifetime QALYs gained was comparable for standard medical therapy and medical therapy + VSL#3 at 24.93 versus 25.05, respectively. Using the definition of ICER <50,000/QALY as a cost-effective intervention, medical therapy + VSL#3 produced an ICER of $79,910 per QALY gained, making this strategy cost-ineffective. Sensitivity analyses showed that 4 key parameters could affect the cost-effectiveness of the 2 strategies: cost of colectomy + IPAA, maintenance cost after surgery, probability of developing pouchitis after surgery, and the quality of life after a colectomy + IPAA. High surgical and postsurgical costs, a high probability of developing pouchitis, and a low quality of life after a colectomy + IPAA could make adjunct VSL#3 use a cost-effective strategy.Given present data, adjunct VSL#3 use for pediatric UC induction and maintenance of remission is not cost-effective, although several key parameters could make this strategy cost-effective. The quality of life after an IPAA is the single most important variable predicting whether this procedure benefits patients over escalating standard medical therapy.

    View details for DOI 10.1097/MPG.0b013e3182293a5e

    View details for Web of Science ID 000296383000007

    View details for PubMedID 21694634

  • Affordable Simulation for Small-Scale Training and Assessment SIMULATION IN HEALTHCARE Edler, A. A., Chen, M., Honkanen, A., Hackel, A., Golianu, B. 2010; 5 (2): 112-115

    Abstract

    High-fidelity patient simulation is increasingly recognized as an effective means of team training, acquisition and maintenance of technical and professional skills, and reliable performance assessment; however, finding a cost effective solution to providing such instruction can be difficult. This report describes the rationale, design, and appropriateness of a portable simulation model and example of its successful use at national meetings.The Stanford Simulation Group, in association with several other centers, developed a portable Pediatric Simulation Training and Assessment Program (Pediatric Anesthesia in-Situ Simulation) and presented it at two national meetings. The technical challenges and costs of development are outlined, and a satisfaction survey was conducted at the completion of the program.All respondents (100%) either agreed or strongly agreed that the course was useful, met expectations, was enjoyable, and that the scenarios were realistic.The Portable Simulation Training and Assessment Program (Pediatric Anesthesia in-Situ Simulation) presents innovative educational and financial opportunities to assist in both training and assessment of critical emergency response skills at smaller institutions and allows specialized instruction in an in situ setting.

    View details for DOI 10.1097/SIH.0b013e3181c76332

    View details for Web of Science ID 000276938400007

    View details for PubMedID 20661010

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