Bio

Clinical Focus


  • Anesthesia
  • Pediatric Anesthesiology

Academic Appointments


Administrative Appointments


  • Medical Director of Clinical Informatics, Perioperative Services, Information Services, Stanford Children's Health (2012 - Present)

Professional Education


  • Fellowship:Stanford University Anesthesiology Residency (2012) CA
  • Board Certification: Clinical Informatics (2017)N/A
  • Board Certification, Clinical Informatics, American Board of Preventative Medicine (2017)
  • Board Certification: Pediatric Anesthesia, American Board of Anesthesiology (2013)
  • Residency:UCLA (2007) CA
  • Medical Education:University of California San Francisco (2003) CA
  • Board Certification: Anesthesia, American Board of Anesthesiology (2008)
  • Fellowship:Children's Hospital Boston (2008) MA
  • Internship:Alameda County Medical Center (2004) CA

Research & Scholarship

Clinical Trials


  • Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) Use in Pediatric Procedures Recruiting

    THRIVE (Transnasal Humidified Rapid-Insufflation Ventilatory Exchange) refers to the use of high-flow nasal cannula to augment the ability to oxygenate and ventilate a patient under general anesthesia. The use of high-flow nasal cannula oxygen supplementation during anesthesia for surgical procedures has been a recent development in the adult population, with limited data analyzing the pediatric population. This study will determine whether high flow nasal cannula oxygen supplementation during surgical or endoscopic procedures can safely prevent desaturation events in children under anesthesia.

    View full details

Publications

All Publications


  • Programmed Intermittent Bolus Regimen for Erector Spinae Plane Blocks in Children: A Retrospective Review of a Single-Institution Experience. Anesthesia and analgesia Munshey, F., Caruso, T. J., Wang, E. Y., Tsui, B. C. 2018

    Abstract

    With few published reports on erector spinae plane block use in children, limited guidance on perioperative local anesthetic dosing exists. We present a series of 22 patients who received erector spinae plane catheters with programmed intermittent bolus for various surgeries. Median loading dose of 0.4 mL/kg (interquartile range [IQR], 0.1 mL/kg) ropivacaine 0.5%, intraoperative bolus of 0.3 mL/kg/h (IQR, 0.1 mL/kg) ropivacaine 0.2%, and a postoperative programmed intermittent bolus regimen of maximum 0.6 mg/kg/h resulted in highest pain scores on postoperative day 1 with a median score of 1.7 of 10 (IQR, 1.8) and highest morphine equivalents consumed on postoperative day 2 with a median score of 0.16 mg/kg up to 120 hours after surgery.

    View details for DOI 10.1213/ANE.0000000000003817

    View details for PubMedID 30252704

  • A Retrospective Review of a Bed-mounted Projection System for Managing Pediatric Preoperative Anxiety. Pediatric quality & safety Caruso, T. J., Tsui, J. H., Wang, E., Scheinker, D., Sharek, P. J., Cunningham, C., Rodriguez, S. T. 2018; 3 (4): e087

    Abstract

    Introduction: Most children undergoing anesthesia experience significant preoperative anxiety. We developed a bedside entertainment and relaxation theater (BERT) as an alternative to midazolam for appropriate patients undergoing anesthesia. The primary aim of this study was to determine if BERT was as effective as midazolam in producing cooperative patients at anesthesia induction. Secondary aims reviewed patient emotion and timeliness of BERT utilization.Methods: We conducted a retrospective cohort study of pediatric patients undergoing anesthesia at Lucile Packard Children's Hospital Stanford between February 1, 2016, and October 1, 2016. Logistic regression compared induction cooperation between groups. Multinomial logistic regression compared patients' emotion at induction. Ordinary least squares regression compared preoperative time.Results: Of the 686 eligible patients, 163 were in the BERT group and 150 in the midazolam. Ninety-three percentage of study patients (290/313) were cooperative at induction, and the BERT group were less likely to be cooperative (P = 0.04). The BERT group was more likely to be "playful" compared with "sedated" (P < 0.001). There was a reduction of 14.7 minutes in preoperative patient readiness associated with BERT (P = 0.001).Conclusions: Although most patients were cooperative for induction in both groups, the midazolam group was more cooperative. The BERT reduced the preinduction time and was associated with an increase in patients feeling "playful."

    View details for PubMedID 30229198

  • A RETROSPECTIVE COHORT STUDY OF PREDICTORS AND INTERVENTIONS THAT INFLUENCE COOPERATION WITH PEDIATRIC ANESTHESIA MASK INDUCTION Caruso, T., O'Connell, C., Wang, E., Rodriguez, S., Darling, C., Caruso, J., Tsui, B. LIPPINCOTT WILLIAMS & WILKINS. 2018: 502?3
  • THE INCIDENCE OF DESATURATION DURING MICROLARYNGOSCOPY AND BRONCHOSCOPY: A QUALITY CONTROL REVIEW Caruso, T., Tsui, B., Wang, E., Darling, C., Sidell, D. LIPPINCOTT WILLIAMS & WILKINS. 2018: 572
  • Intraoperative antibiotic redosing compliance and the extended postoperative recovery period: often overlooked areas that may reduce surgical site infections. Paediatric anaesthesia Caruso, T. J., Wang, E., Colletti, A. A., Sharek, P. J. 2018

    Abstract

    It was with great interest that we read Compliance with perioperative prophylaxis guidelines and the use of novel outcome measures by Morse, et al.1 The authors should be applauded for presenting a well-balanced review of the rationale behind the use of prophylactic antibiotics, data supporting dosing intervals, and potential outcome measures. This article is protected by copyright. All rights reserved.

    View details for PubMedID 30592343

  • Enhancing pediatric airway safety using the electronic medical record. The Laryngoscope Rameau, A., Wang, E., Saraswathula, A., Pageler, N., Perales, S., Sidell, D. R. 2018

    Abstract

    Difficult intubations are not uncommon in tertiary care children's hospitals, and effective documentation of the difficult airway is a fundamental element of safe airway management. The primary goal of our quality improvement initiative was to improve access to airway information via an alert and documentation system within the electronic medical record (EMR).We created a difficult airway alert within the EMR, linking common airway evaluation templates used by specialists involved in airway management. We assessed the time required for different specialists to answer an airway information questionnaire using the electronic charts of patients before and after the EMR modification. Satisfaction with the EMR modification was also surveyed.Questionnaires were administered to 12 participants before the Epic (Epic Systems Corp., Verona, WI) changes were implemented and to 19 participants after they were implemented. Each participant was asked to answer the airway data questionnaire for two patients, for a total of 24 questionnaires before the EMR changes and 38 questionnaires after the changes. Respondents averaged 7.24 minutes to complete the entire airway data questionnaire before the EMR changes and 3.16 minutes following modification (P?

    View details for PubMedID 30195274

  • A quality improvement initiative to optimize dosing of surgical antimicrobial prophylaxis. Paediatric anaesthesia Caruso, T. J., Wang, E., Schwenk, H. T., Scheinker, D., Yeverino, C., Tweedy, M., Maheru, M., Sharek, P. J. 2017; 27 (7): 702-710

    Abstract

    The risk of surgical site infections is reduced with appropriate timing and dosing of preoperative antimicrobials. Based on evolving national guidelines, we increased the preoperative dose of cefazolin from 25 to 30 mg·kg(-1) . This quality improvement project describes an improvement initiative to develop standard work processes to ensure appropriate dosing.The primary aim was to deliver cefazolin 30 mg·kg(-1) to at least 90% of indicated patients. The secondary aim was to determine differences between accuracy of cefazolin doses when given as an electronic order compared to a verbal order.Data were collected from January 1, 2012 to May 31, 2016. A quality improvement team of perioperative physicians, nurses, and pharmacists implemented a series of interventions including new electronic medical record order sets, personal provider antibiotic dose badges, and utilization of pharmacists to prepare antibiotics to increase compliance with the recommended dose. Process compliance was measured using a statistical process control chart, and dose compliance was measured through electronic analysis of the electronic medical record. Secondary aim data were displayed as percentage of dose compliance. An unpaired t-test was used to determine differences between groups.Between January 1, 2012 and May 31, 2016, cefazolin was administered to 9086 patients. The mean compliance of cefazolin at 30 mg·kg(-1) from May 2013 to March 2014 was 40%, which prompted initiation of this project. From April 2014 to May 2016, a series of interventions were deployed. The mean compliance from September 2015 to May 2016 was 93% with significantly reduced variation and no special cause variation, indicating that the process was in control at the target primary aim. There were 649 cefazolin administrations given verbally and 1929 given with an electronic order between October 1, 2014 and May 31, 2016. During this time period, the rate of compliance of administering cefazolin at 30 mg·kg(-1) was significantly higher when given after an electronic order than when given verbally, 94% vs 76%.This comprehensive quality improvement project improved practitioner compliance with evidence-based preoperative antimicrobial dosing recommendations to reduce the risk of surgical site infections.

    View details for DOI 10.1111/pan.13137

    View details for PubMedID 28321988

  • A Novel Bed-Mounted Projection System is as Effective as Pharmacologic Modalities to Treat Pediatric Preoperative Anxiety Caruso, T. J., Rodriguez, S., Wang, E., Terajewicz, A., Brockington, D., Cunningham, C., Sharek, P. J., Marquez, J. LIPPINCOTT WILLIAMS & WILKINS. 2017: 23?25

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