Bio

Clinical Focus


  • Anesthesia

Academic Appointments


  • Clinical Associate Professor, Anesthesiology, Perioperative and Pain Medicine

Professional Education


  • Fellowship:Stanford University Pulmonary and Critical Care Fellowship (2012) CA
  • Medical Education:Northeastern Ohio Universities (2005) OH
  • Internship:University of Pittsburgh Medical Center (2006) PA
  • Residency:University of Pittsburgh Medical Center (2009) PA
  • Board Certification: Anesthesia, American Board of Anesthesiology (2010)
  • Fellowship:Stanford University School of Medicine (2011) CA
  • Board Certification: Perioperative Transesophageal Echocardiography, National Board of Echocardiography (2012)
  • Board Certification: Critical Care Medicine, American Board of Anesthesiology (2012)
  • Fellowship:Lucile Packard Children's Hospital

Teaching

Graduate and Fellowship Programs


Publications

All Publications


  • Inhaled Nitric Oxide (iNO) and Inhaled Epoprostenol (iPGI(2)) Use in Cardiothoracic Surgical Patients: Is there Sufficient Evidence for Evidence-Based Recommendations? JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Rao, V., Ghadimi, K., Keeyapaj, W., Parsons, C. A., Cheung, A. T. 2018; 32 (3): 1452?57

    View details for PubMedID 29336971

  • Ambulating femoral venoarterial extracorporeal membrane oxygenation bridge to heart-lung transplant. The Journal of thoracic and cardiovascular surgery Shudo, Y., Kasinpila, P., Lee, A. M., Rao, V. K., Woo, Y. J. 2018

    View details for PubMedID 29628344

  • Postoperative Respiratory Impairment Is a Real Risk for Our Patients: The Intensivist's Perspective ANESTHESIOLOGY RESEARCH AND PRACTICE Rao, V. K., Khanna, A. K. 2018: 3215923

    Abstract

    Postoperative respiratory impairment occurs as a result of a combination of patient, surgical, and management factors and contributes to both surgical and anesthetic risk. This complication is challenging to predict and has been associated with an increase in mortality and hospital length of stay. There is mounting evidence to suggest that patients remain vulnerable to respiratory impairment well into the postoperative period, with the vast majority of adverse events occurring during the first 24 hours following discharge from anesthesia care. At present, preoperative risk stratification scores may be able to identify patients who are particularly prone to respiratory complications but cannot consistently and globally predict risk in an ongoing fashion as they do not incorporate the impact of intra- and postoperative events. Current postoperative monitoring strategies are not always continuous or comprehensive and do not dependably identify all cases of respiratory impairment or mitigate their sequelae, which may be severe and require the use of increasingly limited intensive care unit resources. As a result, postoperative respiratory impairment has the potential to cause significant downstream effects that can increase cost and adversely impact the care of other patients.

    View details for PubMedID 29853871

    View details for PubMedCentralID PMC5952562

  • Barosinusitis: Comprehensive review and proposed new classification system. Allergy & rhinology (Providence, R.I.) Vaezeafshar, R., Psaltis, A. J., Rao, V. K., Zarabanda, D., Patel, Z. M., Nayak, J. V. 2017; 8 (3): 109?17

    Abstract

    Barosinusitis, or sinus barotrauma, may arise from changes in ambient pressure that are not compensated by force equalization mechanisms within the paranasal sinuses. Barosinusitis is most commonly seen with barometric changes during flight or diving. Understanding and better classifying the pathophysiology, clinical presentation, and management of barosinusitis are essential to improve patient care.To perform a comprehensive review of the available literature regarding sinus barotrauma.A comprehensive literature search that used the terms "barosinusitis," "sinus barotrauma," and "aerosinusitis" was conducted, and all identified titles were reviewed for relevance to the upper airway and paranasal sinuses. All case reports, series, and review articles that were identified from this search were included. Selected cases of sinus barotrauma from our institution were included to illustrate classic signs and symptoms.Fifty-one articles were identified as specifically relevant to, or referencing, barosinusitis and were incorporated into this review. The majority of articles focused on barosinusitis in the context of a single specific etiology rather than independent of etiology. From analysis of all the publications combined with clinical experience, we proposed that barosinusitis seemed to fall within three distinct subtypes: (1) acute, isolated barosinusitis; (2) recurrent acute barosinusitis; and (3) chronic barosinusitis. We introduced this terminology and suggested independent treatment recommendations for each subtype.Barosinusitis is a common but potentially overlooked condition that is primed by shifts in the ambient pressure within the paranasal sinuses. The pathophysiology of barosinusitis has disparate causes, which likely contribute to its misdiagnosis and underdiagnosis. Available literature compelled our proposed modifications to existing classification schemes, which may allow for improved awareness and management strategies for barosinusitis.

    View details for PubMedID 29070267

  • Comparative effectiveness of epsilon-aminocaproic acid and tranexamic acid on postoperative bleeding following cardiac surgery during a national medication shortage JOURNAL OF CLINICAL ANESTHESIA Blaine, K. P., Press, C., Lau, K., Sliwa, J., Rao, V. K., Hill, C. 2016; 35: 516-523

    Abstract

    The aim of this study was to compare the effectiveness of epsilon-aminocaproic acid (?ACA) and tranexamic acid (TXA) in contemporary clinical practice during a national medication shortage.A retrospective cohort study.The study was performed in all consecutive cardiac surgery patients (n=128) admitted to the cardiac-surgical intensive care unit after surgery at a single academic center immediately before and during a national medication shortage.Demographic, clinical, and outcomes data were compared by descriptive statistics using ?(2) and t test. Surgical drainage and transfusions were compared by multivariate linear regression for patients receiving ?ACA before the shortage and TXA during the shortage.In multivariate analysis, no statistical difference was found for surgical drain output (OR 1.10, CI 0.97-1.26, P=.460) or red blood cell transfusion requirement (OR 1.79, CI 0.79-2.73, P=.176). Patients receiving ?ACA were more likely to receive rescue hemostatic medications (OR 1.62, CI 1.02-2.55, P=.041).Substitution of ?ACA with TXA during a national medication shortage produced equivalent postoperative bleeding and red cell transfusions, although patients receiving ?ACA were more likely to require supplemental hemostatic agents.

    View details for DOI 10.1016/j.jclinane.2016.08.037

    View details for Web of Science ID 000389785600092

    View details for PubMedID 27871586

  • Salvage Extracorporeal Membrane Oxygenation Prior to "Bridge" Transcatheter Aortic Valve Replacement. Journal of cardiac surgery Chiu, P., Fearon, W. F., Raleigh, L. A., Burdon, G., Rao, V., Boyd, J. H., Yeung, A. C., Miller, D. C., Fischbein, M. P. 2016; 31 (6): 403-405

    Abstract

    We describe a patient who presented in profound cardiogenic shock due to bioprosthetic aortic valve stenosis requiring salvage Extracorporeal Membrane Oxygenation followed by a "bridge" valve-in-valve transcatheter aortic valve replacement. doi: 10.1111/jocs.12750 (J Card Surg 2016;31:403-405).

    View details for DOI 10.1111/jocs.12750

    View details for PubMedID 27109017

  • Factor VIII Inhibitor Bypass Activity and Recombinant Activated Factor VII in Cardiac Surgery JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Rao, V. K., Lobato, R. L., Bartlett, B., Klanjac, M., Mora-Mangano, C. T., Soran, P. D., Oakes, D. A., Hill, C. C., van der Starre, P. J. 2014; 28 (5): 1221-1226

    Abstract

    Postcardiopulmonary bypass hemorrhage remains a serious complication of cardiac surgery. Given concerns regarding adverse effects of blood product transfusion and limited efficacy of current antifibrinolytics, procoagulant medications, including recombinant factor VIIa (rFVIIa) and factor eight inhibitor bypass activity (FEIBA), increasingly have been used in managing refractory bleeding. While effective, these medications are associated with thromboembolic complications. This study compared the efficacy and risk of adverse events of rFVIIa and FEIBA in cardiac surgical patients with refractory bleeding.This retrospective study evaluated 168 patients who underwent cardiac surgery and received either FEIBA or rFVIIa to manage postbypass hemorrhage. Demographic, clinical, and outcomes data were collected and statistical analysis performed to compare thromboembolic event rates, relative efficacy, and 30-day mortality following administration of these medications.Single university hospital.Patients undergoing cardiac surgery.None.Sixty-one patients received rFVIIa, and 107 received FEIBA. Demographics, surgical procedures, and preoperative anticoagulation were similar between the cohorts; however, the rFVIIa cohort had longer durations of cardiopulmonary bypass (305.1 v 243.8 min, p<0.01). There were no significant differences in the number of thromboembolic events, 30-day mortality, or rates of revision surgery. Neither group demonstrated a clear relationship between dosage and occurrence of thromboembolic events. The rFVIIa cohort received more platelets than the FEIBA cohort (3.13 v 1.67 units, p = 0.01), but transfusion rates of other blood products were similar.This study suggests that rFVIIa and FEIBA have similar efficacy and adverse event profiles in managing intractable postbypass hemorrhage in cardiac surgical patients. Further prospective studies are required.

    View details for DOI 10.1053/j.jvca.2014.04.015

    View details for Web of Science ID 000343188500009

  • A cost study of postoperative cell salvage in the setting of elective primary hip and knee arthroplasty TRANSFUSION Rao, V. K., Dyga, R., Bartels, C., Waters, J. H. 2012; 52 (8): 1750-1760

    Abstract

    The increasing costs, limited supply, and clinical risks associated with allogeneic blood transfusion have prompted investigation into autologous blood management strategies, such as postoperative red blood cell (RBC) salvage. This study provides a cost comparison of transfusing washed postoperatively salvaged RBCs using an orthopedic perioperative autotransfusion device (OrthoPat, Haemonetics Corporation) versus unwashed shed blood and banked allogeneic blood.Cell salvage data were retrospectively reviewed for a sample of 392 patients who underwent primary hip or knee arthroplasty. Mean unit costs were calculated for washed salvaged RBCs, equivalent units of unwashed shed blood, and therapeutically equivalent volumes of allogeneic RBCs.No initial capital investment was required for the establishment of the postoperative cell salvage program. For patients undergoing total knee arthroplasty (TKA), the mean unit costs for washed postoperatively salvaged cells, unwashed shed blood, and allogeneic banked blood were $758.80, $474.95, and $765.49, respectively. In patients undergoing total hip arthroplasty (THA), the mean unit costs for washed postoperatively salvaged cells, unwashed shed blood, and allogeneic banked blood were $1827.41, $1167.41, and $2609.44, respectively.This analysis suggests that transfusing washed postoperatively salvaged cells using the OrthoPat device is more costly than using unwashed shed blood in both THA and TKA. When compared to allogeneic transfusion, washed postoperatively salvaged cells carry a comparable cost in TKA, but potentially represent a significant savings in patients undergoing THA. Sensitivity analysis suggests that in the case of TKA, however, cost comparability exists within a narrow range of units collected and infused.

    View details for DOI 10.1111/j.1537-2995.2011.03531.x

    View details for Web of Science ID 000307392800017

    View details for PubMedID 22339139

  • Recognition of local anesthetic maldistribution in axillary brachial plexus block guided by ultrasound and nerve stimulation JOURNAL OF CLINICAL ANESTHESIA Veneziano, G. C., Rao, V. K., Orebaugh, S. L. 2012; 24 (2): 141-144

    Abstract

    Nerve stimulation may occur despite the presence of a fascial barrier between the needle tip and the nerve, which may prevent appropriate flow or distribution of local anesthetic solution. During an axillary nerve block, ultrasound (US) guidance was used to identify the median nerve. Insertion of a needle with US and nerve stimulator guidance resulted in the appearance of the needle tip in contact with the nerve. However, as local anesthetic injection was begun, it was clear that the injectate was accumulating superficial to the investing fascia of the neurovascular bundle. No injectate was seen below the fascia. With US guidance, the needle was repositioned at a greater depth. Repeat injection of local anesthetic clearly flowed around the nerve.

    View details for DOI 10.1016/j.jclinane.2011.06.009

    View details for Web of Science ID 000301894600012

    View details for PubMedID 22414707

  • Analysis of major complications associated with arterial catheterisation QUALITY & SAFETY IN HEALTH CARE Salmon, A. A., Galhotra, S., Rao, V., DeVita, M. A., Darby, J., Hilmi, I., SIMMONS, R. L. 2010; 19 (3): 208-212

    Abstract

    Arterial catheterisation is used for continuous haemodynamic monitoring in patients undergoing surgery and in critical care units. Although it is considered a safe procedure, a major complication such as arterial occlusion and limb gangrene can occur.To determine the incidence, outcome and potential to avoid complications associated with arterial catheterisation.The number of arterial catheterisation was determined using an anaesthesiology and critical care medicine billing database over a period of 4 years (1 January 2003 to 31 December 2006). Possible major complications were identified from two hospital databases; all identified charts were screened and then reviewed by an expert panel that determined causation. A major complication was defined as requiring operative intervention and/or resulting in permanent harm.15 (0.084%) major complications were identified among 17 840 instances of arterial catheterisation insertions. Of 15 arterial catheterisations, nine were performed in the operating room and six in the intensive care unit. Nine patients suffered ischaemic injury, which progressed to gangrene in three patients. Three patients developed haematoma that required surgical evacuation; two of these required vascular repair. One patient had compartment syndrome requiring fasciotomy and two patients had sheared catheter fragments that needed to be removed. All 15 patients had multiple comorbidities, and those in the operating room had an American Society of Anesthesiologists score of >or=3. Seven (46.6%) had arterial catheterisation done under emergent circumstances. Six (40%) died during hospitalisation because of complications unrelated to arterial catheterisation.Arterial catheterisation had a very low rate of major complications. They seem associated with high severity of illness and emergency surgery.

    View details for DOI 10.1136/qshc.2008.028597

    View details for Web of Science ID 000279355700010

    View details for PubMedID 20194221

Footer Links:

Stanford Medicine Resources: