Bio

Clinical Focus


  • Anesthesia
  • Regional Anesthesia

Academic Appointments


Professional Education


  • Fellowship:Stanford Hospital and ClinicsCA
  • Fellowship:Stanford Medical Center - Anesthesia (2014) CA
  • Residency:Stanford University Hospital - Anesthesia Dept (2013) CA
  • Internship:Jackson Memorial Hosp (2009) FL
  • Medical Education:University of Miami School of Medicine (2008) FL

Publications

Journal Articles


  • Risk factors for respiratory depression in patients undergoing retrobulbar block for vitreoretinal surgery. Ophthalmic surgery, lasers & imaging retina Silva, R. A., Leng, J. C., He, L., Brock-Utne, J. G., Drover, D. R., Leng, T. 2015; 46 (2): 243-7

    Abstract

    To determine the risk factors for respiratory depression during retrobulbar block administration before vitreoretinal surgery.Prospective, observational case series of 113 patients undergoing monitored anesthesia care and retrobulbar block before vitreoretinal surgery at a tertiary medical center.Chin lift, jaw thrust, and bag mask ventilation were performed in eight (7.1%), nine (8%), and six (5.3%) patients, respectively. No patients required intubation. Age, sex, body mass index, history of obstructive sleep apnea, American Society of Anesthesiologists physical status level, and baseline oxygen saturation were not predictive of airway intervention. Of the four anesthetic agents utilized (midazolam, fentanyl, alfentanil, and propofol), only propofol and fentanyl were associated with an increased risk for clinically significant apnea. Use of three medications for sedation was associated with a 5.4-fold increase in the relative risk of requiring a respiratory rescue intervention.During preoperative sedation for retrobulbar block administration, the use of propofol, fentanyl, or a combination of three anesthetics is associated with a statistically significant increase in the risk for respiratory depression requiring resuscitation. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:243-247.].

    View details for DOI 10.3928/23258160-20150213-22

    View details for PubMedID 25707051

  • A pilot study to assess adductor canal catheter tip migration in a cadaver model. Journal of anesthesia Leng, J. C., Harrison, T. K., Miller, B., Howard, S. K., Conroy, M., Udani, A., Shum, C., Mariano, E. R. 2014

    Abstract

    An adductor canal catheter may facilitate early ambulation after total knee arthroplasty, but there is concern over preoperative placement since intraoperative migration of catheters may occur from surgical manipulation and result in ineffective analgesia. We hypothesized that catheter type and subcutaneous tunneling may influence tip migration for preoperatively inserted adductor canal catheters. In a male unembalmed human cadaver, 20 catheter insertion trials were divided randomly into one of four groups: flexible epidural catheter either tunneled or not tunneled; or rigid stimulating catheter either tunneled or not tunneled. Intraoperative patient manipulation was simulated by five range-of-motion exercises of the knee. Distance and length measurements were performed by a blinded regional anesthesiologist. Changes in catheter tip to nerve distance (p = 0.225) and length of catheter within the adductor canal (p = 0.467) were not different between the four groups. Two of five non-tunneled stimulating catheters (40 %) were dislodged compared to 0/5 in all other groups (p = 0.187). A cadaver model may be useful for assessing migration of regional anesthesia catheters; catheter type and subcutaneous tunneling may not affect migration of adductor canal catheters based on this preliminary study. However, future studies involving a larger sample size, actual patients, and other catheter types are warranted.

    View details for DOI 10.1007/s00540-014-1922-7

    View details for PubMedID 25288506

  • An Anesthesia Resident's Prayer. Anesthesiology Leng, J. C. 2013; 119 (2): 483-?

    View details for DOI 10.1097/ALN.0b013e31829b36c2

    View details for PubMedID 23719614

Presentations


  • Monitored Anesthesia Care for Vitreoretinal Surgeries: Which Technique is Safest?

    Many ophthalmology cases require anesthesiology assistance for monitored anesthesia care (MAC). In our institution, the majority of vitreoretinal surgeries involve providing fast-acting anesthetics immediately prior to placement of retrobulbar blocks. In some cases, anesthesia providers were intervening with chin lift, jaw thrust, or mask ventilation after block placement. The purpose of our study was to investigate which, if any, combination of anesthetics provides adequate analgesia while minimizing the need for airway intervention.  

    Time Period

    10/12/2013

    Presented To

    American Society of Anesthesiologists (ASA) Annual Meeting

    Location

    San Francisco, CA

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