Bio

Clinical Focus


  • Anesthesia
  • Anesthesia for otolaryngologic and neurotologic surgery, head and neck cancer surgery, obstructive sleep apnea surgery, maxillofacial and orthognatic surgery, facial aesthetic surgery.

Academic Appointments


Professional Education


  • Board Certification: Anesthesia, American Board of Anesthesiology (1997)
  • Residency:UCSF Medical Center (1996) CA
  • Internship:California Pacific Medical Center (1993) CA
  • Medical Education:Pavlov Medical School (1979) Russia

Research & Scholarship

Clinical Trials


  • Postoperative Pain and Functional Patient Outcomes After Functional Endoscopic Sinus Surgery Not Recruiting

    The aim of the study is to quantify postoperative pain after functional endoscopic sinus surgery (FESS) and investigate whether preemptive analgesia may positively impact intraoperative anesthetic management, decrease patient postoperative pain and discomfort, and improve patient functional outcomes.

    Stanford is currently not accepting patients for this trial. For more information, please contact David Drover, (650) 725 - 0364.

    View full details

Teaching

2013-14 Courses


Publications

Journal Articles


  • The Analgesic and Antihyperalgesic Effects of Transcranial Electrostimulation with Combined Direct and Alternating Current in Healthy Volunteers ANESTHESIA AND ANALGESIA Nekhendzy, V., Lemmens, H. J., Tingle, M., Nekhendzy, M., Angst, M. S. 2010; 111 (5): 1301-1307

    Abstract

    Transcranial electrostimulation (TES) has been reported to produce clinically significant analgesia, but randomized and double-blind studies are lacking. We investigated the analgesic and antihyperalgesic effects of TES in validated human experimental pain models.In 20 healthy male subjects we evaluated the analgesic and antihyperalgesic effects of TES(60Hz) and TES(100Hz) to heat and mechanical pain in experimentally induced ultraviolet B skin sunburns and in normal skin. Previous animal studies in our laboratory predicted that TES(60Hz) would provide significant analgesia, and TES(100Hz) was a suitable active control. The study was conducted in a double-blind, randomized, 2-way cross-over fashion. TES was administered for 35 minutes. Quantitative sensory testing evaluating heat and mechanical pain thresholds was conducted before TES, during TES, and 45 minutes after TES.TES (TES(60Hz) > TES(100Hz)) evoked rapidly developing, significant thermal and mechanical antihyperalgesic effects in the ultraviolet B lesion, and attenuated thermal pain in unimpaired skin. No long-lasting analgesic and antihyperalgesic effects of a single TES treatment were demonstrated in this study.TES produces significant, frequency-dependent antihyperalgesic and analgesic effects in humans. The characteristics of the TES effects indicate a high likelihood of its ability to modulate both peripheral sensitization of nociceptors and central hyperexcitability.

    View details for DOI 10.1213/ANE.0b013e3181e3697e

    View details for Web of Science ID 000283675000034

    View details for PubMedID 20530614

  • The effect of deliberate hypercapnia and hypocapnia on mtraoperative blood loss and quality of surgical field during functional endoscopic sinus surgery ANESTHESIA AND ANALGESIA Nekhendzy, V., Lemmens, H. J., Vaughan, W. C., Hepworth, E. J., Chiu, A. G., Church, C. A., Brock-Utne, J. G. 2007; 105 (5): 1404-1409

    Abstract

    Anesthetic management during functional endoscopic sinus surgery is aimed at minimizing bleeding and establishing a near-perfect surgical field. We investigated whether deliberate intraoperative hypercapnia and hypocapnia may affect blood loss and quality of surgical field through a proposed modulating effect of different carbon dioxide (CO2) tension levels on nasal vasculature.One hundred and eighty patients were randomly assigned to normocapnia (end-tidal CO2 [ETco2] 37 +/- 2 mm Hg), hypercapnia (ETco2 60 +/- 2 mm Hg), and hypocapnia (ETco2 27 +/- 2 mm Hg) groups. Anesthetic management was with propofol and remifentanil infusions, nitrous oxide, and moderate controlled hypotension. Blood loss and operating conditions were assessed by the surgeon who was blinded to group assignment. Differences among the study groups, the effect of the study group and time on ETco2 levels and hemodynamic variables, and the association of blood loss with surgical covariates were analyzed.There were no differences in blood loss and quality of surgical field among the study groups. Patients in the hypocapnia group demonstrated the highest, and in the hypercapnia group, the lowest, requirements for remifentanil, labetalol, and administration of the antihypertensive medications in general. The computed tomography-graded severity of sinonasal disease and duration of surgery were the only independent predictors of intraoperative blood loss.CO2 management during functional endoscopic sinus surgery does not influence operating conditions or blood loss.

    View details for DOI 10.1213/01.ane.0000282781.56025.52

    View details for Web of Science ID 000250317500037

    View details for PubMedID 17959973

  • Flash Pulmonary Edema: An Unusual Presentation during Orthognathic Surgery PLASTIC AND RECONSTRUCTIVE SURGERY Broujerdi, J. A., Keifa, E., Nekhendzy, V., Schendel, S. A. 2007; 119 (6): 133E-137E
  • The role of the craniospinal nerves in mediating the antinociceptive effect of transcranial electrostimulation in the rat ANESTHESIA AND ANALGESIA Nekhendzy, V., Davies, M. F., Lemmens, H. J., Maze, M. 2006; 102 (6): 1775-1780

    Abstract

    Transcranial electrostimulation (TES) has been reported to elicit significant analgesia, but its mechanism of action has not been elucidated. In a recently introduced clinically relevant rat model of TES we have validated and characterized the TES antinociceptive effect, suggesting involvement of the sensory nerves of the rat's scalp in mediating that effect. In this study, we have further investigated the role of the craniospinal nerves by attempting to block the TES antinociceptive effect with local anesthetic injected under the TES electrodes. We also applied different transcutaneous electrical nerve stimulation modalities through the TES electrodes and compared the elicited antinociceptive effect to that of TES. The antinociceptive effect was assessed by measuring nociceptive thresholds in the tail-flick latency test in awake, unrestrained male rats. Data were analyzed by one-way analysis of variance followed by the Bonferroni t-test. The TES antinociceptive effect was significantly reduced after local anesthetic injection, and administration of 100 Hz transcutaneous electrical nerve stimulation was, over time, capable of eliciting the same degree of antinociceptive effect as TES. We conclude that sensory craniospinal nerves play a critical role in mediating the TES antinociceptive action and offer a hypothesis on the underlying mechanism(s) responsible for this action.

    View details for DOI 10.1213/01.ANE.0000219588.25375.36

    View details for Web of Science ID 000237859300033

    View details for PubMedID 16717325

  • The antinociceptive effect of transcranial electrostimulation with combined direct and alternating current in freely moving rats ANESTHESIA AND ANALGESIA Nekhendzy, V., Fender, C. P., Davies, M. F., Lemmens, H. J., Kim, M. S., Bouley, D. M., Maze, M. 2004; 98 (3): 730-737

    Abstract

    Transcranial electrostimulation (TES) has been reported to elicit significant analgesia, allowing a substantial reduction of intraoperative opioids. Acceptance of TES into clinical practice is hampered by lack of controlled clinical trials and inconclusive animal data regarding the TES antinociceptive action. This inconclusive data may be explained, in part, by failure in rat experiments to simulate the variables used in humans when TES electrodes are positioned on the skin. In this study we validated the TES antinociceptive effect in a novel animal model of cutaneously administered TES, when the stimulating conditions mimic the ones used in clinical practice. The antinociceptive effect was assessed by measuring nociceptive thresholds in the tail-flick and hot-plate latency tests in awake, unrestrained male rats. Data were analyzed by analysis of variance and mixed-effects population modeling. The administration of TES at 2.25 mA produced an almost immediate, sustained, frequency-dependent (40-60 Hz) antinociceptive effect, reaching approximately 50% of the maximal possible value. We conclude that an antinociceptive effect of cutaneously administered TES can be demonstrated in the rat. Some characteristics of the effect suggest an important role of the sensory nerves of the rat's scalp in mediating the TES antinociceptive response.Transcranial electrostimulation produces a significant, frequency-dependent antinociceptive effect that may be mediated by cutaneous nerves of the scalp.

    View details for DOI 10.1213/01.ANE.0000096007.12845.70

    View details for Web of Science ID 000189250000031

    View details for PubMedID 14980928

  • Rigid bronchoscope-assisted endotracheal intubation: Yet another use of the gum elastic bougie ANESTHESIA AND ANALGESIA Nekhendzy, V., Simmonds, P. K. 2004; 98 (2): 545-547

    Abstract

    We describe a technique by which a gum elastic bougie (GEB) is used to facilitate an anticipated difficult endotracheal intubation in a patient undergoing rigid bronchoscopy. After placing the GEB through the lumen of the rigid bronchoscope, the GEB-suction catheter assembly was used to safely withdraw the bronchoscope in a manner mimicking the withdrawal of an intubating laryngeal mask airway (LMA) over the endotracheal tube using a stabilizer rod. The rationale for management and potential advantages of this approach versus use of an airway exchange catheter (including increased stability of an intubation guide) are discussed.We describe a technique of using a gum elastic bougie to facilitate an endotracheal intubation in a patient undergoing rigid bronchoscopy, which can be useful in a variety of clinical situations when the rigid bronchoscope is used in patients with abnormal airway.

    View details for DOI 10.1213/01.ANE.0000097184.55842.C2

    View details for Web of Science ID 000188438700051

    View details for PubMedID 14742404

Conference Proceedings


  • The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery Cho, D., Drover, D. R., Nekhendzy, V., Butwick, A. J., Collins, J., Hwang, P. H. WILEY-BLACKWELL. 2011: 212-218

    Abstract

    The sphenopalatine ganglion block (SPGB) with local anesthetic is used to treat facial pain and headache of various etiologies; it has been widely used during functional endoscopic sinus surgery (FESS). The purpose of this study was to investigate whether preemptive SPGB may positively impact postoperative pain and functional outcomes after FESS.A prospective, double-blind, randomized, placebo-controlled study was performed. A total of 60 patients (18-70 years), undergoing general anesthesia for bilateral FESS, were randomly assigned to receive SPGB with either 2 mL 0.25% bupivacaine with epinephrine 1:100,000 (BP, treatment group) or normal saline (NS, control group). SPGB was performed preemptively 10 minutes before the start of surgery. Preoperative and postoperative (day 0, day 7, and day 30) visual analog pain scale, Sino-Nasal Outcome Test (SNOT-20), computed tomography (CT) and endoscopic scores were compared between the 2 groups.A total of 29 patients were enrolled in BP, and 27 were enrolled in NS. Three patients withdrew from the study, and 1 was withdrawn by the investigator due to severe hypertension after induction of anesthesia. There were no differences in patient demographic characteristics between the study groups. On day 7, the mean visual analog pain scales were 1.12 ± 0.3 in NS and 0.48 ± 0.23 in BP (p = 0.053). There were no statistical differences in other outcome measures (SNOT-20, CT and endoscopic scores) between the 2 groups.A limited trend toward reduced postoperative pain after FESS was noted with bupivacaine compared to saline, but statistical significance was not achieved. Preemptive SPGB may offer sinonasal symptomatic benefits for patients undergoing FESS, but larger studies are warranted.

    View details for DOI 10.1002/alr.20040

    View details for Web of Science ID 000308912700014

    View details for PubMedID 22287376

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