A5026327063- Congenital Heart Disease Studies
- Anesthesia and Neurotoxicity Research
- Cardiac, Anesthesia and Surgical Outcomes
- Pulmonary Hypertension Research and Treatments
- Anesthesia and Sedative Agents
- Congenital Diaphragmatic Hernia Studies
- Cardiac Structural Anomalies and Repair
- Intensive Care Unit Cognitive Disorders
- Tracheal and airway disorders
- Congenital heart defects research
- Cardiac Valve Diseases and Treatments
- Cardiac Arrhythmias and Treatments
- Vascular anomalies and interventions
- Aortic Disease and Treatment Approaches
- Neuroscience and Neuropharmacology Research
- Mechanical Circulatory Support Devices
- Cardiovascular Issues in Pregnancy
- Cardiac and Coronary Surgery Techniques
- Coronary Artery Anomalies
- Cardiovascular Conditions and Treatments
- Cardiac Ischemia and Reperfusion
- Congenital Anomalies and Fetal Surgery
- Cardiac pacing and defibrillation studies
- Electrolyte and hormonal disorders
- Pediatric Hepatobiliary Diseases and Treatments
Stanford University
2013-2023
Stanford Medicine
2009-2023
Lucile Packard Children's Hospital
2014-2022
Palo Alto University
2017-2022
University of Colorado Denver
2009-2010
Children's Hospital Colorado
2009-2010
Duke University
2004-2009
University of Colorado Health
2009
Boston Children's Hospital
2001-2005
Harvard University
2001-2004
Tetralogy of Fallot with major aortopulmonary collateral arteries is a complex and heterogeneous condition. Our institutional approach to this lesion emphasizes early complete repair the incorporation all lung segments extensive lobar segmental pulmonary artery reconstruction.We reviewed patients who underwent surgical intervention for tetralogy at Lucile Packard Children's Hospital Stanford (LPCHS) since November 2001. A total 458 surgery, 291 (64%) whom their initial procedure LPCHS....
In Brief Prolonged exposure of postnatal day (PND) 7 rat pups to anesthetics, which act via N-methyl-d-aspartate antagonism and/or γ-amino butyric acid enhancement, causes neurodegeneration and persistent behavioral deficits. We studied these findings in vitro determined whether the age used for study or duration anesthetic modulates resultant neurodegeneration. Organotypic hippocampal slices (OHSs) were prepared from on PNDs 4, 7, 14 cultured days vitro. The exposed 1.5% isoflurane fresh...
Both in vitro and vivo evidence supports the reduction of early ischemic, both global focal, brain injury by volatile anesthetics. However, protection afforded anesthetics later neuronal death, i.e., apoptosis, caused ischemia has not been investigated. We induced oxygen glucose deprivation cortical cell cultures prepared from newborn rats on Days 10–14. This hypoxic (Po2 <50 mm Hg) condition was maintained continuously (30, 60, 90 min). In a separate experiment, were exposed to isoflurane...
Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated electrolyte imbalance compounded by over- or underhydration. In this study authors developed prospectively evaluated a multidisciplinary approach to management of DI comparison 19 historical control children. Eighteen either preoperative undergoing neurosurgical operations high risk for developing postoperative were identified managed using standardized protocol. all patients...
To evaluate the utility of Cook airway exchange catheter (CAEC) for extubation/reintubation in pediatric patients with a known difficult airway.Prospective, nonrandomized.Pediatric intensive care unit; single academic institution.Twenty intubated children </=18 yrs age requiring extubation.The CAEC was inserted into trachea before extubation who were at risk reintubation. The provided means "guided" reintubation while maintaining ability to provide supplemental oxygenation directly...
The GABA(A) receptor subunit composition undergoes a switch from predominantly alpha2 to alpha1 around postnatal day (PND) 7 in rat pup. This developmental the changes kinetics and pharmacologic properties of receptor. Using organotypic hippocampal slice model, we hypothesized that may promote neurodegeneration after exposure sevoflurane.Organotypic slices (OHS) were prepared pups on PND 4, 7, 14 exposed 2.0% sevoflurane or air for 5 hours. Hippocampal CA1, CA3, dentate gyrus neuronal...
Anesthetic neurotoxicity has been a hot topic in anesthesia for the past decade. It is of special interest to pediatric anesthesiologists. A subgroup children potentially at greater risk anesthetic neurotoxicity, based on prolonged exposure early development, are those receiving surgical repair congenital heart disease. These have known neurologic deficit after cardiopulmonary bypass Yet, type used not considered as potential etiology their deficits. only receive during repair, but also...
Abstract Background: Children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collaterals (TOF/MAPCAs) are at risk for post-operative respiratory complications after undergoing unifocalisation surgery. Thus, we assessed further defined the incidence airway abnormalities in our series over 500 children TOF/MAPCAs as determined by direct laryngoscopy, chest computed tomography (CT), and/or bronchoscopy. Methods: The medical records all patients who underwent or artery...
Multi-institutional databases and registries have proliferated over the last decade in all specialties of medicine. They may be especially helpful low-frequency/high-acuity fields such as pediatric congenital heart diseases. The Society Thoracic Surgeon’s Congenital Heart Surgery Database (STSCHSD) is largest single data set for disease population includes contemporaneous from 120 programs United States (and several outside States), capturing greater than 98% cardiac surgical procedures...
Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated electrolyte imbalance compounded by over- or underhydration. In this study authors developed prospectively evaluated a multidisciplinary approach to management of DI comparison 19 historical control children. Eighteen either preoperative undergoing neurosurgical operations high risk for developing postoperative were identified managed using standardized protocol. all patients...
Neuronal cell death may occur via two pathways: those causing necrosis or apoptosis. Apoptosis can be activated during periods of stress such as oxygen and glucose deprivation. Anesthetic agents desflurane sevoflurane attenuate early neuronal necrotic death, but their effect on deprivation-induced apoptosis has not been investigated. cultures were prepared from neonatal rat cortex used between 10 14 days in vitro. The pretreated 30 minutes prior to deprivation with either (N = 18). Three...
Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collaterals (TOF/PA/MAPCAs) is a heterogeneous disease varying degrees severity, requiring complex anesthetic management. Our institution has adopted the approach early complete repair incorporation all lung segments, extensive lobar branch segmental artery reconstruction, ventricular septal defect closure. While surgical management TOF/PA/MAPCAs been extensively described varies depending on institution, there paucity...
Children with Tetralogy of Fallot, Pulmonary Atresia, and Major Aortopulmonary Collaterals (TOF/PA/MAPCAs) undergoing unifocalization surgery are at risk for developing more postoperative respiratory complications than children other types congenital heart surgery. Bronchoscopy is used in the perioperative period diagnostic therapeutic purposes. In this study, we describe bronchoscopic findings identify factors associated selection bronchoscopy.Retrospective case-control.All patients...
Volatile anesthetics reduce acute excitotoxic cell death in primary neuronal/glial cultures. We hypothesized that cells protected by isoflurane against N-methyl-d-aspartate (NMDA)-induced necrosis would instead become apoptotic. Primary mixed cultures prepared from fetal rat brain were exposed to dissolved (0 mM, 0.4 mM [1.8 minimum alveolar anesthetic concentration], or 1.6 [7 concentration]) and NMDA 100 microM) at 37 degrees C for 30 min. Dizocilpine (10 plus microM served as a positive...