On the Frontlines of the COVID-19 Pandemic

Posted on 05/08/20 by Allied Anesthesia

Anesthesiologists are playing a vital, and in many ways, new role in fighting the COVID-19 pandemic, and many Allied Anesthesiologists are on the frontlines of that fight.

While anesthesiologists are most often associated with managing pain and safely putting patients to sleep during surgeries, today, many are working to keep patients alive and healthy in the fight against COVID-19 infections. Most often, this happens in two critical ways: working to keep patients off ventilators when possible by managing the delivery of lifesaving oxygen, and intubating patients when necessary to deliver lifesaving treatment from ventilators.

Of course, Allied Anesthesiologists have earned a reputation for going above and beyond, and the COVID-19 crisis is no exception.  We’ve been leading the charge to form policies and procedures at all the hospitals we serve at, to help fight the pandemic, and to protect our patients and the healthcare workers we work side-by-side with every day.

At CHOC Children’s Hospital in Orange, our anesthesiologists have helped to arrange COVID-19 testing for all surgical patients, and at St. Joseph’s and St. Jude’s, we created policies that included ways to safely resterilize n95 masks during critical PPE shortages.

Dr. Jas Singh, Chief of Cardiothoracic Anesthesia at St. Mary’s Medical Center

In more normal times, Dr. Jas Singh is the chief of cardiothoracic anesthesia at St. Mary’s Medical Center in Apple Valley. Since early April, Dr. Singh has been leading the hospital’s COVID-19 response in the ICU. Besides managing COVID-19 patients, Dr. Singh has been helping the hospital address challenges that no hospital has faced before, in a rapidly evolving pandemic.

As information came in from anesthesiologists around the world dealing with COVID-19 patients, Dr. Singh worked with his colleagues to develop and evolve the most effective protocols for confronting the disease. That has meant everything from managing the delivery of lifesaving oxygen to finding sources of convalescent plasma from patients who have recovered from the disease to deliver antibodies to COVID-19 patients.

Fighting a largely unknown disease with a limited toolset, challenging conditions and a real personal risk of infection is no small task. As Dr. Singh said in an email to colleagues, “the past weeks have been very hard, physically and emotionally. We are literally writing the playbook on a daily basis.”

Still, even in a crisis, there are lighter moments that remind us that we’re all in this together. Like the other week, when an 11-year-old Boy Scout named Matthew raised $150 to bring pizza to the St. Mary’s ICU nurses, and the local Pizza Factory added an extra five pies to say thanks to the healthcare providers who are providing care in our region.

As we all experience challenges related to the pandemic, we’d like to take a moment to thank all the healthcare providers who are working in physically and emotionally challenging conditions, and putting themselves at risk to confront COVID-19.

Thank you for all that you do.

Doctor checking a tablet/computer for medications

Automated Software Application Improves Perioperative Controlled Substance Management

Posted on 01/30/20 by Allied Anesthesia

As healthcare professionals, we are under increasing scrutiny of medication handling, particularly in light of the opioid epidemic in the United States. In response, many hospitals and providers are undergoing efforts to make changes to their protocol, decrease errors in management and implement increased accountability mechanisms in order to decrease the risk of controlled substance diversion.

In response, the University of Michigan’s Department of Anesthesiology decided to implement an automated controlled substance management application. “An Automated Software Application Reduces Controlled Substance Discrepancies in Perioperative Areas,” published in a recent issue of Anesthesiology, recorded the observations from this single-center implementation. The results reveal a hopeful trajectory for our industry, concluding:

“A software application that tracks perioperative controlled substance kits with deep integration into the electronic health record and pharmacy systems is associated with a decrease in management errors.”[i]

The Site of the Study 

The University of Michigan’s Department of Anesthesiology is a tertiary care center with approximately 450 anesthesia providers and 30 pharmacy staff. Annually, they conduct 85,000 procedures per year and administer “more than one million doses of controlled substances annually across six geographically distinct facilities (adult and pediatric inpatient facilities and several ambulatory surgery centers) and more than 100 anesthetizing locations.”[ii]

The Data

Over a more than two-year period (from December 1, 2014 to March 31, 2017), the authors of this study “obtained missing controlled substance medication, controlled substance kit, and witness return signature data during the pre-implementation, implementation, and study period of the controlled substance management application.”[iii] They collected data from 54,302 cases during pre-implementation, 57,670 cases during implementation and 65,911 cases during the study period.

The Results

Most significantly, after the software was implemented on site, there was a decrease in the number of kit return errors and missing medications:

“The number of missing controlled substance medication (difference 0.7 per 1,000 cases; 95% CI, 0.38–1.02; P < 0.001) and kit return errors (difference 0.45 per 1,000 cases; 95% CI, 0.24–0.66, P < 0.001) declined after implementation of the application.”[iv] [emphasis ours]

Additionally, a user (provider) survey, with a 42% response rate, showed that providers found that the new automated software “managed controlled substances better than the previous system.”[v] [emphasis ours]


Of course, the cost of implementation, including technical infrastructure, is always a key consideration. The study reports that the overall implementation cost was approximately $500,000, with ongoing maintenance and support approximately $50,000 per year (across 100+ anesthetizing sites).[vi]

And while the results from this study have promising implications, today — beyond this single site study — little data are available to support the use of automated, web-based software applications for the management of controlled substances. In order to validate the findings, additional similar studies are needed in the future as our industry moves toward a more robust management of controlled substances within our care.

At all of Allied Anesthesiology’s institutions and surgery centers, we are extremely vigilant about narcotic accounting and integration, checking and balancing inventory counts to usage. As a company, we enforce drug testing when appropriate to ensure that our patients stay safe, doing everything possible to prevent these types of events from occurring.

[i] Nirav Shah, Anik Sinha, Aleda Thompson, Kevin Tremper, Arjun Meka, Sachin Kheterpal; An Automated Software Application Reduces Controlled Substance Discrepancies in Perioperative Areas. Anesthesiology 2019;131(6):1264-1275. doi: https://doi.org/10.1097/ALN.0000000000002957.[ii] Ibid[iii] Ibid
[iv] Ibid
[v] Ibid
[vi] Ibid
Surgeon analyzing a 3D image of a brain

New NIH-Funded Study Reveals That Personalizing the Definition of Hypotension May Better Protect the Brain

Posted on 01/23/20 by Allied Anesthesia

What if clinicians could move beyond the current one-size-fits-all approach to monitoring a patient’s blood pressure in the operating room? What if we were given the tools for personalizing each patient’s definition of hypotension? As you are fully aware, determining a true “baseline” blood pressure is challenging in the operating room — as anesthesiologists, it is one of the constant pressures of our profession.

While the 2018 Wesselink et al.[1] systematic review of the literature was important for synthesizing what we know about blood pressure cutoffs in relation to adverse patient outcomes after noncardiac surgery, its synthesis does not provide evidence that a single threshold for hypotension applies to all patients.

Why Do We Need a New Method?

Why do we need a better method for defining and approaching intraoperative hypotension? Because, as you know, intraoperative hypotension is connected to poor patient outcomes. For example, hypotension can be a cause of organ injury. It can also “exacerbate injury from other sources such as embolism (i.e., thrombo- or atheromatous embolism).” There are also data showing a relationship between low mean arterial pressure (MAP) “during cardiac surgery using cardiopulmonary bypass (CPB) and adverse patient outcomes including stroke and acute kidney injury.”[2]

“Simply raising contemporary MAP targets during surgery may result in a MAP that is higher than the upper limit of autoregulation in some patients. In this situation, cerebral blood flow will increase proportionally with MAP, potentially leading to cerebral hyperperfusion, a situation that is associated with cerebral edema and brain dysfunction in nonsurgical patients.”[3]

And the list of complications and poor patient outcomes continues.

The Study

Seeking to address the fact that applying a single threshold for hypotension to all patients is unsubstantiated by the data, a new study argues against the current industry standard: maintaining a mean arterial pressure (MAP) of “more than 80 mmHg in all patients in all clinical situations.”

Personalizing the Definition of Hypotension to Protect the Brain” — a study funded in part by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health — advances a new method for “potentially defining hypotension individually based on monitoring cerebral blood flow autoregulation.”

Their method advocates for “defining hypotension based on arbitrary or population-driven thresholds.”

The research was conducted mainly in cardiac surgery settings in which an arterial catheter was available for direct blood pressure monitoring. Their methods included “correlating low frequency changes in cerebral blood flow with MAP not systolic or diastolic blood pressure.”

Key Findings

This study has accomplished the following:

  1. validated clinically feasible methods of cerebral blood flow autoregulation in laboratory animals and humans;
  2. demonstrated a relationship between a MAP outside the autoregulation boundaries and brain dysfunction and other organ injury; and
  3. shown that acting on MAP that is lower than the lower limit of autoregulation during cardiac surgery reduces the frequency of delirium after surgery.[4]

It should be noted that the majority of this research was conducted in cardiac surgery settings and may not be applicable in other settings. Given those limitations, as well as the fact that a clinically available autoregulation monitor does not currently exist, the researchers note:

“We have found that the ‘optimal MAP’ (i.e., MAP with the most robust autoregulation or the lowest mean velocity index) during CPB in adults is (mean ± SD) 78 ± 11 mmHg (g. 2). The results of our studies of 617 patients undergoing cardiac surgery found that the average (±SD) lower limit of autoregulation was 65 ± 12 mmHg, and the average upper limit of autoregulation was 84 ± 11 mmHg.”[5]


While current data continues to suggest that there are limitations to deploying “a single blood pressure cutoff for a wide population of patients because the individual’s lower limit of autoregulation may or may not be above this arbitrary cutoff,” the study’s authors admit that in the meantime, like all of us, they will continue to use this method until an FDA-approved monitor for autoregulation data in the operating room can be developed, tested and put into practice. As always, the researchers call for more research to “confirm and extend” these promising results.

At Allied, patient safety is our top priority. We do everything we can to ensure proper cerebral or coronary blood flow (CBF) in our patients and continually monitor our patients to ensure the best of outcomes. When necessary, our Allied Anesthesiologists will monitor beat-to-beat fluctuations in blood pressure using an arterial catheter to ensure blood pressure never falls or rises to dangerous levels; and we treat these fluctuations when appropriate.


[1] Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA: Intraoperative hypotension and the risk of postoperative adverse outcomes:A systematic review. Br J Anaesth 2018; 121:706–21

[2] Reich DL, Bodian CA, Krol M, Kuroda M, Osinski T, Thys DM: Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery. Anesth Analg 1999; 89:814–22

Rettig TCD, Peelen LM, Geuzebroek GSC, van Klei WA, Boer C, van der Veer JW, Ho and J, van de Garde EMW, Noordzij PG: Impact of intraoperative hypotension during cardiopulmonary bypass on acute kidney injury after coronary artery bypass grafting. J Cardiothorac Vasc Anesth 2017; 31:522–8

Gottesman RF, Sherman PM, Grega MA, Yousem DM, Borowicz LM Jr, Selnes OA, Baumgartner WA, McKhann GM: Watershed strokes after cardiac surgery: Diagnosis, etiology, and outcome. Stroke 2006; 37:2306–11

Sun LY, Chung AM, Farkouh ME, van Diepen S, Weinberger J, Bourke M, Ruel M: Defining an intraoperative hypotension threshold in association with stroke in cardiac surgery. Anesthesiology 2018; 129:440–7

[3] Miller JB, Suchdev K, Jayaprakash N, Hrabec D, Sood A, Sharma S, Levy PD: New developments in hypertensive encephalopathy. Curr Hypertens Rep 2018; 20:13

[4] Brady KM, Mytar JO, Lee JK, Cameron DE,Vricella LA, Thompson WR, Hogue CW, Easley RB: Monitoring cerebral blood flow pressure autoregulation in pediatric patients during cardiac surgery. Stroke 2010; 41:1957–62

Brady KM, Lee JK, Kibler KK, Smielewski P, Czosnyka M, Easley RB, Koehler RC, Shaffner DH: Continuous time-domain analysis of cerebrovascular autoregulation using near-infrared spectroscopy. Stroke 2007; 38:2818–25

Ono M, Arnaoutakis GJ, Fine DM, Brady K, Easley RB, Zheng Y, Brown C, Katz NM, Grams ME, Hogue CW: Blood pressure excursions below the cerebral autoregulation threshold during cardiac surgery are associated with acutekidneyinjury.CritCareMed2013;41:464–71

Ono M, Brady K, Easley RB, Brown C, Kraut M, Gottesman RF, Hogue CW Jr: Duration and magni- tude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality.JThorac Cardiovasc Surg 2014; 147:483–9

Hori D, Brown C, Ono M, Rappold T, Sieber F, Gottschalk A, Neufeld KJ, Gottesman R, Adachi H, Hogue CW:Arterial pressure above the upper cerebral autoregulation limit during cardiopulmonary bypass is associated with postoperative delirium. Br J Anaesth 2014; 113:1009–17

Hori D, Ono M, Rappold TE, Conte JV, Shah AS, Cameron DE, Adachi H, Everett AD, Hogue CW: Hypotension after cardiac operations based on auto- regulation monitoring leads to brain cellular injury. Ann Thorac Surg 2015; 100:487–93

Brown CI, Neufeld K,Tian J, Probert J, La am A, Max L, Hori D, Nomura Y, Mandal K, Brady K, Hogue C: Targeting mean arterial pressure during cardiopulmonary bypass using cerebral autoregulation monitoring to reduce delirium. JAMA Surg 2019; 154:819–26

[5] Hori D, Nomura Y, Ono M, Joshi B, Mandal K, Cameron D, Kocherginsky M, Hogue CW: Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring. J Thorac Cardiovasc Surg 2017; 154:1590–8

Operating room with surgeons and anesthesiologist

The Most Critical Factor in Tracheal Intubation: Your Clinical Judgment, Planning and Preparation

Posted on 12/17/19 by Allied Anesthesia

As long as the field of anesthesiology has been around, so has been the two-fold challenge: intubation and oxygenation. If you have been in practice for any amount of time, you are quite familiar with “can’t intubate, can’t oxygenate” emergencies. Tracheal intubation is difficult if not, at times, downright impossible. This is a given that comes with the territory. So, what can we do about it?

First, what can we learn from the history of tracheal intubation, and where can we go from there?

As you may know, in 1993, the first difficult airway guideline — the Peterson report [i] — was published. It has subsequently been updated twice. In our field, we have also recently seen the invention of video laryngoscopies as well as supraglottic airway devices, both aimed at making the role of the anesthesiologist less difficult in achieving the flawless tracheal intubation.

What Is Difficult Intubation and Why Does This Matter?

Difficult intubation is defined as multiple attempts at tracheal intubation, or failed intubation. In a study [ii] conducted by Peterson et al. of cases (that led to claims) that occurred between 2000 and 2012, difficult intubation was identified as the primary damaging event leading to patient injury. Patient injury ranges from tracheal injury to brain damage to death.

The Critical Factor: Your Clinical Judgment, Planning and Preparation

The most important finding in this study is something completely within your power. This study found that the judgment of the anesthesiologist was by far one of the most important, and critical, factors leading to poor surgical outcomes. Here’s what the study, Management of Difficult Tracheal Intubation: A Closed Claims Analysis, found:

“Almost three fourths of 2000 to 2012 claims exhibited judgment failures, including lack of a proper airway management plan and, during a ‘can’t intubate, can’t oxygenate’ emergency, the failure to utilize a supraglottic airway as a bridge to oxygenation and delay in attempting a surgical airway.”

While “deficiencies in clinical judgment” occurred in the majority of recent claims (73%; n = 71 of 97) that could be adequately assessed in the study, this North American study is not alone or unique in its findings. The Danish Anesthesia Database produced similar findings (over a six-year study period) [iii] — as well as the Fourth National Audit Project of the Royal College of Anaesthetists in the United Kingdom, which found that “nontechnical skill deficits” were major contributors to poor patient outcomes. [iv]

What Can Be Done About Judgment Errors? Make an Airway Strategy

First, be aware of their high probability, the likelihood for occurrence within the area of tracheal intubation. Plan for it. The study[v] found that “a lack of adequate planning for intubation difficult or failure” contributed to poor outcomes. This is something that we have the power to change.

1. Formulate an Airway Strategy

Do you have an airway strategy, or a coordinated series of airway plans that you can turn to in case of difficulties? It is of particular importance that this airway strategy be in place when your patient presents preoperative predictors of difficulty.

Making an airway strategy includes situational awareness. What factors are present in your context? What equipment do you have on hand? Do you have the skills to use other devices should your device of choice fail you? Are you lacking in a secondary device should your primary device(s) fail? Are you and your team able (as well as willing and prepared) to move on — and quickly — if the technique you are using is not working?

Remember, current guidelines suggest that anesthesiologists deploy a supraglottic device while concurrently preparing “to perform an immediate emergency ‘surgical airway’” should the supraglottic airway fail.[vi]

Are you prepared to do that — have you been implementing this best practice in your operating room?

2. Get Familiar With All of Your Equipment

Get to know all of the equipment available to you.

 “Practitioners must familiarize themselves with locally available airway equipment, which should be placed appropriately within the construct of published difficult airway guidelines. Simple task trainers and/or dedicated manikins should be used to train appropriate handling of this equipment.”[vii]

Have dress rehearsals. Rehearse. Practice makes perfect. So, practice the correct application of your equipment. Plan for difficult — and seemingly impossible — airway situations. With your team, focus on applying and honing your technical skills.

3. Don’t Be Ashamed to Use Cognitive Aids

Teams should consider practicing managing “the inevitable” airway emergency as well as deploying cognitive aids in the operating room.[viii] “Incorporation of cognitive aids specific to difficult airway management may cue practitioners to the need to move on to another plan in their airway strategy while ‘in the heat of the moment.’”[ix]


Today, practitioners are presented with the opportunity to stop and evaluate our current practices and methodologies in light of these findings. It offers us the opportunity to reevaluate how we conduct our training for airway management and how we might implement positive changes in our future practice.



[i] Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW: Management of the di cult air- way: A closed claims analysis. Anesthesiology 2005; 103:33–9[ii] Ibid

[iii] Rosenstock C, Hansen EG, Kristensen MS, Rasmussen LS, Skak C, Østergaard D: Qualitative analysis of unanticipated di cult airway management. Acta Anaesthesiol Scand 2006; 50:290–7

[iv] Cook TM,Woodall N, Frerk C; Fourth National Audit Project: Major complications of airway management in the UK: Results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Di cult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011; 106:617–31
__Cook TM, Woodall N, Harper J, Benger J; Fourth National Audit Project: Major complications of airway management in the UK: Results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: Intensive care and emergency departments. Br J Anaesth 2011;106:632–42

[v] Aaron M. Joffe, Michael F. Aziz, Karen L. Posner, Laura V. Duggan, Shawn L. Mincer, Karen B. Domino; Management of Difficult Tracheal Intubation: A Closed Claims Analysis. Anesthesiology 2019;131(4):818-829. doi: https://doi.org/10.1097/ALN.0000000000002815.

[vi] Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A; American Society of Anesthesiologists Task Force on Management of the Di cult Airway: Practice guidelines for management of the di cult air- way: An updated report by the American Society of Anesthesiologists Task Force on Management of the Di cult Airway. Anesthesiology 2013; 118:251–70
__Law JA, Broemling N, Cooper RM, Drolet P, Duggan LV, Griesdale DE, Hung OR, Jones PM, Kovacs G, Massey S, Morris IR, Mullen T, Murphy MF, Preston R, Naik VN, Scott J, Stacey S, Turkstra TP, Wong DT; Canadian Airway Focus Group: The di cult air- way with recommendations for management–part 1–di cult tracheal intubation encountered in an unconscious/induced patient. Can J Anaesth 2013; 60:1089–118
__Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, O’Sullivan EP, Woodall NM, Ahmad I; Di cult Airway Society Intubation Guidelines Working Group: Di cult Airway Society 2015 guidelines for management of unanticipated di cult intubation in adults. Br J Anaesth 2015; 115:827–48

[vii] Joffe, Aaron M., et al.

[viii] Duggan LV, Brindley PG, Law JA: Improving communication, teamwork, and action during a “can- not intubate cannot oxygenate (CICO)” emergency: Employing CICO as a cognitive aid mnemonic. Can J Anaesth 2018; 65:1087–92

[ix] Joffe, Aaron M., et al.


Senior couple walking through the park in autumn

Moving Beyond the Question “Can You Walk Up 10 Stairs?”

Posted on 12/10/19 by Allied Anesthesia

Integrating Accelerometers and More in Your Surgical Risk Assessment

How do you typically assess a patient’s functional capacity, or their ability to perform submaximal physical daily activities prior to surgery? As you are aware, this capacity plays a major role in the perioperative cardiovascular evaluation (as well as the perioperative and postoperative management) of your surgical patients (excluding your cardiac surgery patients).

Many of us rely too heavily on the formalized questionnaire (i.e., the Duke Activity Index Status), and not enough on other, more objective methods of testing. Many of us rely on the power of standardized questions, i.e., from the Physical Functioning Questionnaire (PFQ):

  1. “Do you have difficulty walking up 10 stairs?”
  2. “Do you have difficulty walking for a quarter mile / two to three blocks?”
  3. “Do you have difficulty walking between rooms on the same floor?”

Today, the time has come, and evidence has shown that these questions (the questionnaire method) are simply inadequate and must be replaced by more stringent and helpful methodologies for accurately assessing noncardiac surgical patient risk.

Why Does Self-Reporting Result in Unclear Results?

Well, for one, patients are human beings, and they often tend to overestimate (or underestimate) their abilities. Patients do not, and cannot, always accurately report their physical capabilities and limitations. For example, in a recent study, accelerometer-based physical activity measurements were shown to be more accurate than answers to self-reported physical function questions.[i] As with any self-reporting methodology, human beings have the tendency to “fudge” — to downplay or to play up the true (factual) narrative of their lives. Therefore, it is the role of the anesthesiologist and medical practitioner to ensure that this does not happen.

“Patients may inaccurately self-report for other reasons as well including poor recall, social desirability, and misinterpretation of questions.”[ii]

While self-reporting can play a helpful role in validating your patient’s functional capacity, it should not serve as your sole source of information.

Ask the 10 Stairs Question, but Test the Results

We are not advocating that you completely eliminate your patient preop questionnaires, for they do have their benefits and their place. For example, a recent study found that “self-reported ability to walk up 10 stairs without difficulty best predicted the presence of a 2-min bout of moderate-vigorous physical activity during a week of accelerometer wear among adult participants with at least one Revised Cardiac Risk Index condition.”

However, despite this question’s high sensitivity, this single question “remains insufficiently specific to identify patients with a poor functional capacity.”[iii] Therefore, the ability to identify these patients remains your primary responsibility.

Here are two practices to consider including in your noncardiac surgical patient risk assessment in order to test the results of the self-reporting questionnaire.

Consider the Six-Minute Walking Test and the Accelerometer

At minimum, you can implement short exercise tests such as a six-minute walking test. For example, in this test, “distance is strongly correlated with the ventilatory threshold and distance can be used to risk stratify patients before major noncardiac surgery.”[iv]

Secondly, you might include an accelerometer in your practice. Preoperative accelerometers have been shown to improve patient risk assessment and perioperative care. “Accelerometers can detect the presence of moderate-vigorous physical activity, which includes the 4 metabolic equivalents threshold.”[v]


These more objective measures — accelerometers and short exercise tests — are absolutely essential for practitioners who desire more accurate perioperative risk stratification. So, despite the challenges of increased time, personnel and cost, think about how you can begin to include these measures in your practice today.



[i] Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M: Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 2008; 40:181–8

[ii] Kowalski K, Rhodes R, Naylor PJ, Tuokko H, MacDonald S: Direct and indirect measurement of physical activity in older adults: A systematic review of the literature. Int J Behav Nutr Phys Act 2012; 9:148

[iii] Daniel S. Rubin, Megan Huisingh-Scheetz, Anthony Hung, R. Parker Ward, Peter Nagele, Ross Arena, Donald Hedeker; Accuracy of Physical Function Questions to Predict Moderate-Vigorous Physical Activity as Measured by Hip Accelerometry. Anesthesiology 2019;131(5):992-1003. doi: https://doi.org/10.1097/ALN.0000000000002911.

[iv] Sinclair RC, Batterham AM, Davies S, Cawthorn 
L, Danjoux GR: Validity of the 6 min walk test in prediction of the anaerobic threshold before major non-cardiac surgery. Br J Anaesth 2012; 108:30–5; Shulman MA, Cuthbertson BH, Wijeysundera DN, Pearse RM,Thompson B,Torres E,Ambosta A,Wallace S, Farrington C, Myles PS; Measurement of Exercise Tolerance for Surgery Study Investigators: Using the 6-minute walk test to predict disability-free survival after major surgery. Br J Anaesth 2019; 122:111–9

[v] Troiano RP, et al.

Nurse holding hand with patient suffering from pulmonary complications

Consider Lower Peak Pulmonary Pressure to Improve Intraop and Postop Outcomes

Posted on 11/28/19 by Allied Anesthesia

As you know, postoperative pulmonary complications, or pulmonary injury, is a well-documented group of complications that occur after most major surgeries. With these complications come the following negative outcomes:

  1. Increased patient mortality rate by four times
  2. Increased hospital and ICU length of stay
  3. More than $20,000 in institutional expenses (per event)

Among your cardiac surgery patients, who is at risk? Well, really, everyone — for “measurable derangements in
pulmonary function” occur in nearly all patients who undergo cardiac surgery. So, given that fact, how can you
best plan for intraoperative and postoperative pulmonary complications after cardiac surgery?

3 Components of a Modern Ventilation Bundle

The practice of intraoperative lung-protective ventilation is one very important part in the process of care associated with postop pulmonary complications. Modern ventilation approaches in surgery include a bundle of three separate functions:

  • Lower tidal volumes (VT)
  • Lower peak pulmonary (or driving) pressures1
  • Positive end-expiratory pressure (PEEP)

Each function, or component, contributes independently (as well as collectively) to the reduction of postop pulmonary complications. Today, the exact contribution of each function in reducing complications in your adult cardiac surgical population is not known, and further studies are needed. However, a recent study did reveal some interesting findings regarding the total impact of the modern ventilation bundle — and, specifically, the advantages of administering lower peak pulmonary pressure in the surgical room.

Results of the Study

In a recent observational cohort study of 4,694 cases discussed in Intraoperative Mechanical Ventilation and Postoperative Pulmonary Complications after Cardiac Surgery, the authors reviewed nonemergent cardiac surgical procedures using cardiopulmonary bypass at a tertiary care academic medical center from 2006 to 2017. What were their findings?

Overall, an intraoperative lung-protective ventilation bundle was associated with decreased pulmonary complications.

The three individual components of the ventilation bundle (noted above), via a sensitivity analysis, were also analyzed separately. Here are the results:

Modified driving pressure (below 16 cm H2O) was associated with decreased pulmonary complications, while lower tidal volumes (below 8 ml/kg) and positive end-expiratory pressure (greater than or equal to 5 cm H2O) were not associated with decreased pulmonary

Additionally, another recent study22 (during thoracic surgery) also demonstrated “a driving pressure-guided ventilation strategy during one-lung ventilation to be similarly associated with a lower incidence of postoperative pulmonary complications” (as compared with conventional ventilation strategies).

Conclusion: What This Might Mean for Your Practice

Today, anesthesiologists have the opportunity to provide improved patient care by implementing a lung-protective ventilation protocol favoring lower peak pulmonary pressure. As studies have shown, this can lead to improved patient outcomes. However, due to the observational nature of the study discussed here, these findings will require further evaluation and validation. In the meantime, where appropriate, you can favor lower peak pulmonary pressure in your operating room, and watch for improved intraop and postop outcomes.

  1. Please note that this blog does not have time to cover, but acknowledges that there is also a difference between peak pulmonary pressure and mean (average) ventilation pressures that should be taken into consideration.
  2. Park M, Ahn HJ, Kim JA,Yang M, Heo BY, Choi JW, Kim YR, Lee SH, Jeong H, Choi SJ, Song IS: Driving pressure during thoracic surgery: A randomized clinical trial. Anesthesiology 2019; 130:385–93.

Read More:

Is Four-Factor Prothrombin Complex Concentrate the Answer to Coagulopathy Prevention?

Posted on 11/19/19 by Allied Anesthesia

As you know, coagulopathy — common in trauma and perioperative bleeding — must be addressed. When this situation presents, increased morbidity and mortality result, and “anticoagulation can further increase a patient’s risk of developing coagulopathic bleeding.” Is four-factor prothrombin complex concentrate (PCC) the answer? Can it help anesthesiologists better manage patients who are receiving direct oral anticoagulants?


Best Practices for Surgical Patients on Chronic Steroid Therapy

Posted on 10/04/19 by Allied Anesthesia

When patients on chronic steroid therapy show up for surgery, many of us are uncertain about what to do. As you know, when a chronic steroid-use patient presents for surgery, they carry with them a potential complication: the possibility of developing secondary adrenal insufficiency, which can translate into full-scale adrenal crisis. So, what is secondary adrenal insufficiency?

“Patients on chronic steroid therapy may experience HPAA suppression, resulting in low CRH and ACTH levels that lead to atrophy of the adrenal zona fasciculata and a decrease in cortisol production. And, as a result, inadequate cortisol production may predispose to vasodilatation and hypotension.”

Additionally, chronic steroid therapy is known “to be associated with risk of immunosuppression, impaired wound healing, hyperglycemia, and psychologic disturbances in the postoperative period.”

Given that the literature surrounding this topic is “muddied” at best, how are anesthesiologists to proceed? Will these chronic steroid-treated patients require perioperative stress-dose steroids, or not? And how will you decide what is in the patient’s best interest?

In this post, we will review the article, “Perioperative Steroid Management: Approaches Based on Current Evidence,” as well best practices for these patients based on the current evidence that we do have.

What Is the Risk in Administering Perioperative Stress-Dose Steroids?

How common is the occurrence of HPAA dysfunction? A 2001 study concluded that “perioperative hypotension due to adrenal crisis is rare, with an estimated incidence of 1 to 2%.” However, while this complication may be rare, it is potentially fatal, and must therefore be handled with great caution. As always, you must weigh your patient’s risk for adrenal crisis against the risks of unnecessary steroid supplementation.

As the literature notes, unfortunately this decision is not clear-cut, and the current textbook recommendations that we have are inconsistent and lacking in class A and B evidence. Additionally, perioperative adrenal crisis is a diagnosis of exclusion, requiring a high index of suspicion since the signs and symptoms will be largely absent and/or nonspecific in the anesthetized or postop patient.

So, given that information, how should you proceed?

A Brief History of Findings: What We Do Know About Perioperative Stress-Dose Steroids

First, the two major cases that form the foundation for much of what we think we know about perioperative stress-dose steroids are from the 1950s. Since that time, both cases have been criticized for complicating factors (i.e., withholding aggressive fluid resuscitation, vasopressors, antibiotics and the lack of biochemical proof of adrenal insufficiency via measurement of serum cortisol levels ). Studies since then have been limited and insufficiently powered to come to any clear-cut conclusions.

That said, a 1973 study of 73 minor and major surgical patients on chronic steroid therapy concluded that preoperative plasma cortisol is “not the prime determinant of the level of blood pressure in the glucocorticoid-treated patients during and after surgery, and acute stress-induced adrenocortical insufficiency is rare even when steroids are withheld.” However, limitations of this study include: (1) no agreed-upon definition of low cortisol levels; and (2) a rarely used method of measurement for cortisol levels. The study’s findings have since been criticized.

Interestingly, in 2015, an analysis of the 11,247 records in the Anesthesia Closed Claims Project database revealed that “failure to administer stress steroids generated only two claims that resulted in liability payments, and both of these cases were complicated by other issues.”

Recommendations for Perioperative Patient Care in Major Surgeries

It is important to note that unless a patient is having a major surgery, stress-dose steroids are not recommended. The term “stress dose” comes from the body receiving “the stress” and is therefore applicable to more major surgeries. Although this is true, most practitioners administer steroids because they are unaware of the data and/or they want to err on the side of caution. Given that understanding, let’s turn now to recommendations for steroid administration best practices.

Given the muddied history of findings and the lack of clear evidence, researchers and clinicians recommend a simple approach to chronic steroid-use surgical patient care. First, group your patients into four categories, and then proceed with caution from there.

Category 1: Patients With Diagnosed Secondary Adrenal Insufficiency
This should be determined by the ACTH stimulation test that is the best, most proven way of assessing the integrity of your patient’s HPAA and its function. Please note that this test is not something we typically do in the operating room setting or require before surgery. Additionally, this test has limitations, such as measuring “serum total cortisol levels rather than serum free cortisol levels”; and, at this time, the diagnostic value of free cortisol levels is not definitively proven. Additionally, the test is not yet widely available.

Category 2: High-Risk Patients for HPAA Suppression
The high-risk category includes:

  • Patients taking glucocorticoid (doses equivalent to 20 mg / day or more of prednisone for more than three weeks)
  • Patients with clinical features of Cushing’s syndrome

It is recommended that “unless data confirming the integrity of the HPAA is available, these patients would benefit from perioperative stress-dose steroids with dosing based on surgical stress.”

Category 3: Low-Risk Patients for HPAA Suppression
The low-risk category includes:

  • Patients taking any dose of glucocorticoid for less than three weeks
  • Patients taking morning doses of prednisone of 5 mg / day or less
  • Patients taking prednisone of 10 mg / day every other day

For patients in this category, perioperative stress-dose steroids are not recommended unless signs of HPAA suppression are present.

Category 4: Intermediate-Risk Patients for HPAA Suppression
The intermediate-risk category includes:

  • Any patients on chronic steroid therapy who do not fit into the first three categories.


In conclusion, it is debatable whether or not perioperative stress-dose steroids further increase risk in chronic steroid-use patients. It may be best practice to withhold the stress dose and consider using stress-dose steroids at the first sign of any issues during a case. For example, if there is any out-of-the-ordinary hypotension during a case, you may consider giving steroids at that time on an as-needed basis.

As always, use your best judgment when administering treatment to patients on chronic steroid therapy. While it should be noted that hydrocortisone is currently the drug of choice for stress- and rescue-dose steroid coverage, please see “Perioperative Steroid Management: Approaches Based on Current Evidence” for tables including steroid choices, potency, dosages and conversion charts to help you navigate this muddied area of perioperative patient care.



  1. Axelrod L: Perioperative management of patients treated with glucocorticoids. Endocrinol Metab Clin North Am 2003; 32:367–83
  2. Zaghiyan K, Melmed G, Murrell Z, Fleshner P: Are high- dose perioperative steroids necessary in patients undergoing colorectal surgery treated with steroid therapy within the past 12 months? Am Surg 2011; 77:1295–9
  3. Brown CJ, Buie WD: Perioperative stress dose steroids: Do they make a difference? J Am Coll Surg 2001; 193:678–86
  4. Melanie M. Liu, Andrea B. Reidy, Siavosh Saatee, Charles D. Collard; Perioperative Steroid Management: Approaches Based on Current Evidence. Anesthesiology 2017;127(1):166-172. doi: 10.1097/ALN.0000000000001659.
  5. Ibid
  6. de Lange DW, Kars M: Perioperative glucocorticosteroid supplementation is not supported by evidence. Eur J Intern Med 2008; 19:461–7
  7. Kehlet H, Binder C: Adrenocortical function and clinical course during and after surgery in unsupplemented gluco-corticoid-treated patients. Br J Anaesth 1973; 45:1043–8
  8. written personal communication, Karen L. Posner, Ph.D., Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, December 2015
  9. Liu et al.
  10. Hamrahian AH, Oseni TS, Arafah BM: Measurements of serum free cortisol in critically ill patients. N Engl J Med 2004; 350:1629–38
  11. Liu et al.

Methadone for Post-Op Pain? A Drug to Watch

Posted on 09/18/19 by Dr. Edward Digiamarino, M.D.

What medical practitioner hasn’t struggled with pain management before, during and after surgery? The relief of postoperative pain, in particular, continues to challenge practitioners today. As you know, even after minor surgical procedures, more than 50% of patients experience moderate to severe pain. So, it naturally follows: We are always looking for the next best thing to relieve our patients’ pain, and to make our jobs easier.

Consider intraoperative methadone—an alternative opioid. While methadone is certainly not a new drug, and has a reputation or stigma for its use with opiate dependence, that being said, it may be time to revisit methadone for post-op pain. Is it effective in this scenario? According to a recent review in Anesthesiology of almost twenty clinical investigations since the 1970s, there may still be potential for its use in surgery.

But here’s what we do know about this unique drug, and how it may benefit your patient population.

What Is Methadone?

Methadone is a long-acting opioid with central nervous system effects. It is both a potent μ-receptor agonist (FOOT 4) as well as an N-methyl-D-aspartate (NMDA) receptor antagonist. In addition, methadone inhibits the reuptake of the neurotransmitter’s serotonin and norepinephrine in the brain, and may potentially provide a mood-elevation effect during post-op.

Methadone has “a long half-life that provides stable blood concentrations after a single intraoperative dose, without the fluctuations associated with repeated injections of high clearance agents like morphine or hydromorphone.”

Because it has a long elimination half-life of 24 to 36 hours, it may be useful for surgical patients. But is it the answer? Here’s what we know.

What Early Trials Reveal (the Key Findings)

Give a Single Dose at the Start of Surgery
To date, the majority of studies have administered a single dose of methadone at the beginning of anesthesia while avoiding the use of other intraoperative opioids.

In 1982, a very small study investigated the effects of a single dose of methadone at the beginning of anesthesia, and since, other small studies have followed. Most investigations found that patients who were administered with methadone before surgery reported:

1. lower pain scores and
2. lower post-op narcotic requirements.

A single dose before surgery was found to be more effective in reducing postoperative analgesic requirements than a dose given at the end of surgery.
Early clinical trials have included more minor surgeries such as: hip replacements, gynecologic and obstetric patients (hysterectomy); ambulatory surgical patients (laparoscopic cholecystectomy, tubal ligation, salpingectomy, oophorectomy or salpingectomy with oophorectomy); pediatric surgical patients; and more.

Additionally, two investigations looked at adults undergoing major spine surgery; and two Brazilian studies examined cardiac surgical patients. In fact, the largest intraoperative clinical trial using methadone with 156 cardiac surgical patients found that “a dose of methadone given before surgery provided a prolonged analgesia benefit”; patient satisfaction with pain management was reported as higher than subjects in the fentanyl group.

What We Don’t Know (Research Limitations)

The primary questions that medical practitioners want answered are these: Is methadone safe? And, is methadone effective? Here’s what we don’t know, or the limitations of the current research.

Small Sample Sizes Are Underpowered
The sample sizes of the studies are simply too small to garner any solid evidence at this point in time. Of all the studies done — less than 20 — only four studies enrolled 100 patients or more. As you know, small sample sizes can not only produce false positives, but can also result in inconclusive findings. Higher-powered studies are needed.

High-Risk Patients Largely Excluded
In addition to the limitations of sample size, many of the early studies excluded high-risk patients, choosing instead to enroll relatively healthy patients who had no significant medical comorbidities.

Findings in Morbidly Obese Patients Are Inconclusive
Although morbidly obese patients were not excluded from the early clinical trials on methadone, the literature at this point suggests that “more cautious dosing and monitoring of the effects of methadone may be required in this patient population.” As this patient population may have a greater sensitivity to the respiratory depressant effects of opioids, proceed with caution when administering this drug.

Keep Your Eye of Methadone, and Use Caution When Administering

At this time, the majority of methadone investigations have been small in sample size and should be considered mere pilot studies. The efficacy and safety of methadone for use in patients during the post-op period is still unclear. Many more randomized and large-scale studies are needed in order to solidify initial findings. Data from such studies is needed before the routine use of methadone can be safely recommended for surgical patients.

So, while it’s still too soon to tell, methadone may be a drug to keep your eye on for future use as new trials bring new data to our operating rooms.



1. Kharasch ED: Intraoperative methadone: Rediscovery, reappraisal, and reinvigoration? Anesth Analg 2011; 112:13–6
2. Davis AM, Inturrisi CE: d-Methadone blocks morphine tolerance and N-methyl-d-aspartate–induced hyperalgesia.J Pharmacol ExpTher 1999;289:1048–53
__Sotgiu ML,Valente M, Storchi R, Caramenti G, Biella GE: Cooperative N-methyl-d-aspartate (NMDA) receptor antagonism and μ-opioid receptor agonism mediate the methadone inhibition of the spinal neuron pain-related hyperactivity in a rat model of neuropathic pain. Pharmacol Res 2009; 60:284–90
3. CoddEE,ShankRP,SchupskyJJ,Ra aRB:Serotonin and norepinephrine uptake inhibiting activity of centrally acting analgesics: Structural determinants and role in ant- inociception. J Pharmacol Exp Ther 1995; 274:1263–70
___Rojas-Corrales MO, Berrocoso E, Gibert-Rahola J, Micó JA: Antidepressant-like effects of tramadol and other central analgesics with activity on monoamines reuptake, in helpless rats. Life Sci 2002; 72:143–52
4. Kharasch ED, 2011
5. Gourlay GK,Wilson PR,Glynn CJ:Pharmacodynamics and pharmacokinetics of methadone during the perioperative period. Anesthesiology 1982; 57:458–67
___Gourlay GK,Willis RJ,Wilson PR: Postoperative pain control with methadone: Influence of supplementary methadone doses and blood concentration–response relationships. Anesthesiology 1984; 61:19–26
6. Gourlay GK,Wilson PR,Glynn CJ, 1982
7. Gottschalk A, Durieux ME, Nemergut EC: Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery. Anesth Analg 2011; 112:218–23
8. Udelsmann A, Maciel FG, Servian DC, Reis E, de Azevedo TM, Melo Mde S: Methadone and morphine during anesthesia induction for cardiac surgery: Repercussion in postoperative analgesia and prevalence of nausea and vomiting. Rev Bras Anestesiol 2011; 61:695–701
9. Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Marymont JH, ShearT,Parikh KN,Patel SS,Gupta DK: Intraoperative methadone for the prevention of post- operative pain: A randomized, double-blinded clinical trial in cardiac surgical patients. Anesthesiology 2015; 122:1112–22
10. Glenn S. Murphy, Joseph W. Szokol; Intraoperative Methadone in Surgical Patients: A Review of Clinical Investigations. Anesthesiology 2019;131(3):678-692. doi: 10.1097/ALN.0000000000002755
11. Ibid
12. Cozowicz C, Chung F, Doufas AG, Nagappa M, Memtsoudis SG: Opioids for acute pain management in patients with obstructive sleep apnea: A systematic review. Anesth Analg 2018; 127:988–1001

Flexibility & Options for Nearly Any Anesthesiologist

Posted on 09/13/19 by Allied Anesthesia

Allied Anesthesia is a group made up of over 100 Southern California anesthesiologists who represent the top 1% in their field.  Allied provides anesthesia services for pediatric and adult operations, surgeries, and pain management procedures for several hospitals in the region.

Are you an anesthesiologist searching for a new opportunity? You may be surprised to learn how many different flexible tracks Allied currently offers for employment with our group. Read on for more.

How is Allied’s Partnership Different?

Whether you’re a single parent just looking to pick up a few days a week, or an ambitious M.D. ready to pursue a partnership track, Allied can welcome you with open arms. It is a high value of Allied to ensure that we have “something for everyone,” as we know that pursuing the best talent in Southern California is synonymous with flexibility.

“The idea is to give people flexibility, because people want different things. For example, many recent graduates prioritize work/life balance. We can tailor to people’s wants. Allied’s model allows for people who don’t want the commitment of nights and weekends, for those who have kids, those who don’t want to be on-call, etc…

Allied has something for everyone.” – Salomon Maya, M.D.

While our newly re-opened partnership track is the most sought-after option at Allied, we have also recently opened new hourly and part-time options for employees. These fresh options have allowed for a wide variety of extremely talented anesthesiologists to consider working with one of the most exclusive Groups in Southern California. It’s a win/win for everyone.

Could You Be Our Next Employee, or Partner?

Allied has received a 5-Star Excellence Award from Professional Research Consultants for three consecutive years. Allied is a founding participant in the National Anesthesia Quality Institute, a first-of-its-kind national program designed to compare performance among anesthesia providers from coast to coast.

Allied anesthesiologists are the exclusive anesthesia providers in some of California’s busiest operating rooms. We safely perform more than 11,000 adult and pediatric anesthesiology procedures annually.

Interested in Applying to Allied?

If you feel you are a qualified candidate for Allied, contact our lead recruiter, Edward Lee, via email. Please also include your CV and a cover letter:

Edward Lee
Allied Anesthesia Recruiter


Searching for the Next Partner: Allied’s Recruitment Process

Posted on 08/29/19 by Allied Anesthesia

Allied Anesthesia began as a group of Orange County anesthesiologists loosely affiliated with one another, but all deeply committed to providing the top anesthesia care in Southern California. Fast-forward to today: Allied’s group is now made up of over 100 anesthesiologists who have each traversed one of the most rigorous vetting processes in the country. 

If you’re interested in working with an anesthesia group with a proven record and rock-solid history in the Southern California medical community, then look no further than Allied Anesthesia.

How Does Allied’s Vetting Process Work?

Allied consistently finds the “cream of the crop” of anesthesiology talent. But what does it look like behind the scenes of the vetting process?

In short, Allied is looking for anesthesiologists who will become a leader in the field. While a prospect who has recently completed a fellowship is ideal, it is not required. Ultimately, we are on the lookout for the needles in the haystacks, the hidden gems in the field who will prove to be all-around excellent, patient-centric, team-oriented anesthesiologists. We are seeking anesthesiologists who endeavor to become leaders for the entire specialty. Does this sound like you?

“The most important asset of Allied Anesthesia by far are the anesthesiologists. That’s why we continue to select only the best candidates like we have for years. This is also why we prioritize offering the best package possible to all our physicians.” – Edward Lee, Lead Recruiter, Allied Anesthesia

Allied’s recruiting and interview process intentionally focuses on the top 1% of anesthesiologists. Our vetting process includes not only the typical fare such as letters of recommendation and interviews, but also an extensive oral interview very similar to a board exam. For those who are offered a commitment letter, they can also expect to proctor about 20 cases alongside other anesthesiologists to demonstrate their capacity in the operating room.

Since we recently reopened our partnership track, we expect that we will continue to attract the top talent in the field, even as the competition for anesthesiologists becomes even tighter.

Allied’s Accolades: Could You Be Our Next Partner?

Allied has received a 5-Star Excellence Award from Professional Research Consultants for three consecutive years. Allied is a founding participant in the National Anesthesia Quality Institute, a first-of-its-kind national program designed to compare performance among anesthesia providers from coast to coast.

Allied anesthesiologists are the exclusive anesthesia providers in California’s second-busiest operating rooms. We safely perform more than 11,000 pediatric anesthesiology procedures annually.

Interested in Applying to Allied?

If you feel you are a qualified candidate for Allied, contact our lead recruiter, Edward Lee, via email. Please also include your CV and a cover letter:

Edward Lee
Allied Anesthesia Recruiter


Dr. Jack Canton, M.D. - Allied Anesthesia

How Does Allied Anesthesia Work?

Posted on 07/29/19 by Allied Anesthesia

You’re a patient who’s heard about Allied Anesthesia, and now you want to ensure you receive treatment from one of our group’s top-notch anesthesiologists for your surgery or pain management. But, as is the case with a lot of healthcare-related endeavors, it’s not always so simple as requesting a doctor. Here’s a brief overview of who we are, how we work, and how we can help provide the best anesthesiology services for your procedure.

What is Allied Anesthesia?

Allied Anesthesia is a group of over 100 Southern California anesthesiologists who have passed a rigorous vetting process to represent the top 1% in their field. They provide anesthesia services for pediatric and adult operations, surgeries, and pain management procedures for several hospitals in the region. The group is carefully structured and managed to ensure top performance across the board.

How can I ensure an Allied Anesthesia group member handles my anesthesia needs during my procedure?

Our group is the exclusive anesthesiology provider for a number of hospitals and medical facilities, so the best way to ensure that you’re treated by one of our physicians is to receive treatment at one of these locations. Check out our General Inquiry page to view a full list of our affiliated locations.

How does Allied Anesthesia partner with healthcare organizations and hospitals?

Usually, we contract with a surgery center or hospital to provide all anesthesia services for that facility. As per this contract, we will reliably staff their facility with our group’s anesthesiologists and provide coverage for any type of surgery. We will also provide the facility with physicians who hold different sub-specializations to meet almost any need. Allied anesthesiologists are not direct employees of our partner hospitals or medical facilities and are independently contracted with almost all insurance carriers.

I’d like to consult with an anesthesiologist outside of the operating room for pain management. Am I able to directly book an appointment with one of AA’s physicians?

Our group includes several physicians who can be seen directly for pain management. Generally speaking, these doctors perform interventional pain management procedures that aim to treat the root cause of pain rather than provide chronic care with medication. If you’re interested in consulting with one of these specialists, please fill out our General Inquiry form and mention that you’re seeking a direct appointment for pain management.


For other questions regarding Allied Anesthesiology’s practices, please check out our Patient FAQ section, or fill out a General Inquiry form at the link above. It’s our pleasure to do all we can to help get you the answers and care you need.


Two teenagers with juvenile arthritis stretching on football field

July is Juvenile Arthritis Awareness Month

Posted on 07/03/19 by Allied Anesthesia

Arthritis is generally thought of as an ailment of the elderly, an inflammation of the joints that can be caused by a number of age-related factors. But juvenile arthritis – which occurs in patients 16 and under – affects over 300,000 children and teens in the US alone. In honor of Juvenile Arthritis Awareness month, we’ve compiled some information to shed some light on this lesser-known condition.

What causes juvenile arthritis?

The exact cause of juvenile arthritis is idiopathic, or unknown, but physicians and researchers classify it as an autoimmune disorder. This means that it occurs as a result of the body mistaking its own systems for harmful foreign substances. As a result, the body attacks itself as it would a virus or bacteria, producing symptoms that can range from mild to debilitating. In the case of juvenile arthritis, these symptoms manifest as a swelling of the synovium – the tissue that lines the joints – causing pain, stiffness, and a potential loss of motion in various joints in the body.

There are actually several different types of juvenile arthritis that present themselves in different areas of the body. These include Stills disease (also called systemic arthritis), oligoarthritis (also called juvenile rheumatoid arthritis), polyarthritis, psoriatic arthritis, and enthesitis-related arthritis.

How is juvenile arthritis diagnosed?

Often times, juvenile arthritis does not present any symptoms, or its symptoms are easily misattributed to another illness. To get the correct diagnosis, physicians will likely use process of elimination, first testing for other more common ailments like bone disorders, Lyme disease, fibromyalgia, lupus, or cancer via blood tests, bone scans, x-rays, or joint-fluid sampling. Once those have been ruled out, and arthritis is determined as the likely culprit, additional tests will be conducted to discern what kind of arthritis is present.

How is juvenile arthritis treated?

Exercises, medication, and, in some cases, operations, can help alleviate the pain, swelling, and lack of mobility associated with juvenile arthritis, and help to prevent further damage to the joints. Allied Anesthesia’s physicians not only provide general anesthesia for children undergoing arthritis-related surgery, but also help to administer acute postoperative pain management treatments for those suffering from the condition. The physicians assigned to juvenile arthritis patients are deeply committed to their treatment, and work closely with the families affected over time to ensure the best possible care.

Does juvenile arthritis ever go away?

While there is no definitive cure for the condition, pain and swelling can be managed with effective ongoing treatment. There are also cases where children outgrow their arthritis as they enter adulthood, though this is not the norm. The good news is that research and funding is helping to develop new, more effective treatments for the condition. To find out more, head to https://curearthritis.org/juvenile-arthritis-awareness-month/.

Woman under anesthesia - eco-friendly

Can Anesthesia Go Green?

Posted on 06/25/19 by Allied Anesthesia

Did you know that some forms of anesthesia are greener than others? It’s true. A recent article in the Los Angeles Times shared the story of Dr. Brian Chesebro, a Portland, Oregon-based anesthesiologist who decided to conduct some independent research on the sustainability of different types of anesthesia. He focused on sevoflurane and desflurane, two commonly used anesthetic gases.

Used in a wide range of procedures, anesthetic gases are inhaled by patients through breathing masks. Most of the gas is exhaled—only about 5% is actually metabolized—and sucked into a ventilation system, which ultimately carries it up to the roof and into the atmosphere.

What Dr. Chesebro discovered upon further investigation surprised him (and many others in the medical and environmental fields): desflurane has catastrophic impacts on the environment. In fact, the amount of desflurane used in a typical procedure does the same amount of environmental damage as a fleet of 12 Hummers operating for the same duration of time. When it comes to trapping heat in the Earth’s atmosphere, desflurane is 20 times more powerful than sevoflurane, and it remains in the atmosphere for much longer—14 years—as opposed to a single year for sevoflurane.

There is good news. Thanks to these findings, anesthesiologists can make better-informed decisions about what  anesthetics to use. We’re pleased to share that propofol, the anesthetic preferred by the doctors here at Allied, has very minimal environmental impact. However, it’s important to note that we do use anesthetic gases—including desflurane—in some procedures. But we administer the more sustainable sevoflurane much more frequently than desflurane. In fact, we only use desflurane in special cases, when the benefits of patient safety with desflurane clearly outweigh other anesthetic options. Furthermore, whenever we use any anesthetic agent, we make a point to use them in the most environmentally friendly way possible.

Infant baby in hospital after surgery anesthesia

Infants, Anesthesia & Safety

Posted on 06/13/19 by Allied Anesthesia

Many of the doctors here at Allied Anesthesia are pediatric anesthesia experts and parents. We know how stressful it can be to have a child undergo a significant medical procedure and receive general anesthesia—especially when the child is very young and unable to understand what’s going on or communicate how they are feeling. More importantly, many parents are concerned that general anesthesia could negatively impact their child’s development, particularly if the child is an infant.

While this is an understandable concern, the science shows that general anesthesia is safe for pediatric patients. A recent study published in The Lancet found that general anesthesia poses no more risk in babies than regional anesthesia. Because most minor surgeries in babies do not take longer than an hour, the study, which included 722 infants in 7 countries, compared an hour of general anesthesia to an hour of regional anesthesia. When the children were assessed for IQ, attention, memory, executive function and behavior at age five, there were no differences between the children who had received general anesthesia and those who had received regional anesthesia.

At Allied, we have considerable experience in administering anesthesia to infants, including both premature and full-term babies. Our youngest pediatric patients can be as young as 28 weeks (gestational age). We even provide anesthesia to babies that haven’t been born yet! In these instances, known as EXIT procedures, we administer anesthesia to babies in utero that may have airway malformations so they can be delivered safely.

From our own experience and research, we know that general anesthesia, when administered carefully and correctly, is safe for use in infants, but we always appreciate studies like these that we can share with patients (or more likely, their parents).

If you’re a parent and your pediatrician has recommended a surgery that involves general anesthesia, we encourage you to talk more to your child’s doctor and get in touch with us here at Allied to learn more about our pediatric expertise.

It’s also important to know that you’re not alone—many parents are surprised to learn that general anesthesia in young children is actually fairly common. The same Lancet study notes that by age three, about 1 in 10 children will have undergone general anesthesia at least once for procedures like hernia repair, ear tube placement, tonsil removal or MRI completion.

Surgeons applying anesthesia to patient

Local, Regional, General, and Everything in Between: The Different Types of Anesthesia, Explained

Posted on 06/03/19 by Allied Anesthesia

Patients frequently ask us about the difference between the types of anesthesia available, how each kind is used, and what we recommend for specific procedures. For example, we’re often asked, “Do I need local or regional anesthesia?” or “What’s the difference between general anesthesia and twilight?”

To answer those questions and many others, we’ve developed this easy-to-understand guide to local, regional, and general anesthesia, how they’re used, and what to expect.

Local Anesthesia

What It Does: Temporarily numbs a small portion of the body for outpatient or minor procedures
Administered Via: Injection or topical application
Patient Status: Conscious
May Be Administered With: Sedative for relaxation or sleep
Side Effects: Numbness, weakness, tingling

Regional Anesthesia

Also Known As: Regional nerve block, conscious sedation
What It Does: Temporarily blocks pain in the portion of the body that will be affected by the procedure
Administered Via: Injection in a cluster of nerves (e.g., spinal, epidural)
Patient Status: Conscious or, in some cases, asleep if sedatives are also used
May Be Administered With: Sedative for relaxation or sleep
Side Effects: Numbness, weakness

General Anesthesia

Also Known As: Deep sleep, twilight
What It Does: Keeps patient unconscious and still throughout procedure with no awareness of pain or memory of the event
Administered Via: Breathing mask or IV
Patient Status: Unconscious
May Be Administered With: Sedatives for relaxation, breathing tube
Side Effects: Depends on type of anesthetic used, but side effects can include nausea, fatigue, irritability

A Closer Look at Anesthesia vs. Sedation

Anesthesia, as a general term, typically refers to two different types of drugs: anesthetics, which reduce or prevent pain by impacting the nervous system, and sedatives, which relax patients and, depending on the dosage, can keep them “asleep” during a procedure and unable to feel, hear, move, or remember the event.

While terms like “conscious sedation” and “twilight” are widely used in the medical field, there are some misconceptions about how they are related to general anesthesia.

If a patient is asleep and cannot respond to commands, they are under general anesthesia. If a patient is conscious and can respond to commands but cannot feel pain, they are “consciously sedated” (using a sedative) and an anesthetic has also been used, either regionally or locally, to block or prevent pain.

“Twilight” is general anesthesia, though some healthcare practitioners may use it to refer to general anesthesia that has fewer side effects (grogginess, fatigue, nausea, etc.) than other general anesthesia. The difference in side effects is typically a result of the amount and type of medication used.

At Allied Anesthesia, we prefer to use the sedative propofol for general anesthesia. When administered by experts, propofol allows patients to wake up with virtually no lasting side effects. Plus, most patients can breathe on their own when receiving propofol, so we can avoid intubation entirely.

Ultimately, the type of anesthesia used for any given procedure is determined based on a number of factors, including patient health and the procedure itself, but now that you know a little more about your options, don’t hesitate to discuss them with your doctor.

Women in hospital bed with husband and nurses in the room

Why Anesthesia is Important for IVF

Posted on 05/08/19 by Allied Anesthesia

In July 1978, Louise Brown was born in England; she was the first baby born who had been conceived via IVF. Though the fertilization process, led by Sir Robert Edwards and Dr. Patrick Steptoe, took place in a petri dish before being implanted into Louise’s mother’s uterus, Louise was commonly referred to as the first “test tube baby.”

In the forty-plus years since, the use of IVF has increased dramatically—and the technology has evolved along with it. Today, approximately 1-2% of all U.S. births annually are via IVF.

By enabling women with fertility issues or genetic problems to become pregnant, IVF has changed the lives of millions. In 2010, Sir Robert Edwards was awarded a Nobel Prize in Physiology and Medicine for his role in developing the procedure. But as groundbreaking as IVF is, it’s well known to be an arduous and taxing process for women—physically, emotionally and financially. As a result, there is considerable incentive to achieve pregnancy in as few rounds of IVF as possible. While many people may not associate IVF with anesthesia, it can play a critical role in minimizing pain and optimizing success in IVF.

IVF begins with taking a medication that stimulates follicles in the ovaries to produce eggs. Once the eggs are produced and mature, they are retrieved via surgery. During the egg retrieval, a doctor will typically use an ultrasound to locate the follicles and eggs, and then carefully extract the eggs using a thin, hollow needle and a suction device.

For years, anesthesia was not used in the egg retrieval process. Though the egg retrieval is fairly quick—typically taking between 20-30 minutes—at best, it’s uncomfortable. At worst, it’s extremely painful.

Today, most doctors use some sort of sedation during the procedure, including regional anesthesia, “conscious sedation,” in which the patient is awake and can respond to commands, and general anesthesia, in which the patient is asleep. At Allied, we work with multiple IVF clinics to provide anesthesia during the egg retrieval process. Propofol is our anesthetic of choice for IVF procedures for a few reasons:

  • Patients are completely asleep and feel no pain during the procedure, enabling the doctor to carefully extract as many eggs as possible.
  • Patients can easily wake from the procedure quickly and experience minimal side effects (unlike the fatigue, nausea and other side effects common with other sedatives).
  • When administered by an expert, propofol does not require intubation.

While we highly recommend incorporating a skilled anesthesiologist into the egg retrieval process, we strongly encourage women undergoing egg retrieval to have a conversation with their doctor about how best to minimize discomfort and optimize results.

Bottle of opioid pills and needle

Doing Our Part to Solve the Opioid Crisis

Posted on 04/24/19 by Allied Anesthesia

It’s no secret that there’s a countrywide opioid crisis. According to the National Institute of Health, more than 130 Americans die each day from overdosing on some kind of opioid: prescription opioids, heroin, fentanyl, and others. This crisis didn’t come out of nowhere—it’s been brewing for nearly three decades and is a result of a number of different elements: over-prescription by healthcare providers, a lack of awareness about how addictive opioids can be, a disproportionate focus on subjective measures of pain control, and a skewed reimbursement system. With so many contributing factors, it comes as no surprise that there is no easy fix.

Restricting opioid prescriptions has been floated as one viable method for cutting down on opioid related overdoses, and there has been some success here; according to the FDA,  the number of opioid prescriptions dispensed by pharmacies is at a 15 year low. But cutting back on opioid prescription has its own unintended and severe consequences:

  • People are turning to unregulated, illegal substances (e.g., heroin) as a less expensive and more accessible alternative
  • Many people with acute or chronic pain are not getting the treatment they need to function

Recent legislation aimed to address the crisis by limiting opioid prescriptions for acute pain—like the pain that may occur after a surgery—to just seven days. Though this well-intentioned bill is careful to focus solely on acute pain, rather than chronic pain, the potential consequences are problematic across the board.

The National Institutes of Health reported recently that about 25.3 million adults experienced pain every day for 3 months while nearly 40 million adults experience severe levels of pain. For many of these people, opioids are critical to their ability to function on a daily basis.

So how do we solve a national health crisis that affects the lives of so many Americans? It’s going to take a significant amount of collaboration on the part of healthcare providers, insurers, drug companies and governmental regulatory bodies.

For our part, we are determined to help our patients manage chronic or acute pain effectively and responsibly. There are a couple of ways we do that.

While we do use opioids to help patients cope with acute post-operative pain, we often rely on other methods, like individual nerve blocks, epidurals and other types of steroid injections to reduce pain or “numb” a certain area. In fact, regional nerve blocks often mean that patients are completely pain-free for 24-72 hours after surgery. By the time the nerve block wears off, many patients no longer need or want opioids; they are able to find pain relief with over-the-counter medications like Tylenol or non-steroidal anti-inflammatory drugs (NSAIDs).

For patients suffering from severe chronic pain, we do sometimes prescribe (and carefully manage) opioids if other methods are not working and opioids dramatically improve a patient’s quality of life.

As more solutions arise for opioid crisis, we are committed to working with other players in the healthcare space to do our part. As always, patients come first—we’ll continue to explore multiple pain-relief alternatives while also being conscientious and mindful in our use of opioids for pain management.

Does Anesthesia Affect Childhood Development? New Research Says No.

Posted on 04/17/19 by Allied Anesthesia

Undergoing serious medical procedures can be stressful at any age, but when you’re a parent and the patient is your young child, it’s particularly worrying. Aside from concerns about the nature of the procedure itself, many parents are hesitant to expose children to general anesthesia for fear that the medicine might have a negative impact on their child’s developing brain. Good news: it won’t.

A new study published in JAMA Pediatrics found that exposure to anesthesia does not inhibit a child’s brain development. The study followed nearly 10,000 sibling pairs between the ages of 5 and 6 who had Early Development Instrument (EDI) data completed prior to the study. The EDI assesses a child’s readiness and ability to learn based on five different factors:

  1. Physical health and well-being
  2. Social knowledge and competence
  3. Emotional health and maturity
  4. Language and cognitive development
  5. Communication skills and general knowledge

In more than 2,000 pairs (of the original 10,000+), one but not both siblings had undergone a surgery requiring general anesthesia. Upon evaluating the pairs, it was determined that there were no developmental differences between siblings who had been exposed to general anesthesia and those who hadn’t.

While previous studies using rat models suggested that anesthesia could impact the developing brain, these new findings make it clear that those results are specific to the species and not applicable to human children.

Even with these encouraging results, surgery or medical procedures requiring general anesthesia in young children is stressful for parents. We get it—that’s why our award-winning team includes board-certified pediatric anesthesiologists. Many of our doctors are parents themselves, so they know how important it is to give our pediatric patients the best available care.

From pediatric cardiothoracic services to complex pediatric pain blocks to rare conditions, our pediatric anesthesiologists handle more than 15,000 cases per year—and in every one, our utmost concerns are ensuring our little patients’ safety and easing any discomfort or pain they might have. Learn more about our pediatric specialists.

Prescription bottles laying together

Take Back Your Drugs on April 27

Posted on 04/11/19 by Allied Anesthesia

In 2017, at least 6 million Americans misused controlled prescription drugs, according to the National Survey on Drug Use and Health. Many of these prescription drugs were taken from the medicine cabinets of friends and family members.

If you’ve ever had a pain medicine prescription following a procedure, you may not have ended up using all of the medication. Once you’re feeling better, it’s not uncommon to forget about the prescription medication completely or decide to save it in case the pain returns.

Unfortunately, unused or expired medication is very easily lost, stolen or misused. In an effort to reduce the impact of this misuse—which includes addiction, overdose and accidental poisoning—the Drug Enforcement Agency (DEA) established April 27 as National Prescription Drug Take Back Day.

There are Take Back days in both April and October, and with thousands of collection sites across the country, it’s easy to safely (and anonymously) drop off unused prescriptions and controlled substances. Last year, 949,046 pounds (or about 475 tons) of drugs were collected from 5,842 sites and disposed of safely by the DEA.

What about simply throwing unused medication out or flushing it down the toilet? There are a few reasons why these disposal methods are strongly discouraged:

  • Even when in the trash, drugs can easily be stolen and then illegally used or sold.
  • If drugs are thrown out, the active chemicals in the medications can pose a danger to sanitation workers. Once in a landfill, these chemicals can damage the surrounding environment or seep into water sources.
  • Medicines that are flushed down the toilet are frequently not removed by water treatment plants or septic systems. These chemicals can end up polluting water sources, poisoning animals and contaminating our food and water supplies.

Keep your family, friends, community and environment safe this spring and find a time this month to collect your unused and expired prescription medicines. Then find a nearby collection site and safely dispose of your medications on April 27. We’ll be doing it too!


Doctor showing patient a slideshow

The Future of Anesthesia

Posted on 04/05/19 by Allied Anesthesia

Could anesthesia be used in the treatment of PTSD, depression and related conditions? It’s certainly possible.

A new study from the Universidad Politécnica de Madrid  found that when administered under specific circumstances, the anesthetic propofol can help alter traumatic and debilitating memories. The study included 50 patients who were undergoing procedures (like endoscopies and colonoscopies) and would be treated with propofol. A week before surgery, patients were shown a slideshow of emotionally charged images and a slide show of neutral images. Immediately before the procedure, the researchers “reactivated” the memories of both slide shows by asking the patient to recall the images.

Twenty-four hours after the procedure, researchers found that the memory of the emotionally charged slide show had been impaired—but not the memory of the neutral slide show. It’s important to note that the propofol did not make the memory disappear, it just made the recall of that memory a less emotional, disturbing experience.

A Scientific American article reporting on the research notes that in this study, propofol “functioned exactly as a PTSD drug should—impairing the disturbing memories and leaving the others alone.”

This study’s small sample size certainly does not prove that propofol or any anesthesia can treat PTSD, depression or related conditions—much more research will need to be conducted before anesthetics are used in this capacity. But this small study is an excellent illustration of how the medical community at large is continuing to learn about the far-reaching benefits of anesthesia.

At Allied, we specialize in all aspects of anesthesia, but as doctors and scientists, we are always interested in developments that could ultimately help our patients. Our priority, first and foremost, is to responsibly use anesthesia and other measures to help our patients.

Dr. Armen Chalian

National Doctor’s Day – Meet Dr. Armen Chalian

Posted on 03/29/19 by Allied Anesthesia

Armen Chalian Allied AnesthesiaMarch 30 is National Doctor’s Day, and to celebrate, we decided to interview Dr. Armen Chalian, one of the many incredible physicians we have here at Allied Anesthesia, about what made him want to become a doctor (in particular, an anesthesiologist).

Dr. Chalian joined Allied in 1993; since then, he has handled more than 20,000 cases with us. Dr. Chalian currently specializes in anesthesiology for pediatric, obstetric, neurology and orthopedic patients, as well as chronic pain management. Previously, he specialized in anesthesia for pediatric and adult open-heart surgery.

Here’s what he had to say.


Did you always know you wanted to be a doctor?

In high school, I really enjoyed the humanities—English and history. I wasn’t particularly interested in the sciences. I went to college at UCLA, and my dad told me to take a biology class just to try it. There were 600 students in the class, and I ended up being in the top 3. And I just kept going!

A little backstory here: My grandparents survived the Armenian genocide and escaped to the Middle East. Then my father similarly escaped war-torn Beirut to come here to the States. It was important for my dad and his siblings that their children become doctors, in part because doctors provide a critical service to others. And we did. Every single one of my cousins is a doctor or dentist.


What made you decide to get into anesthesiology?

That was an easy decision. Anesthesiology is the best and most exciting field in medicine—by far.

As an anesthesiologist, you have to be an expert in all fields of medicine—not just anesthesia—because administering anesthesia affects all organ systems. Anesthesiologists are the only doctors who need to have this broad base of knowledge and expertise.

It’s also the only field of medicine where, as a doctor, you have a cart full of medications and you can grab and administer them in real-time, which often ends up saving patients’ lives. I always tell people that if you had to pick one doctor to have around if you’re going to be very ill, it’s an anesthesiologist. We’re trained to spring into action, and our work depends on expertise across the medical spectrum.


What do you think is the biggest misconception about anesthesiology?

I think the biggest misconception is that anyone can administer anesthetic. And it’s not just a misconception on the part of patients. There are even doctors who think that!

But in reality, anesthesiology is not just pushing medicine in an IV and watching someone fall asleep. Every patient has unique things about them—age, general health, specific medical conditions, medications—and all of these characteristics factor into how anesthetic will affect them.

Another misconception is that anesthesiologists just administer anesthesia at the beginning of a procedure and then go home. You’re there the whole time, monitoring the patient, ensuring that they’re responding well to both the anesthesia and the procedure itself, and will wake up at the end of the procedure feeling better.

It’s an art form more than a medical practice. Everyone in my family knows that if they undergo a procedure, they have to demand to have an anesthesiologist present. Not a nurse anesthetist or a physician’s assistant, but an MD specializing in anesthesiology.


What do you like about working at Allied Anesthesia?

It’s been incredible to get to work in so many fields of anesthesia alongside such talented people. There are leadership opportunities here at Allied, and I’m not just a cog in an enormous healthcare machine. I’m practicing the kind of medicine I want to practice and have the freedom and support to be a true advocate for my patients. It’s the best job I can imagine.

Doctor and cancer patient look at data on computer

Can Anesthesia Impact Cancer Surgery Outcomes?

Posted on 03/07/19 by Allied Anesthesia

Many people think of an anesthesiologist’s role as limited to providing comfort during surgery—that our role begins and ends in the operating room. As our patients and their families know, anesthesiologists do much more. At Allied, we specialize in pediatric anesthesia, cardiac anesthesia, and chronic pain management. Other examples of anesthesiologist specialties are neuroanesthesia or anesthesia as apart of obstetrics or emergency care.

One of the most exciting parts of being a doctor, regardless of the specialty, is how the science of medicine is constantly advancing—as we learn more and more about certain diseases and treatments, our ability to help our patients gets better and better. Anesthesiology is no exception.

For example, a recent article published in JAMA Surgery suggests that modifying anesthetic techniques when operating on cancer patients could actually reduce the postoperative incidence of cancer metastasis, and therefore improve long-term survival.

First, some background. In general, regardless of the health of the patient, the experience of surgery can have lasting effects on your physiology. Specifically, surgery can induce stress and inflammatory responses that have a measurable impact on cellular systems and can ultimately compromise a patient’s immune system. These changes don’t just occur during or immediately after the surgery—they can extend well beyond the actual event.

We know that reducing pain and inflammatory responses after surgery helps people heal faster and makes them less prone to infection. Is the same true for anesthesia?

In a recent Anesthesiology editorial, the authors note that clinical evidence suggests that there are three different anesthetic approaches that might reduce the risk of cancer recurrence:

  • Regional anesthesia, including nerve blocks
  • Anesthetic adjuvants to help prevent infection
  • Using propofol as a replacement for anesthesia

All three of these approaches are currently being evaluated, and we’re very much looking forward to the results.

At Allied, we’re committed to helping our patients before, during, and after surgery—so if there are anesthetic management changes we can make to help reduce the risk of recurrence in our patients living with cancer, we’ll be among the first to implement them.

Operating room team

The Year Ahead

Posted on 02/01/19 by Allied Anesthesia

2018 was a whirlwind at Allied Anesthesia and we’ve already hit the ground running in 2019. Our highlights for the year include:

  • Adding five surgery centers to our partners (we now provide anesthesia services at a total of 32 different locations)
  • Treating a record number of cases: about 111,000
  • Bringing on highly skilled new team members
  • Providing top-notch care to our patients across southern California (as always)

2018 also came with its challenges, in particular Assembly Bill 72. The bill, which the California legislature passed in September 2016, was designed to eliminate patients’ “surprise medical bills” for out-of-network care. For example, if a patient goes to an in-network facility for care but receives treatment from an out-of-network doctor, they could be billed later for that doctor’s fees.

Of course, we fully support the thinking behind this legislation. As a medical group that partners with many hospitals and ambulatory surgery centers, one of our highest priorities is ensuring that patients are not billed separately for our anesthesia services. We feel strongly that patients should not shoulder the burden for out-of-network services they receive as part of covered treatment.

Unfortunately, the implementation of this bill hasn’t been this straightforward—in fact, it’s been deeply flawed. It doesn’t just eliminate surprise bills for patients (which is undoubtedly a good thing)—it gives large insurance companies with lots of resources even more leeway to take advantage of small, specialty practices like Allied Anesthesia.

By allowing insurance companies to severely limit how much reimbursement they provide to specialized, out-of-network doctors, it’s no wonder that insurance companies fully supported AB 72—while our peers in the medical industry strongly opposed it.

One of our primary goals for 2019 is to work with the authors of AB 72 to make them aware of the unintended consequences of this legislation. Ultimately, we want to help them find a solution that protects patients from unexpected costs and enables us to continue bringing in exceptionally talented physicians to provide the highest quality care to our patients.

That’s just one of the many things we plan to accomplish in 2019:

  • Establish new partnerships. We currently work with many renowned hospitals and ambulatory surgery centers, including Hoag, CHOC Children’s, St. Jude’s, St. Joseph’s, and more. We’re look forward to collaborating with all of our existing partners and some new ones in the new year.
  • Continue to add to our team. We’re looking forward to another successful recruitment season where we can bring on 6-10 more talented doctors
  • Expand our role. We’re looking forward to expanding our role in the perioperative process as we use multimodal therapies to decrease cancellations and improve efficiency in the operating room.
  • Decrease opioid use. Opioids are extremely useful in treating severe pain, but they come with many complications. We’ll be limiting our use of opioids through intraoperative nerve blocks and administering other types of medications that affect pain pathways.
  • Continue to provide exceptional care to our adult and pediatric patients. It will come as no surprise to our patients that this is always our top priority.


Doctor talking to patient in hospital

Current Trends in Anesthesia

Posted on 01/24/19 by Allied Anesthesia

One of the most fascinating things about working in medicine, and anesthesiology in particular, are the near-constant advances in medical technology and their implications for our work. While there’s no telling exactly what medical breakthroughs will occur in the coming months and years, some of the developments we’ve encountered recently are excellent indicators about where we’re headed this year and beyond.

Improving Sleep in Post-Operative Patients

If you’ve ever had major surgery, you know how difficult it can be to sleep immediately afterwards—especially if you’re in the hospital. Discomfort is a primary factor, but age, medication, anesthesia type, surgery type/method and environmental stress can also be factors. Trouble sleeping isn’t just an inconvenience—We need sleep to maintain our physical and mental health, and sleep is an important part of the healing and recovery process. A recent article in Current Opinion in Anesthesiology notes that there are pharmacological and nonpharmacological measures (like dim lighting, ear plugs, and eye masks) that can be used to promote sleep during recovery.

Using Data to Predict Outcomes

Doctors are scientists, and like all scientists, data is one of the most important aspects of our work. While vast medical databases have existed for years, only recently have nationwide databases been established especially for anesthesiologists’ use. The data collected by these databases help doctors document patterns across wide patient groups, enabling them to better predict outcomes in future cases. This data can also help healthcare providers identify rare but significant reactions or complications and respond to them appropriately. In order to be of real, lasting value, these databases will need to be consistently monitored for security and methodology, and the data itself must be validated, but their existence looks to be a promising one for the future of anesthesia.

Anesthesia Without Opioids

In an effort to minimize opioid use and the resulting complications, a movement around opioid-free anesthesia (OFA) is gaining traction. While opioids are incredibly important for pain management during and after surgery, they also have well-known adverse effects, including slowing down recovery and leading to long-term use or addiction. While comprehensive, multi-center studies are needed to better understand the risks and benefits associated with OFA, it’s definitely an avenue worth exploring.

Managing Chronic Pain

Chronic pain isn’t new, but given that more than 100 million adults live with it, it’s an important and ongoing focus in medicine. Defined as pain that lasts three months or longer, chronic pain limits your ability to work, sleep, relax, or eat. It also plays a huge role in mental health; studies show it is a prevalent factor in deaths by suicide. Most people know that anesthesiologists help manage pain before and after surgery, but many don’t realize that anesthesiologists specialize in the management of chronic pain. For example, at Allied, we have an award-winning pain management team that helps patients dealing with chronic neck and back pain.


Are there any recent medical advances you’re personally (or professionally) excited about? Let us know in the comments.



Man and woman working out in park - healthy lifestyle resolutions

The Best Resolutions You Can Make

Posted on 01/17/19 by Allied Anesthesia

Making New Year’s resolutions is easy, but keeping them? That’s another story.

If you’re hoping to make a resolution this year you can actually keep, try focusing on quality rather than quantity. In other words, instead of picking multiple resolutions, focus instead on one or two resolutions—clear, strong ones that will have a significant impact on your life and health.

1. Quit smoking.

This one might seem obvious, but there’s a reason for it—approximately 37.8 million American adults are still regular smokers, and more than 16 million Americans are living with a smoking-related disease. As any smoker knows, nicotine is highly addictive, and quitting is easier said than done. But there are a number of options for quitters, and the Mayo Clinic has a solid overview of them.

2. Eat healthy.

It’s hard not to indulge a little over the holidays, so it’s no wonder many people start off the New Year with a diet. But diets, and crash diets especially, can be difficult to follow (and easy to drop), so we recommend focusing on eating healthy, high-quality foods rather than restricting yourself to a rigid diet or completely eliminating certain foods or ingredients. Try to incorporate fruits and vegetables into every meal, limit animal products, and avoid sugars, fats, and processed foods as much as possible.

3. Develop an exercise routine.

Exercise doesn’t just give you a sense of accomplishment and increase your endorphins—It can lengthen your life expectancy, repair heart disease, and decrease your risk of getting cancer.

Experts recommend three to five hours of moderate physical activity (something that gets your heart rate up and makes you sweat) each week, or about 30-45 minutes a day, as well as two or three strength training weekly sessions.

4. Keep track of your BMI.

Your body mass index is your weight-to-height ratio and can be a good indicator of whether or not you’re overweight. Calculate your BMI and try to get to (and maintain) the “normal” range of 18.5-24.9.

5. Drink in moderation.

Some studies suggest drinking any amount of alcohol increases your cancer risk, while others show some alcohol consumption can help prevent cardiovascular disease. Either way, if you enjoy drinking, try to do so in moderation, which the CDC defines as up to 1 drink per day for women and up to 2 drinks per day for men.


Referred to as “intensive lifestyle change” by researchers, these resolutions may collectively seem prohibitively difficult. Try focusing on just one or two at a time, and remember that overall, each on its own will make a positive impact on your life—for this year and many to come.

Surgeons washing their hands before surgery

Staying Healthy All Year

Posted on 01/07/19 by Allied Anesthesia

Winter isn’t all festive holiday cheer and new beginnings in the New Year—it’s also (unfortunately) synonymous with cold & flu season. But there are two things you can do during the winter months (and the rest of the year!) to stay as healthy as possible.

As anesthesiologists, handwashing is a critical part of our daily work. Whether it’s a complex surgery or a simple office visit, we always wash our hands before and after having direct contact with a patient. We also wash our hands after having any contact with blood, other body fluids, or medical equipment/objects in close proximity to our patients. We wash our hands after removing our gloves and, just like everyone else, after using the restroom or before eating.

For routine examinations and office visits, we follow the healthcare provider handwashing recommendations issued by the CDC, which are probably similar to the hand-washing you’re familiar with:

  1. Wet hands with water.
  2. Apply the amount of soap recommended by the manufacturer.
  3. Rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers.
  4. Rinse your hands with water and dry with disposable towels. Use the towel to turn off the faucet.

Surgery, however, is another story. Because surgery sites are prone to infection, there is a thorough surgical handwashing procedure that every doctor, nurse or technician in the surgery suite follows:

  1. Remove rings, watches, and bracelets—your fingers and wrists should be free of any jewelry.
  2. Wet hands.
  3. Apply antimicrobial soap.
  4. Choose one hand/arm to start on. Using a clean scrub brush, scrub each side of each finger, between the finger, and the back and front of the hand for two minutes.
  5. Next, move up the arm, keeping the hand upright so that water from the arm does not flow down to contaminate the clean hand.
  6. Wash each side of the arm, all the way up to three inches above the elbow, for one minute.
  7. Repeat on the other hand and arm. If the hand touches anything except the brush at any time, the scrub must be lengthened by one minute for every area that has been contaminated.
  8. Rinse hands and arms by passing them through the water in one direction only, from fingertips to elbow. Do not move the arm back and forth through the water.
  9. Proceed to the operating room suite holding hands above elbows.
  10. Once in the operating room suite, hands and arms should be dried using a sterile towel and aseptic technique before you don your gown and sterile gloves.

If that sounds a little overwhelming, don’t worry; the guidelines for handwashing for the general public are much less intensive—but just as important! Handwashing is one of the best methods people have to avoid getting sick or getting other people sick. In fact, handwashing can prevent 30% of diarrhea-related sicknesses and about 20% of respiratory infections.

When you wash your hands, follow these steps from the CDC:

  1. Wet hands with clean, running water, and then turn off the tap.
  2. Add soap to your hands and rub together, being sure not to overlook the backs of your hands, between your fingers and under your nails.
  3. Scrub your hands for at least 20 seconds—about as much time as it takes to sing the “Happy Birthday” song twice from beginning to end.
  4. Rinse your hands well under running water.
  5. Dry your hands with a clean towel or air dry them.

In terms of when to wash your hands, the CDC recommends washing them before, after, and during food preparation, before eating and before and after caring for someone who is sick or wounded (including yourself). It’s also important to wash your hands after using the bathroom, changing diapers, touching animals, handling animal food or waste or dealing with garbage.

One of the illnesses handwashing helps prevent is influenza (or the flu), a common virus that affected more than 48.8 million people in the 2017-2018 season. With symptoms that include fever, chills, body or muscle aches, headaches and fatigue, the flu is incredibly unpleasant—but for people with compromised immune systems, babies, and older adults, it can be deadly. That’s why it’s important to get a flu vaccination every year (in addition to washing your hands regularly).

While the effectiveness of the vaccine varies year to year, studies show that getting vaccinated can reduce the risk of getting the flu by 40% to 60%. For children, pregnant women, older adults and people with chronic conditions, the flu vaccine is especially important in staying healthy.

All of us here at Allied get vaccinated every year—and you should too.


Allied Anesthesia doctors at St. Joseph's 2018 Celebration Gala

Allied Members Celebrate 60 Years of St. Joseph Partnership at Annual Gala

Posted on 10/30/18 by Allied Anesthesia

On a recent evening in Anaheim, Allied Anesthesia doctors, along with many in the Orange County medical community, came together for St. Joseph Hospital’s annual Celebration gala. It was an extra-special event for a number of reasons, not the least of which was honoring Ron Moeller, a grateful patient and philanthropist of St. Joseph.

The event also celebrated the 10th anniversary of the opening of the Center for Cancer Prevention and Treatment (CCPT), which has provided expert cancer care for thousands over the past decade. CCPT often employs the services of Allied Anesthesia physicians; and Allied doctors have partnered with St. Joseph for over 60 years, being a part of many medical triumphs over the decades, including the first open-heart surgery and pacemaker procedure in Orange County, the first-ever artificial hip replacement surgery and the first-ever knee replacement surgery, among many others.

“Allied is always grateful to be a part of the effort,” said Dr. Alex Ramirez, one of the many Allied members who attended the gala to support Allied’s fruitful and long-standing relationship with St. Joseph. “It was a great night for an incredible cause!”

It was also an opportunity for long-time Allied members to reflect on the progress that has been made, in no small part due to the groundbreaking work of St. Joseph and Allied Anesthesia medical innovators.

“As an anesthesiologist working in the Cancer Center, we often provide anesthesia services for adults with severe cancer pain, or pediatric cases from [Children’s Hospital of Orange County],” said Allied physician, Dr. Salomon Maya. “It’s amazing how far this technology has come! We’ve seen vast improvements in the outcomes of these cases, and I can’t think of a better cause to be a part of.”

But – let’s be honest – it was also a great party, truly worthy of the title, “Celebration!” Allied members were dazzled by the delicious dining options, silent and live auctions, and even a live musical performance by Postmodern Jukebox.

“The gala was so well organized and a truly excellent opportunity to raise money for a hospital that is especially important to the Allied family,” said Dr. Kishan Patel. “We loved it!”

We’re sad that we have to wait a whole year for the next Celebration gala, but we’re excited that Allied Anesthesia will be able to continue contributing to St. Joseph Hospital and the well-being of its grateful patients every day by providing high-quality, professional pain management support. Here’s to 60 more years of partnership and progress between St. Joseph Hospital and Allied Anesthesia!


Allied Anesthesia Choc Walk 2018 Disneyland group

Allied Walks for Kids at CHOC Walk in the Park at Disneyland

Posted on 10/03/18 by Allied Anesthesia

Allied Anesthesia was honored and thrilled to participate in the Children’s Hospital of Orange County (CHOC) Walk in the Park.  If you aren’t familiar with the CHOC Walk in the Park, it’s a fundraising event for the CHOC Children’s programs and services with the greatest needs, from mental health services to expanded neonatal intensive care units. And it’s held at The Happiest Place on Earth: Disneyland®.

It all started almost 30 years ago – on November 10, 1990 – when the entire Children’s Hospital (doctors, nurses, staff and patients) began the process of relocating from their original building, built in 1964, to a brand-new, six-story building a few miles away. The original walk began at the Main Place Mall in Santa Ana, passed by CHOC Children’s and wove its way through local neighborhoods before ending at the Disneyland parking lot. While the route changed a few times in its first decade, in 2002, it returned to its first home and became known as the CHOC Walk in the Park presented by Disneyland.

In the event’s 28-year history, it has raised more than $32 million for CHOC Children’s, and CHOC Children’s at Mission Hospital.

Tony Adkins of Choc Children's

Tony Adkins of CHOC

This year, we had an all-star team that included special guest Tony Adkins, a skilled CHOC physician assistant who has gone viral thanks to a special talent: using dancing as a way to cheer up and connect with his pediatric patients.

The Allied team also included Dr. Claudia Moreno and her family. “I wanted to participate in this event because I believe in providing the best possible care for our patients undergoing surgery at CHOC,” said Dr. Moreno. “I want parents to know that while their little one is in surgery, he/she becomes my little one, and that is the greatest honor and responsibility. My patients stay in my mind and heart.”

Dr. Rebecca Sanger and her family were there too. “The CHOC walk is an excellent opportunity for my own children to understand what I mean when I say I’m taking care of other people’s kids. It’s a chance for them to see other kids that have overcome and persevered through tough times with the help of doctors, nurses and so many wonderful staff members at CHOC.”

Learn more about the event and mark your calendars for next September … we’ll be there!

Allied Anesthesia Choc Walk 2018 Disneyland group Tony Adkins - Allied Anesthesia Choc Walk 2018 Disneyland Allied Anesthesia Choc Walk 2018 Disneyland

6 Reasons to Staff Your ASC With an All-Physician Anesthesia Group

Posted on 07/23/18 by Allied Anesthesia

Every ASC has several options when it comes to anesthesia staffing. You can hire anesthesiologists or nurse anesthetists directly, you can contract with them individually, you can contract with a large anesthesia group that operates on the care team model, or you can work with a specialized all-physician anesthesia group like Allied Anesthesia.

Here are six great reasons to consider bringing in a group like Allied to your surgery center this year.

#6 – Eliminate Cancellations From Coverage Issues

Many surgery centers don’t have the volume to employ a full-time anesthesia provider, and very few have the volume to support multiple providers.

Individual hires and contracts can lead to serious staffing issues. Are you willing to shut down your ASC because your anesthesia provider is sick or on vacation? Reschedule surgeries because they have a family emergency?

With a model like Allied’s, coverage issues are eliminated thanks to our pool of over 100 qualified physician anesthesiologists. Our anesthesiologists arrive on time, ready to deliver high quality care and won’t leave until patients are discharged from your ASC.

#5 – Benefit From Providers Who Are Ready for Anything

Variety isn’t just the spice of life – it’s also a helpful attribute in any profession. Medicine is no exception. Surgical care in an ASC setting is often routine and uneventful. But when the unexpected happens, you need a surgical team that can handle a curveball.

At Allied, all our anesthesiologists rotate through a variety of settings, from specialty outpatient surgical centers to fast-paced trauma centers and complex inpatient surgeries at some of California’s largest hospitals. That means that when your OR is staffed by an Allied anesthesiologist, it’s staffed by an anesthesiologist who’s ready for anything from the routine to the unexpected.

#4 – Improve Reimbursement

Appropriate and timely reimbursement is a big part of any successful outpatient surgery center. At Allied, our group has developed relationships and contracts with essentially every insurance company in our region. That not only ensures appropriate reimbursement for anesthesia services, it also lets you lean on our experience for help in negotiating reimbursement for all your ASC services. This ultimately leads to very happy patients that won’t receive unexpected medical bills and are more likely to return to your center for future procedures.

#3 – Keep Your Surgeons Happy

Surgeons prefer to work with anesthesiologists who have the same level of training and experience that they do. While there’s certainly a place for the care team model, our surgical satisfaction surveys have shown that most surgeons prefer to work with Allied’s physician anesthesiologists who can tailor an anesthetic plan to specific surgeon preferences. Allied anesthesiologists can also perform regionalized pain procedures that lead to lower pain scores after surgery which result in happier patients and surgeons.

#2 – Enjoy Customized Protocols

Despite what some large national anesthesia groups would have you believe, there is no one-size-fits-all in anesthesia. That’s why we develop customized protocols for every individual location and surgeon we work with. Whether it’s adapting the latest advanced procedures to an outpatient setting or accommodating individual preferences, our group works to deliver care in the right way for your ASC.

#1 – Improve Patient Care

Nothing is more important to our anesthesiologists than improving patient care, and we help our ASC partners reach that goal in a variety of ways: from implementing checklists and clinical decision pathways, to maintaining the safety of your ASC to helping to bring in new, advanced procedures and protocols to your facility. When you choose to work with a qualified anesthesia group like ours, you’re choosing a partner who’s always working toward the best for your patients.

Interested in learning what working with Allied could do for your outpatient surgery center? We’d love to hear from you.

St. Joseph Hospital Celebration 2017 Silent Auction

Allied Anesthesia Is Proud to Be a Silver-Level Sponsor of St. Joseph Hospital’s Celebration 2017 Benefit

Posted on 12/19/17 by Allied Anesthesia

On October 7, St. Joseph Hospital hosted Celebration 2017, an annual fundraising event whose proceeds benefit the St. Joseph Hospital Heart and Vascular Center. This year’s funds will go toward building a new, next-gen cardiac catheterization laboratory for technologically advanced procedures. The Celebration, which took place at the City National Grove of Anaheim, raised a record-breaking $450,000 for the center. Allied Anesthesia was proud to be one of the event’s sliver sponsors and a contributor to the event’s rare wine raffle. (more…)

pediatrician listening to patient's heart

3 Important Facts About Anesthesia Awareness

Posted on 10/05/17 by Allied Anesthesia


Anesthesia awareness is what people often refer to as “waking up” during surgery. It’s one of the greatest concerns among patients scheduled for surgical procedures. And this makes sense considering the terrifying urban legends around anesthesia awareness. Those stories are enough to make anyone think twice about going under. (more…)

doctors performing surgery

ERAS & Alternatives to Opiate Drugs

Posted on 09/07/17 by Allied Anesthesia


By Dr. Peter Sawras

Last month, I brought up the issue of the U.S. opiate drug crisis and the need for alternatives to opiate drugs. Drugs like morphine are important during recovery from major surgery, but other methods of pain management exist.


doctor writing for a medical blog

Our New Medical Blog, Allied Answers & Insights, Kicks Off!

Posted on 07/05/17 by Allied Anesthesia

The first post, written by Allied physician Dr. Peter Sawras, offers a bit of pre-surgery advice for patients

It’s official! Our new medical blog, Allied Answers & Insights, is live. If you’ve ever wondered why you can’t eat before surgery (and who hasn’t?), check out the very first post in the series right here. In the article, our very own Dr. Peter Sawras offers up the history behind the ban and gives all the good reasons for it. (more…)

woman eating tortellini

Carb Loading: Why Can’t You Eat Before Surgery?

Posted on 07/03/17 by Allied Anesthesia

Allied Answers & Insights

It’s the question we hear most: “Why can’t I eat before surgery?” It just so happens there are some really good reasons. Read on to find out!

By Allied Anesthesiologist Dr. Peter Sawras

In 1848 a pregnant woman went under anesthesia and died from aspiration. Yup, she had a meal before surgery and all that semi digested food ended up in the lungs. You are right, that is bad. (more…)

Dr. Lisa Wilson Receives Values in Action Award for Excellence

Posted on 06/06/17 by Allied Anesthesia

Dr. Lisa Wilson Allied Anesthesiologist

St. Mary Medical Center has awarded Allied Anesthesiologist Dr. Lisa Wilson the Values in Action Award for Excellence—the hospital’s highest honor

We’re proud to announce that Allied Anesthesiologist Dr. Lisa Wilson is the recipient of this year’s Values in Action Award for Excellence from St. Mary Medical Center in Apple Valley, the fine hospital where she practices regularly. The award is the highest honor the medical center’s administration gives its physicians. Dr. Wilson received the award at a ceremony at St. Mary Medical Center on May 17. (more…)

Welcome aboard sign

Meet Our New Doctors

Posted on 05/09/17 by Allied Anesthesia

Our team is growing! We recently added eight new board-certified physicians in our Orange and Fullerton divisions. Many of the new doctors are fellowship trained in pediatric anesthesia or in regional anesthesia and acute pain management. (more…)

allied anesthesia physician paul yost

Allied’s Own Dr. Paul Yost Named New Board Chair for CalOptima

Posted on 03/23/17 by Allied Anesthesia

We’re proud to announce that one of our leading physicians, Dr. Paul Yost, will begin serving as new board chair for Orange County health care system CalOptima on March 31. Dr. Yost will serve the remainder of soon-to-be former chair Mark Refowitz’s term, which runs through June 30 of this year, until another election is held. (more…)

operation smile logo

Allied Physician Brings Healing Through Medical Missions

Posted on 03/01/17 by Allied Anesthesia

Dr. Clifford Char, our colleague and friend—and LA Times’ “Unsung Hero” for 2016—has completed 25 medical mission trips around the globe since 1998.

As of 2016, Allied physician Clifford Char has completed 25 medical mission trips in underdeveloped nations, averaging more than one trip per year since 1998. Char was named the Los Angeles Times’ “Unsung Hero” for 2016. An article on the website features the details of his charitable work. Char has been an Allied Anesthesiologist since 2000. (more…)

orange coast magazine 2017 physicians of excellence

 7 Allied Docs Named 2017 Top Doctors

Posted on 02/07/17 by Allied Anesthesia

Orange County Medical Association and Orange Coast Magazine honored seven Allied Anesthesia physicians in January, naming the doctors to the highly publicized 2017 Top Doctors list.

Allied Anesthesia announced today that Orange County Medical Association (OCMA) chose seven of the group’s anesthesiologists as 2017 Top Doctors. The Top Doctors program is a collaborative effort between OCMA and Orange Coast Magazine. (more…)

thumbs up for another year of growth

Another Year of Growth for 2016

Posted on 01/24/17 by Allied Anesthesia

Award-winning medical group Allied Anesthesia today confirmed that 2016 was another year of growth in size, significant methodological advancements and widespread adoption of new technologies. The group credits the openness of its partners to progressive approaches and its individual physicians’ commitments to innovative health care for the year’s success. (more…)

first-person perspective of having surgery

Questions About Having Surgery? We’ve Got Answers!

Posted on 07/21/16 by Allied Anesthesia

We all have burning questions about general anesthesia, but, with all of the appointments and other business around scheduling surgery, it can be tough to remember to ask those questions. So the Allied Docs put together answers to some of the questions patients might have about this critical part of the surgical experience. (more…)

doctors who are futurists

Allied Anesthesia Announces Successful First Year, Says Today’s Doctors Must Be ‘Collaborative Futurists’

Posted on 03/02/16 by Allied Anesthesia

Successful first year solidifies group’s belief that future-minded, collaborative members are key to success without corporate management or big-bank backing in the rapidly changing health care market .

Allied Anesthesia Supports Disabled American Veterans Project to Honor the Late Dr. Jeff Katz

Posted on 01/27/16 by Allied Anesthesia

Avid fly fisherman doctor dedicated his free time to helping struggling disabled American veterans heal through the sport, Allied Anesthesia seeks to carry on this legacy

In an effort to promote awareness of the needs of disabled American veterans and create a meaningful memorial to the late Dr. Jeff Katz, Allied Anesthesia recently presented a generous gift to Project Healing Waters Fly Fishing (PHWFF). Dr. Katz and his wife Carole Katz were deeply involved in the extraordinary project, which aims to empower and heal disabled veterans both mentally and physically through the art of fly fishing. (more…)

New Podcast Tackles Hot-Button Public Health Issues

Posted on 01/12/16 by Allied Anesthesia

 Topics range from cancer and contraception to obesity and transgender transition on Allied Physician’s new podcast “Straight Talk MD”

Transgender youth. Cell phones and brain tumors. Economics of obesity.

No public health topic is too sensitive or too controversial for Dr. Frank Sweeny’s podcast, “Straight Talk MD”. (more…)

CHOC Halloween: Allied Anesthesia physicians give out goodies

Posted on 12/01/15 by Allied Anesthesia

Four Allied Anesthesia physicians dressed in costume and handed out candy as part of Children’s Hospital of Orange County’s annual trick-or-treat event Oct. 30.

Drs. Raymond Bailie, Gregory Perkins, Manoj Kulkarni and Joe Kim were among the volunteers who took time off work to help bring goodies and good cheer to CHOC’s young patients.

Bailie, who dressed as Buddy Blue from the Rainbow Brite franchise, said Halloween is one of his family’s favorite holidays.

“It was important for us to be involved at CHOC’s Halloween celebration so the children at the hospital would not miss out on Halloween,” Bailie said. “It was especially heartwarming to see the genuine smiles from the children and all the adult participants.”

Perkins, a hockey player, dressed as an Anaheim Ducks hockey player.

“The look of amazement on the younger kids’ faces was priceless and very satisfying,” Perkins said.

He said the older children were more subdued because they realized what they were missing by being in the hospital during Halloween. However, he said, they appreciated all the great costumes and decorations.

Everyone from neurologists to security officers participate in CHOC’s annual Halloween event, which is open to inpatients and outpatients alike. Many of the children wear costumes, some of which are donated.

Child Life specialists guide the patients down to the second floor where they walk around to collect their candy.  They also go trick-or-treating for patients in isolation and deliver the goodies to their rooms.

“It is important for Allied physicians to participate in such events to build teamwork with CHOC Children’s Hospital,” Perkins said. “We provide exceptional care in the operating rooms but it was nice to provide compassion and generosity outside of the ORs as well.”

CHOC’s New Neurointervention Suite Improves Outcomes

Posted on 11/06/15 by Allied Anesthesia


The new neurointervention suite at Children’s Hospital of Orange County is designed to increase survival and reduce disability among pediatric patients with neurological anomalies.

Allied Anesthesia physician Joseph Kim, who is the medical director of anesthesia at CHOC, was directly involved in creating the service that recently opened. Kim worked closely with Dr. Shuichi Suzuki, neurointervention specialist at the UC Irvine Medical Center, to ensure the opening went smoothly.

Previously, when children needed this procedure, they would have to be transferred to UC Irvine Medical Center or other outside hospitals, which caused logistical problems and potentially life-threatening delays in treatment.

“What this does is provide a central location for the pediatric population to come and have their neurological anomalies treated in a timely manner by eliminating the need to transfer back and forth between CHOC and other hospitals,” Kim said.

Two of the most common conditions that require neurointervention techniques are arteriovenous malformations and cerebral aneurisms, according to Kim. Some conditions are congenital and some are the result of trauma.

Kim recalls one patient, a young girl whose head was run over by a car resulting in multiple arteriovenous malformations. CHOC’s neurointervention team has treated her twice already to try to eliminate the malformations.

“We’re excited to have started this service at CHOC,” Kim said.

Allied Anesthesia is a Proud Partner of St. Jude

Posted on 09/03/15 by Allied Anesthesia

Recognized as leading stroke center, St. Jude’s “smart” surgical suites set it apart. 

Allied Anesthesia is a proud partner of St. Jude Medical Center in Fullerton, where innovative medicine is the norm not the exception.

St. Jude was recently named one of the nation’s top stroke centers by The Joint Commission and the American Heart Association/American Stroke Association, making it one of only 10 hospitals in the state to earn the distinction.

The chances of survival for stroke patients and others suffering neurological disorders were enhanced when St. Jude opened its $255 million Northwest Tower, which includes a neurosurgical operating suite outfitted with high-resolution, digital intra-operative magnetic resonance imaging (iMRI) coupled with sophisticated new surgical navigation, visualization and information capabilities.

The neurosurgical operating suite, which is one of 14 “smart” surgical suites located on the tower’s third floor, is the first of its kind in California.

“Independently, the iMRI operating suite and Comprehensive Stroke program are both highly specialized and not commonly found in most hospitals; rarely are they found in the same hospital,” said Dr. Kyle Wehner of Allied Anesthesia, which provides anesthesia services to St. Jude Medical Center. “These combined programs truly set us apart from other Southern California hospitals.”

The iMRI suite allows neurosurgeons to assess their progress using real-time MRI imaging while the patient is still anesthetized. They can ensure that an entire tumor is resectioned and check for bleeding or other complications that could require additional surgery.

Allied Anesthesia physician Dr. Tim Downing was directly involved in the stroke certification process and was the first anesthesiologist to be trained on the iMRI protocols.

“Anytime you can minimize a patient’s exposure to anesthesia, it lowers the risk of complications,” Downing said.

The iMRI operating suite complements the hospital’s state-of-the-art Neurointerventional Lab, where stroke patients are taken to be catheterized if preliminary procedures are unsuccessful. If the patient requires surgery, the iMRI suite is close by.

“This will absolutely improve the stroke patient’s odds of survival,” Downing said.

The Advanced Certification Comprehensive Stroke Center designation recognizes St. Jude’s superiority in expertise, resources and training that are necessary to successfully treat complex stroke cases.

St. Jude already has been recognized nationally for exceptional neurosurgical outcomes, including being named a top neurosurgery hospital by Blue Shield/Blue Cross.

Allied Anesthesia has an excellent reputation and proven track record for quality of care, efficiency and patient satisfaction.

Allied Anesthesia physician wraps up year as CSA president

Posted on 07/22/15 by Allied Anesthesia

Paul Yost served at a time of tumult, transition and transformation

Allied anesthesiologists contribute in many ways.  For the past year, Dr. Paul Yost served as President of the California Society of Anesthesiologists,  representing more than 3,000 anesthesiologists throughout California.

Under Yost’s leadership, the CSA joined the effort to defeat Proposition 46, ensuring that all Californians continue to have access to highly specialized surgery and anesthesia care.

Working to allow the practice of Anesthesiologist Assistants in California, the CSA introduced its first credible legislative effort with the expert help of KP Public Affairs.  AB 890 (Ridley-Thomas) would allow certified Anesthesiologist Assistants (physician assistants for anesthesiologists) to practice in California.  Although the bill didn’t make it out of committee during this legislative session, the CSA is leveraging its experience in the legislative arena to represent its patients and the specialty.

From an organizational perspective, Yost’s most memorable achievement was completing a strategic analysis and reorganization of the CSA management structure.  Following the analysis, CSA moved its central office from San Mateo to Sacramento, with closer proximity to the Capitol where the CSA can better advocate for its physician members and their patients.

Yost said, “It was an incredibly tumultuous and busy year, filled with world class educational events in Hawaii and San Francisco, board meetings, strategic planning sessions, national meetings, Capitol hearings, press releases, visits to anesthesiology training programs, interfacing with the ASA, CMA and other specialty societies, district meetings, and just talking with members.

“Although it was a year filled with upheaval, change brings opportunity.  The CSA has taken advantage of that opportunity and is now financially stable and very well positioned to represent our patients and our specialty well into the future.”  From a personal standpoint, Yost was humbled to be the spokesperson for his profession and his physician anesthesiologist colleagues in California.

Yost practices adult and pediatric anesthesiology at St. Joseph Hospital in Orange, where he is Director of Cardiac Anesthesiology, and at Children’s Hospital of Orange County (CHOC Children’s), where he is Chair of the Department of Anesthesiology, Co-Director of Pain Management and Past President of the Medical Staff.

Yost thanked his colleagues at Allied Anesthesia for allowing him the time to be involved on behalf of the CSA.

“This year has frequently taken me away from my clinical responsibilities and I know that my absence has been a burden upon other Allied physicians who had to cover my clinical cases and call,” Yost said. “Thank you!  Allied anesthesiologists are the best!”

Allied MD Writes for WebMD Network

Posted on 07/13/15 by Allied Anesthesia

Allied Anesthesiologist Lynnus Peng, MD, is a medical author on eMedicineHealth.com, part of the WebMD network.  Dr. Peng wrote eMedicineHealth.com’s article on Outpatient Surgery.

Peng’s article explains the process of outpatient surgery, from preparation and testing through the actual surgery and post-surgical recovery.  For patients with an upcoming outpatient procedure, the article can help to inform about what to expect during what can be an intimidating process.

Allied Anesthesia physicians release summertime safety tips

Posted on 07/07/15 by Allied Anesthesia

Parent precautions designed to keep emergency room visits to a minimum

Today, the physicians at Allied Anesthesia, who provide services to Children’s Hospital of Orange County and other major medical facilities in Orange and San Bernardino counties, released a series of tips to help children stay safe over the summer months.

Summer can be a particularly hazardous time of year for children, who spend more unsupervised time outdoors.

The most common causes of injuries and death for young children are drowning, biking, falls, car accidents and pedestrian mishaps.

“By being aware of the most common injuries and how to avoid them, parents can keep their families safe and secure this summer,” said Dr. Paul Yost, an Allied anesthesiologist and director of cardiac anesthesia at St. Joseph Hospital of Orange. “The fewer children we see in the emergency room, the happier we are.”

Here are some tips to help children avoid the emergency room this summer:

Pedestrian accidents

  • Children younger than 10 should never cross the street alone or play unsupervised near roadways.
  • Teach young children to look left, right and left again before crossing the street and to make eye contact with drivers as they are walking.
  • Tell them never to run out in the street to chase a ball or pet.

Water safety

  • Children should always wear a life jacket when in a boat or riding on a personal watercraft.
  • Never leave children alone near swimming pools or other bodies of water even if they know how to swim.
  • In group situations, designate a “water watcher,” who agrees to monitor the water at all times.

Heat-related injuries

  • Never leave a child alone in a car, not even briefly. Place your purse, briefcase or cell phone in the back seat next to your child as a reminder.
  • When parked, keep your car locked to keep children from climbing inside and becoming trapped.
  • Apply sunscreen with an SPF of at least 15 on your child 30 minutes before he or she goes outside. Reapply the sunscreen every two hours and after swimming or sweating.
  • Make sure children drink lots of water during the day to stay hydrated.

Bicycles, skateboards and scooters

  • Children should always wear helmets when they ride bikes, skateboards, skates or scooters.
  • Limit riding to daylight hours.
  • Children younger than 10 should stay on a bike path or sidewalk.
  • In addition to helmets, skateboarders and skaters should wear wrist guards, knee pads, elbow pads and mouth guards.


  • The safest way to enjoy fireworks on July 4th is by attending a public display.
  • Even “Safe and Sane” fireworks can cause severe burns and eye injuries.

Allied Anesthesia physicians volunteer to help Orange County’s uninsured

Posted on 06/30/15 by Allied Anesthesia

Health-care events provide patients with free surgeries and procedures

Orange, Calif. – Allied Anesthesia physicians are committed to giving back to the community.

Eleven physicians from Allied’s Fullerton division volunteered to help provide free outpatient procedures to some of Orange County’s neediest residents during the 8th annual Super Surgery Saturday, March 21, at St. Jude Medical Center.

The event was coordinated by AccessOC, which was founded in 2007 to address the medical care needs of Orange County’s uninsured population

AccessOC is just one of a number of community health-care initiatives that Allied physicians participate in.

Recently, three physicians from Allied’s Orange division assisted in performing free endoscopies at St. Joseph Hospital of Orange.

“It’s incredibly rewarding to see how grateful the patients and their families are to receive world-class health care in an environment where they don’t have to worry about the financial burden,” said Dr. David English, of Allied’s Orange division, who has participated in three community health-care events.

“When Allied asks for volunteers, there are always more volunteers than there are spots available,” English said. “That says a lot about Allied, that so many anesthesiologists are willing to give their time for a worthy cause.”

Since 2007, AccessOC has mobilized more than 800 volunteers to provide more than 450 uninsured patients with donated surgeries and procedures valued in excess of $6 million.  The procedures not only improve patient health but their quality of life as well.

Doctors perform a variety of surgeries including: hernia repair, cataract, biopsies, gallbladder and minor gynecological procedures.

“Some of the patients have lived with a correctable medical problem for years but were never able to get the problem fixed until they came to St. Jude as part of AccessOC,” said Dr. Kyle Wehner, of Allied’s Fullerton division, who has volunteered for five AccessOC events.

About 30 patients are treated several times a year at five different hospitals after being screened for eligibility by participating community clinics in Orange County where about 18 percent of adults are uninsured.

“Members of Allied strive to provide the highest quality anesthesia care to all members of our community regardless of their financial status,” Wehner said. “A sense of community is a quality we look for when hiring new anesthesiologists.  Volunteering and charity work are part of our culture.”

Allied Anesthesia Physicians Promote Gentle C-sections

Posted on 04/28/15 by Allied Anesthesia

New Movement Focuses On Creating A More Enjoyable And Memorable Experience

Allied Anesthesia physicians are embracing the concept of “gentle C-sections” which was pioneered in Boston and is swiftly gaining ground across the country.

Unlike traditional cesarean sections, gentle C-sections focus on making the experience more enjoyable and memorable for the mother by making her comfortable and speeding up the bonding process between mother and baby.

“We’re the hand holders of the patients,” said Dr. Salomon Maya of Allied.

Maya and other Allied anesthesiologists have been known to entertain their patients, turn on music, make sure they have fresh, warm towels, and even scratch their nose for them if necessary.

“We almost pamper them to make sure the birthing experience is as positive as humanly possible for them,” Maya said. “A lot of times they are afraid or nervous and they just want someone to hold their hand during the C-section. And, we do all that.”

Allied physicians go one step further than most by performing a regional nerve block called a TAP block, which helps alleviate the pain of a C-section once the epidural wears off. The TAP block is done after the C-section is completed and while the patient is still numb from either her epidural or spinal anesthesia.

“Most women, all they need to take is Motrin and they don’t have to take any narcotics which can cause side effects like nausea and constipation,” Maya said.

Gentle C-sections also commonly involve removing arm straps from the mother so she and baby can have immediate skin-so-skin contact. Skin-to-skin contact, which is more common in vaginal births, promotes quicker bonding and gives them a head start on breastfeeding.

“It’s really a team effort with us figuring out exactly what we can do for the OB and what we can do for the mom,” Maya said. “We’re the ones making sure everything goes smoothly.”

Allied Anesthesia Promotes Healthy Hearts During American Heart Month

Posted on 03/10/15 by Allied Anesthesia

Allied Anesthesia physicians are observing American Heart Month by explaining their role in keeping the heart healthy during surgery and encouraging patients to work toward a healthier heart in general.

Most patients don’t realize that anesthesiologists do a lot more than just put them to sleep before surgery and administer pain medication after they wake up. Anesthesiologists play a critical role in monitoring, regulating and stabilizing the heart during surgical procedures.

In addition to blocking the nerves that send pain messages to the brain, anesthesia slows the heart and causes the patient’s blood pressure to drop. For someone with a healthy heart, there are usually no complications.

But if the heart is defective, especially if the defect or condition has been undiagnosed, the role of the anesthesiologist is even more critical.

Typically, anesthesiologists will review the patient’s chart, interview the patient and conduct a brief physical examination to determine if there are any undiagnosed heart issues before surgery.

If the patient has been experiencing chest pain, pressure or shortness of breath, it’s important that they share that with their anesthesiologist.

Allied physician Dr. Rajesh Bhat, a specialist in cardiothoracic anesthesiology, often assists during open-heart surgery or when the patient has a serious pre-existing heart condition.

“Patients also should discuss with their surgeon and anesthesiologist before suddenly stopping any medications before surgery and to make sure the anesthesiologist is aware of all the medications that they take,” Bhat said.

Since Allied’s recent merger with Fullerton and Upland anesthesiology groups, Allied has more cardiothoracic anesthesiology specialists than any other group in the region.

During open-heart surgery, these specially trained physicians use a state-of-the-art probe inserted into the esophagus and stomach to take detailed ultrasound images of the heart. The procedure allows them to constantly monitor the heart, to detect structural heart problems and to assess the results of the surgery while the patient is still on the operating table.

The easiest way to avoid heart issues in the first place is to follow these tips for a healthy heart:

  • Don’t smoke.
  • Be physically active.
  • Maintain a healthy weight.
  • Cut fats and add more plants and fish to your diet.
  • Keep blood pressure below 120/80 and cholesterol below 200 milligrams/deciliter.

Allied Anesthesia Has More Pediatric Subspecialists than Any Other Group in Orange County

Posted on 02/26/15 by Allied Anesthesia

Seven Allied Anesthesia physicians recently became board-certified pediatric anesthesiologists, bringing the total number of Allied physicians with the new subspecialty to 36.

Allied Anesthesia, which serves Children’s Hospital of Orange County in addition to numerous hospitals and health care facilities throughout Southern California, is the only group in Orange County with that many board-certified pediatric anesthesiologists.

Drs. Kaveh Matin, Ralph Da Graca, Jack Canton, Lorraine Kaelin, Norichika Okada, Kishan Patel and Eric Ontiveros joined the other Allied pioneers in the specialized field of pediatric anesthesiology, which was first offered by the American Society of Anesthesiologists in 2013.

“Board certification helps assure the families that the physicians caring for their children really do understand the specific needs and issues that pertain to the pediatric patient population,” said Da Graca, a board-certified pediatrician and neonatologist who has been with Allied since 2008.

He said pediatric anesthesiologists are often dealing with high-risk patients who have multiple medical problems so it’s critical to have a firm grasp of pediatric physiology and the various metabolic, genetic and cardiac issues that are unique to the pediatric population. And, dosages for children are more critical because they are based on a patient’s size.

Da Graca and Matin, Allied’s CEO, said having the board certification is a validation of their knowledge and multiple years of experience working with children.

Matin said eventually having all Allied physicians who work at CHOC becoming board-certified in pediatric anesthesia will be a selling point for the hospital.

“It gives the hospital a sense of security in knowing they have the highest quality physicians caring for their young patients,” Matin said. “And, it will help them promote themselves as one of the leading hospitals in pediatric care going forward.”

Looking Forward to a New Year with Optimism

Posted on 01/23/15 by Allied Anesthesia

Happy New Year!

As we move forward into a new year, we hope to improve our services, and continue to provide the best health care for our patients. Every year, our physicians work with children from Children’s Hospital of Orange County and at other area hospitals taking care of young patients.

We have gathered our most helpful tips to keep in mind if your child has a procedure scheduled later this year. In addition to these tips, you can always ask your physician for any other advice to prepare your child for the big day.

Address Anxiety with Honesty

For anyone about to undergo a procedure, there may be some anxiety, but for children, the anxiety may be accompanied by fear and anger. As parents, you can curb that nervousness by helping your child understand their procedure, and address any other emotions they may have with encouragement and positive words.

Make Your Child as Comfortable as Possible

Before the big day, make sure that your child feels calm going into the situation. Make certain that the room is comfortable, and reassure them that they are in good hands. You can bring certain items to the hospital that may comfort them when they wake, or just be supportive with your own presence.

Be Strong and Set a Good Example

As a caring parent, it is natural that you may be concerned or nervous as well, but putting on a strong face for your child is critical.

Assure Your Child of a Positive Outcome

Explain the procedure as honestly as possible without using any alarming language. It may not be necessary to go into details of the procedure, as long as your child knows that after everything is said and done, he or she will be feeling better.

Present Information to Them So They Understand

You can use books or toys to help children through the process. There are many stories about children staying in the hospital, or you can show your child what to expect using a doll or stuffed animal. Remind them that a doctor is there to help them feel better, not hurt them.

Do Some Prep Work

If you can, go to the hospital beforehand and show your child around. Introduce them to the staff, and let them get a sense that the hospital is a good place to get better and it’s a safe place.

Finally, be positive and know that your child will be in good hands.

Once again, Happy New Year!

Allied Works to Adopt Electronic Records

Posted on 12/09/14 by Allied Anesthesia

Allied Anesthesia physicians in Orange are working to adopt electronic records for the hospitals they service in order to bring more efficient care to their patients.

Bringing together all of a patient’s information and streamlining it electronically is fairly standard in most hospitals, but physicians hope to bring it to every hospital. In addition to reducing costs, implementing electronic records will provide more accurate and faster access to patient information, physician comments, and any other necessary notes.

Allied physician Dr. Manoj Kulkarni explains, “When you accumulate a large number of electronic records, you can easily evaluate the data and perform really strong studies to improve your practice.”

Digitizing medical files is positive for many reasons. From the physician’s perspective, electronic records provide quicker, more accurate, and complete patient information that multiple medical professionals can access simultaneously. The records also highlight critical information that can help provide better service to patients in terms of which procedures or medications best fit individual needs based on medical history or medication allergies. The system also can ensure more safety; physicians can see any patient conditions immediately, and safely take the next step.

Dr. John MacCarthy, president of Fullerton Anesthesia Associates, which was recently acquired by Allied Anesthesia, agrees that this system is key to efficiency. He said, “Electronic records make for much more accurate and faster charting so more of your attention can be directed towards taking care of the patient.”

The electronic files are also a smart fiscal decision. They allow for more accurate collections using fewer employees, and the program also tracks billing information, so hospitals can receive optimal payments electronically.

The combination of these features makes it easier for healthcare professionals to give attention to their patients, and that’s the most important thing of all.

SurveyVitals Feedback Helps Allied Anesthesia Learn and Grow

Posted on 10/23/14 by Allied Anesthesia

The team members of Allied Anesthesia are always working to make our patients comfortable during every step of any procedure. To make each patient’s experience the best it can possibly be, we hired an independent company, SurveyVitals, to survey all of our patients on a scale of 1 to 5. We wanted to know how they felt about the quality of care they received, and how we could improve. Now, there is even an optional Contact Me feature, so if patients would like to discuss their experience via email or phone, they can request to do so.

We believe that by providing our patients the option to give feedback about their experience, we can improve our quality of care, and better understand the experience from a different perspective.

We are grateful to have the opportunity to stretch and grow from new knowledge, and it’s a wonderful opportunity to improve our practices. “We’ve received a lot of positive feedback,” said Dr. Salomon Maya, who coordinates the survey for Allied Anesthesia. “It reinforces the message that we do our best to go above and beyond for our patients.”

Further, we can learn from other comments that may or may not relate to anesthesiology, but rather privacy or clarity of information. The feedback helps make us aware of what we can keep in mind during our interactions with our patients.

Patient privacy has always been a concern for healthcare professionals; the surveys have demonstrated that patients value the dedication that Allied physicians give to privacy. Maya explains, “I’m constantly aware and pay special attention to my patients’ privacy.I make sure I close the curtain of the patient’s room and ask if the patient would like their family members to leave the room during my interview.”

He went on to explain his desire to make patients feel listened to and informed and comfortable about anesthesia during whatever procedure they may need. “I make the point with my patients that, although there are different types of anesthesia, it may be, for this type of surgery, our only option is general anesthesia.”

Allied physician Dr. Tony Ho agrees with Maya, and explained that SurveyVitals gives the group a way to compare its performance on more subjective matters, like patient communication and effectively easing a patient’s anxiety, with other anesthesia groups that have also chosen to participate. Ho said that even simple measures, like fully explaining a medication regimen, goes a long way. He added, “We have a lot of good clinicians, but bedside manner is something all of us can strive to be better at.”

We are so encouraged by the feedback from SurveyVitals, and we always welcome feedback from our patients during every step of the process.

Allied Team Members Discuss Addressing Each Patient’s Needs on KFI Radio

Posted on 10/07/14 by Allied Anesthesia

Recent news about Joan Rivers’s death during a routine endoscopy has caused concern among the public. The 81-year-old comedienne passed away a week after going into cardiac arrest during an endoscopic procedure, in which a tiny camera is passed into the esophagus, stomach and intestines to diagnose and treat conditions of the gastrointestinal system.

Although the cause of her death has not yet been determined, the media has focused on anesthesia and her age as a possibility for complications. In a recent interview with KFI radio, Allied Anesthesia physician Dr. Paul Yost, president of the California Society of Anesthesiologists, explained that the risk factors of anesthesia are more complex than just age. He confirmed that a patient’s age is not the sole factor when considering risk, but in fact, other medical conditions and overall health are more significant considerations.

Anesthesiologists take careful measures when preparing patients for procedures. It is critical to address the individual needs of every patient. If an older patient is in good health, his needs will differ greatly from those of a younger patient with serious medical conditions. A physician anesthesiologist should always be the one to administer anesthesia, and be present during any procedure in case of emergency.

Dr. Greg Perkins, chairman of St. Joseph Hospital in Orange and member of Allied Anesthesia, and Dr. Yost agree that the best thing a patient can do, regardless of age or health, is follow the doctor’s instructions. Don’t be afraid to ask questions about the risks, fasting prior to the procedure or medications that are safe to take. Actively working with your physician and following directions throughout any procedure helps ensure a speedy recovery.

Dr. Yost’s interview with KFI can be heard in its entirety at: https://www.youtube.com/watch?v=VGJOw24opMY

a group of piled hands

Allied Welcomes Fullerton Anesthesia Associates and the Upland Anesthesia Medical Group

Posted on 09/30/14 by Allied Anesthesia

We’d like to offer a very warm welcome to our new colleagues from Fullerton Anesthesia Associates and the Upland Anesthesia Medical Group. Allied Anesthesia is now consolidating with two of the most respected anesthesia groups in Southern California.

The new Allied Anesthesia will formally begin operations on January 1, 2015, representing more than 100 physicians operating in at least six hospitals and over a dozen ambulatory service centers.

The merger is a natural move for all three groups. Allied, Fullerton Anesthesia Associates and the Upland Anesthesia Medical Group have all earned reputations as leading anesthesiology groups, known for their track records of improving efficiency while increasing positive patient outcomes.

Many anesthesiologists in all three groups have demonstrated their commitment to excellence by serving in leadership positions within their medical staffs and professional organizations, and all three groups are committed to working as true partners within the institutions where we serve.

By combining the resources and expertise of a larger pool of skilled anesthesiologists, we’ll be able to offer greater levels of patient care and service to our partner institutions.

You can find more details on the consolidation in our press release, and I hope you’ll join all of us in welcoming our new colleagues.

New CSA President Is an Allied Anesthesiologist Physician

Posted on 07/21/14 by Allied Anesthesia

We are excited to announce, the new president of the 3,000-member California Society of Anesthesiologists (CSA) is our very own Allied physician Paul Yost.

Dr. Yost is a very qualified individual for this position. His years of experience, wealth of knowledge and many talents are a testament to the type of leader who should hold such an esteemed position in this statewide organization that promotes the highest professional standards, provides continuing education, and advocates for anesthesiologists and their patients.

As the director of cardiac services at St. Joseph Hospital of Orange, and former president of medical staff and co-director of pain management at Children’s Hospital of Orange County, Dr. Yost has felt that there is strength in teamwork.

He expressed his dedication to organized medicine by explaining, “We’re so much stronger when we work together. To me it’s something you do. It’s a part of your professional life. You get involved and try to leave the organization better than when you started.”

Among his many goals as president, Dr. Yost promised to continue to listen to and learn from his colleagues. He believes that every member of the CSA has a voice that is valid and meaningful, and he encourages other physicians to engage politically with the CSA. For Dr. Yost, the success of the CSA can be measured by demonstrating value to all members.

He also discussed the importance of interacting with new minds within the industry. He plans to visit as many training programs as possible in the next year to reconnect with program directors, chairs and colleagues. These training programs will also provide the opportunity for Dr. Yost to work with younger members.

“I really want to know, what do younger anesthesiologists need? How can we make them and ourselves more successful?” Dr. Yost continued. “Because our youngest members have the longest time left in the specialty, and they are closest to the knife-edge of change, I’d like to identify and respond to their changing needs.”

Dr. Yost expressed gratitude to his colleagues at Allied Anesthesia for allowing him the time to be involved on behalf of the CSA. He plans to keep his Allied Anesthesia colleagues up-to-date on the latest developments in their field for their own growth and for the benefit of their patients.

Congratulations to Dr. Yost on his achievement.

Allied Physicians Honored by Nurses

Posted on 06/24/14 by Allied Anesthesia

The nursing staff at St. Joseph Hospital in Orange honored Allied Anesthesia physicians Frank Sweeny and Phillip Richardson during National Nurses Week in May.

Due to their incredible leadership and collaboration, Drs. Richardson and Sweeny received the 2014 M.D. Friend of Nursing award.

Dr. Richardson’s contributions to the hospital include helping the nursing team to pilot the first cesarean section on-time trial. He is also an advocate for the laborist program and has been available for consultation as the hospital’s maternity program continues to grow.

Dr. Sweeny was nominated for providing leadership and support, and for bringing dignity to every interaction at all levels. He consistently takes the time to work directly with the nursing team to ensure quality patient outcomes.

Both Richardson and Sweeny were surprised and honored by the awards. They are firm supporters of nurses, and recognize the key role that nurses play within the health care system. For them, it is necessary that all members of the team be celebrated and thanked.

“This is truly a special award that will always be dear to my heart,” Richardson said.  “My mother and grandmother were both nurses, and I believe they would be proud that they raised a son/grandson that is being recognized as a Friend of Nursing.” He added, “Every partner in the process is critical for the best outcome for both the mother and baby and we need everyone working together.”

Sweeny also took the opportunity to thank the nurses, who he said “do so much and get so little credit” yet are so critical to positive patient outcomes.

We are pleased that our physicians were recognized for their efforts, and we also would like to take a moment to thank all members of the nursing team at St. Joseph Hospital. Their dedication makes a big difference in the lives of our patients.



What You Need to Know About An Epidural

Posted on 05/30/14 by Allied Anesthesia

Allied Anesthesia physician Dr. Thanh Tran specializes in labor and delivery at St. Joseph Hospital in Orange and spends a lot of time providing information about epidurals for his patients having their babies.

 Epidural Fast Facts:

An epidural is a procedure that numbs pain fibers and prevents transmission of pain signals to the brain.

The name ‘epidural’ comes from its place of delivery into the body, “the epidural space” which lies in front of the spine.

An epidural is a procedure, available to women in labor, that relieves pain and promotes more comfortable labor and delivery.

Unlike receiving systemic narcotics (IV pain medications), the effects of an epidural remain targeted to the area in need, without significantly affecting other areas of their body.

Effects are localized, so less medication is administered. This is safer for the baby and the mother.

Epidurals allow the mother to be awake, alert and comfortable during labor.

Communication During Any Procedure Is Key

To ensure patients are comfortable and at ease with their epidural, Dr. Tran likes to make certain all women’s questions are answered with clarity.

Is it safer than other options?

It’s a safer option. Because there are less drugs in the mother’s system and it’s safer for the mother and baby.

What if I need a C-section?

If a C-section is called for, the epidural can be used to prevent the need for general anesthesia.

What if I’m nervous?

Labor is a time of high anxiety; unfortunately, that anxiety causes an excess production of stress hormones in a mother, which can ultimately slow contractions. The epidural can help with those issues. It’s amazing how many times I’ve seen a labor that’s not progressing be facilitated by an epidural by alleviating pain and anxiety and allowing a patient to relax.

When is it too late for an epidural?

Women can usually receive an epidural at any point during labor, provided there is enough time for it to take effect before delivery.

What are the risks?

Though you should discuss the risks with your doctor, the risks are minor and rare.

There is an increased risk of assisted delivery (forceps or vacuum extraction for delivery).

The medication may decrease blood pressure. Your doctor will monitor your blood pressure and treat as necessary.

Headaches can occur if the needle is inserted through the epidural space into the dural area.

Fever can occur, but the increase in temperature is not believed to be from infectious causes.

Occasionally, an epidural does not work effectively and a woman may still feel pain, or pain on one side.

Meningitis is an inflammation of the membranes that cover the brain and spinal cord, which is a serious but treatable complication. The risk of meningitis is the most common of the “rare neurological complications” occurring in an estimated 1 out of 100,000 patients or at a rate of 0.001%.

Another rare complication is the accumulation of blood in the epidural space, which can cause neurological symptoms. This is a surgical emergency and is typically linked to the concurrent use of blood thinners (anticoagulants) – one of the reasons that women on blood thinners (anticoagulants) are typically not candidates for epidurals.

The development  of spinal epidural abscess after an epidural is extremely rare and estimated to occur in 1 out of 505,000 patients or at a rate of 0.0001%. This rare complication can be life-threatening and can present with signs of back pain, incontinence and neurological symptoms.

Women who are concerned about the epidural’s effects should talk to their anesthesiologist to get the facts.

Allied Anesthesia Continues to Improve Health Care for Patients

Posted on 03/20/14 by Allied Anesthesia

Allied Anesthesia physicians have undertaken a clinical pathways initiative to reduce the amount of time patients spend in post-op following the six most common surgeries performed at St. Joseph Hospital in Orange.

The pain control guidelines are designed to standardize best practices, reduce costs and improve patient safety and outcomes.

Dr. Yost explains, “Allied’s contributions to St. Joseph’s Hospital and its patients extend well beyond the scope of the typical anesthesiology practice. Our physicians work tirelessly to identify areas for improvement and team up with talented surgeons, nurses, technicians and administrators to develop and implement institutional changes to improve the quality of care at St. Joseph’s Hospital and the bottom line.”

The clinical pathways project is just one of a number of initiatives Allied physicians have undertaken in recent years to improve the quality of care at St. Joseph and the bottom line.

Others have included:

  • Enhanced teamwork and communication among physicians, nurses and technicians resulted in immediate and obvious improvements in the ease and speed of patient flow.
  • Increased percentage of patient charts completed 48 hours prior to surgery, from a baseline of 25 percent to more than 80 percent.
  • Educated surgeons’ offices about the importance of making sure each patient’s paperwork and test results arrive at the Preoperative Assessment and Testing Service Center 48 hours before surgery.
  • Revised testing protocols and guidelines to eliminate all unnecessary preoperative testing.
  • Created an OR coordinator position to work with the OR nurse manager to improve the efficiency of daily OR operations.
  • Implemented a “SuperUser” program to fill the gap left by a 45 percent reduction in anesthesia technicians.

As we continue to serve our patients, we are always working to improve our process. We believe that patient comfort and safety are among the most vital components of quality health care.

Eleven Physicians Recognized for Their Leadership and Contributions within the Field

Posted on 02/25/14 by Allied Anesthesia

We are thrilled to congratulate eleven of our physicians who were recognized and honored for all of their hard work and dedication to health care.

In January, Drs. Cliff Char, Ian Chait, Klane Hales, Jack Canton, Eric Ontiveros, Alejandro Ramirez and Paul Yost were selected for inclusion on the Southern California Super Doctors 2014 list, compiled by Key Professional Media and published in Los Angeles magazine.

This is quite an achievement: The Southern California Super Doctors list only represents about five percent of physicians in the region. It identifies physicians who are well-respected and recognized among their peers. Each candidate undergoes an independent evaluation by research staff, a peer review by those in the practice area and a good-standing and disciplinary check.

In addition to our team of super doctors, Drs. Armen Chalian, Tony Ho, Phillip Richardson and Frank Sweeny, Canton, Char and Hales were chosen by the Orange County Medical Association as “Physicians of Excellence”, appearing in Orange Coast magazine.

Applicants selected for this honor were required to meet at least two of the following four criteria: 1) physician leadership; 2) teaching/mentoring; 3) humanitarian service; 4) unique contributions, significant awards and recognitions related to substantial contributions in medicine, health care or on behalf of humanity.

We realize these sorts of awards are an enormous honor, but for the Allied team, making a difference for our patients is the true reward.

Allied Physicians Go Where Help Is Needed

Posted on 02/01/14 by Allied Anesthesia

baby going in to surgery

Recently, Dr. Armen Chalian returned from Armenia where he volunteered to provide anesthesia services for pediatric reconstructive surgeries. Chalian was part of a 17-member team of doctors and nurses from across the country on the 10-day medical mission sponsored by Plasticos Foundation of Orange County, California. The team taught and supervised residents, screened more than 120 children and performed nearly 50 surgeries at Arabkir Children’s Hospital in the capital city of Yerevan.

The days were long and some of the surgeries were very intense, but Dr. Chalian said he felt energized and excited to be helping those in need. Cases ranged from cleft lips and palates, to nose and ear abnormalities, and even post-trauma cases.

Chalian explained that the experience was life-changing for the patients, but equally life-changing for the doctors and nurses who performed the procedures. “We went there to help others but in reality it really helped me more just from the experience of giving,” he said.

While every procedure was memorable and touching, one in particular stood out to Dr. Chalian. Fifteen-month-old Tatevik was severely burned in a cooking accident; her hands had melted into balls of flesh. Though not all the standard medical equipment was available in Armenia, surgeons were resourceful.

The team was able to use needles, instead of surgical pins, as splints on each of Tatevik’s fingers. Following the procedure, her hands were open and the surgeons were confident she would have some movement. The transition will be nothing short of life-changing.

We’re proud of our physicians for constantly reaching out to those in need. As Dr.  Chalian said, “Everyone is just so outstanding and amazing, I felt it was my turn to go and I’m glad I finally did.”

Congratulations to Members of Our Team Who Are Now Board-Certified Pediatric Anesthesiologists

Posted on 12/17/13 by Allied Anesthesia

Doctor TestA few months ago, Allied Anesthesia physicians had the opportunity to take the very first Pediatric Anesthesiology examination, administered by the American Board of Anesthesiologists.

The ABA examines and certifies physicians who complete an accredited program of anesthesiology training in the United States and voluntarily apply for certification.

This particular test offers subspecialty certification specifically for the treatment of children. For our physicians, this was a perfect chance to showcase our specialty: providing quality care and dedication to children in need of medical attention.

Paul Yost explained his enthusiasm about the ABA program and Allied physicians who participated. “We have the utmost concern for all of our patients, which is why we took part in the voluntary certification process; we hold our physicians to the highest standards in both the general and specialty areas of our profession. We have confidence in their expertise, and these results confirm that.”

After the exam, a significant number of physicians became board-certified pediatric anesthesiologists. This was a wonderful opportunity for us to grow as a community and prove our expertise in our field.

Dr. Yost concluded, “Our strong showing on the national certification exam shows off our core competency in the care of children to our patients, their families and our community. This is verification at a national level that Allied physicians are trained and certified to deliver the highest quality pediatric anesthesia service to the children of Orange County.”

We are proud to take part in any endeavor that helps provide our patients with the best possible care.

Congratulations to all the team members who participated.


Five Tips to Keep Kids Out of the ER this Holiday Season

Posted on 12/03/13 by Allied Anesthesia

shutterstock_98881439The holidays are best spent with friends and family in the comfort of home. Waiting in the emergency room during this special time of year is especially hard, but many holiday injuries are preventable with a little extra supervision and caution.

We’ve put together some tips to help keep kids happy, healthy and comfortable throughout the holiday season.

1. Stay Alert while Shopping

Through all the hustle and bustle, it’s likely kids will need to tag along for holiday shopping. This can be a great time to bond, but it can also be dangerous. Every year,  over 25,000 children are treated for injuries related to shopping carts and escalators. Keep little ones buckled into the shopping cart seat, and make certain all shoelaces and loose garments are tied and secure when riding on escalators.

2. Decorate with Discretion

A festive home is a wonderful way to spread holiday cheer. Make sure that small light- bulbs, ornaments and fragile decorations are out of reach. Spun-glass, angel hair and bubble lights are beautiful to look at, but can be harmful if swallowed. It’s also a good idea to keep an eye on small decorations and ornaments that look like candy.

3. Use Caution with Christmas Trees and Other Plants

Christmas trees, mistletoe, holly berries and other plant garlands are a holiday staple. However, they can be fatal if swallowed, so make sure that tasty-looking berries and other poisonous plants are out of reach both to kids and pets. Also, as children marvel at the beautifully decorated Christmas tree, adults should give a little extra supervision to help avoid eye injuries from sharp needles.

4. Make the Holiday Fireproof

There are more than half a million residential fires every winter. In addition to testing your fire alarm batteries frequently, be sure to keep Christmas trees in water, away from fireplaces and radiators. Never leave candles or fireplace fires unattended. And, finally, check tree lights for frayed wires and broken bulbs.

5. Pick out the Right Gift for the Right Age

Riding toys, like scooters, skateboards and skates, can be dangerous for unskilled children. If you do purchase one, be sure to give complementary protective gear. For younger children, check the suggested age range for small toys. Anything smaller than a child’s fist can be a choking hazard, especially for little ones under the age of three.

With these simple tips, holiday injuries can be prevented, and you can focus on family and fun. Like you, we want your kids to be waiting for Santa, not waiting for their doctor.

Happy Holidays from our Family to Yours!

Allied Anesthesia Helps St. Joseph Ranked Among Top 20% of Hospitals Nationwide

Posted on 09/30/13 by Allied Anesthesia

Oct_BlogAllied Anesthesia is invested in a patient’s well-being from the moment they walk through the door until they get back to themselves again. Our hard work every step of the way not only makes our patients happy, it also helps make the hospitals we work with successful.

This is especially true for St. Joseph Hospital of Orange. Consumer Reports Magazine recently ranked them among the top 20% of hospitals in the nation when it comes to avoiding adverse events.

The ratings focused on five measures across 27 commonly scheduled surgeries. This included: infections related to catheters and tubes, surgical-site infections, readmissions, serious complications such as bed sores, collapsed lungs or blood clots and adverse events such as patient death. St. Joseph had 28 percent fewer adverse events than predicted.

Clearly, these results speak to the incredible staff and dedicated doctors at St. Joseph Hospital including the Allied Anesthesia team of physicians. We have worked to provide the best care from admissions through recovery, and in doing so, we have been able to help improve cost efficiencies, patient satisfaction and overall quality over the past decade.

Dr. Alejandro Ramirez, medical director of surgical services at St. Joseph, explained, “Unlike most anesthesiologists, who focus only on the surgical experience, Allied physicians think more globally by addressing risk factors from admissions through recovery. Allied really brings value to the health care that the hospital provides. As a result, St. Joseph is light years ahead of other institutions in terms of positive outcomes and patient and surgeon satisfaction.”

St Joseph Hospital is a wonderful example of what is possible through hard work and dedication. We are excited to support them as they continue to provide outstanding healthcare to Orange County.

For more information please view the Consumer Reports article at: http://www.consumerreports.org/health/doctors-hospitals/hospital-ratings.htm

Allied Anesthesia Helps Out Close to Home

Posted on 08/01/13 by Allied Anesthesia

At Allied Anesthesia we value every member of our community. That’s why when an opportunity arrises where we can improve the health of our community, our physicians are eager to lend a helping hand.

Every year since 2007, the non-profit organization, AccessOC  has worked to provide more than 400 uninsured patients with minor surgeries. Talented specialists across the medical field have volunteered their time and services to patients that live at or below poverty line.

This year a handful of Allied physicians will join the dedicated health-care professionals on Surgery Saturday, Sept. 7. Dr. Paul Yost explained, “Patients are incredibly grateful for getting the procedures. Some have waited months or even years for help.”

Doctors perform a variety of surgeries including: hernia repair, cataract, biopsies, gallbladder and minor gynecological procedures. These expensive procedures not only improve patient health, but improve their quality of life as well.

Allied physicians are really looking forward to the event because it allows them to use their skills to help those in need. Dr. Yost summarized the sentiments of the team by stating, “It reminds me of why I went into medicine to begin with, to use my skills to provide needed services in the community. It’s like Winston Churchill said, ‘We make a living by what we get, but we make a life by what we give.’”

For more  information please visit: www.AccessOC.org

Allied Anesthesia Team Members Continue to Make a Difference

Posted on 06/24/13 by Allied Anesthesia

There is no better feeling than helping someone in need. It’s one of the many reasons we physicians go into our line of work.

Helping children whose families struggle to provide a simple, but life-changing, operation, is even more rewarding.

Although it’s not the first time members of Allied Anesthesia have provided for those in need, and it certainly won’t be the last time, we’d like to spotlight two of our generous and wonderful physicians for their hard work as they selflessly better the lives of others.

We are so proud of Dr. Cliff Char and Dr. Ian Chait for their work with the non-profit organization Operation Smile. The international charity treats thousands of children in developing countries with cleft lip deformities every year.

Dr. Chait with Patient

Dr. Chait with Patient

The simple procedure takes only minutes, but the results last forever. Our doctors have helped children do what we take for granted everyday, including eating, speaking, socializing and even smiling.

Countless times, both Char and Chait have joined other medical professionals from around the world for two-week missions.

During their missions they perform between 100 and 150 surgeries. Additionally, they train local medical practitioners in an effort to create self-sufficient and sustainable solutions within developing countries.

Between the two physicians, their selfless work has stretched across the entire globe. Dr. Chait goes on two missions each year; he’s made a difference for children in Morocco, Peru, China, Egypt, the Philippines, and will be leaving again this fall. Dr. Char just returned from a mission in Nicaragua, but he has also volunteered in India, Ethiopia, Kenya, Morocco, Egypt and Nepal.

For Dr. Chait, helping someone in need is absolutely priceless. “It’s an incredible feeling when you take a kid to the recovery room and the mother comes in and sees the kid with the defect repaired,” Chait said. “The look on the mother’s face is an incredible, emotional experience.”

Dr. Char agrees, “There is so much need out there and the amount of work we do is a lot, but it’s so small when put in the big picture. There’s just so little we can give and we get such huge benefits in return.”

It is with a great deal of pride and appreciation that we thank our team members for helping make such a huge difference in the world.

Dr. Yost Named President-Elect of the California Society of Anesthesiologists

Posted on 05/22/13 by Allied Anesthesia

CSA_logoFor the last several years Allied Anesthesia has been fortunate to have Dr. Paul Yost as a member of our team. He has always been a shining example of what we stand for and what we value. Recently, Dr. Yost was named president-elect of the California Society of Anesthesiologists at the 2013 House of Delegates meeting in Los Angeles.

Dr. Yost is no stranger to incredible achievements. In 1982 he completed his bachelor’s degree in Psychology at Stanford. He then earned his Medical Doctorate degree from Baylor College of Medicine in 1986 and completed two medical residencies: Pediatrics at Jackson Memorial Hospital, Miami, Florida, and Anesthesiology at UCLA.

Currently, Yost practices adult and pediatric anesthesiology at St. Joseph’s Hospital of Orange, where he is director of cardiothoracic anesthesia, and CHOC Children’s Hospital, where he is past president of the medical staff.

In his new position, Dr. Yost will help lead the 3,000-member organization to promote the highest professional standards, provide continuing education and advocating for anesthesiologists and their patients. He will also work closely with the CSA president to find ways to support the membership, their specialty and their patients.

Yost explained how important organized medicine is to both doctors and patients. “We’re so much stronger when we work together. To me it’s something you do. It’s a part of your professional life. You get involved and try to leave the organization better than when you started.”

Although, the CSA position requires Dr. Yost to spend time away from his practice, the team at  Allied Anesthesia was happy to pick up any slack. “The whole group is contributing in a sense by allowing me to do this,” he said. As a result of everyone’s teamwork Yost will be able to keep his colleagues at Allied Anesthesia up to date on the latest developments in their field for their own growth and for the benefit of their patients.


Dr. Paul Yost

We are excited to congratulate Dr. Yost on his latest accomplishment, and we know great things lie ahead for all of the members of Allied Anesthesia.

Allied Anesthesia Excels in Teaching and Providing Excellent Care

Posted on 04/18/13 by Allied Anesthesia

Allied Anesthesia physician, Dr. Thanh Tran was recently recognized as a 2013 Leader in Oral Health by Healthy Smiles for Kids.

Ten years ago, Healthy Smiles for Kids, a non-profit organization, began providing education and dental care to thousands of Orange County children. The program works with USC and CHOC to increase the number of pediatric dentists in the region.

Since its inception, Dr. Tran has played an essential role in developing and coordinating the pediatric sedation training program for USC dental fellows at Children’s Hospital of Orange County.

The success of the program has been clear. In 2003 there were less than 60 pediatric dentists, but thanks to combined efforts from Tran and other members of Allied Anesthesia, there are now 85.

“Everyone at Allied Anesthesia joins in to help train these dentists,” Tran said.  “I’m just the point person who helps the process move along more smoothly. We don’t think of it as a chore or duty,” Tran continued, “It’s part of the profession  and we do it because we love it.”

Dr. Tran also received two Senate resolutions in recognition of his contributions to the oral surgery residency program at USC from Sen. Mark Wyland, 38th District, and Sen. Lou Correa, 34th District.

Allied Anesthesia proudly congratulates Dr. Tran and the other key anesthesiologists that have contributed to Healthy Smiles for Kids‘ success.

Patient Safety Awareness Week Advice

Posted on 03/21/13 by Allied Anesthesia

For the anesthesiologists at Allied, our patient’s safety and comfort is a top priority.

In addition to administering anesthesia in the operating room, the anesthesiologist monitors a patient’s heart rate and breathing during surgery and provides medication and methods to handle pain post operation.

Most patients are a little nervous prior to a medical procedure. Any uncertainties or anxieties about anesthesia should be addressed prior to surgery by talking to your anesthesiologist.

The relationship between patient and anesthesiologist should be a strong one based on trust and understanding. Here are some important questions you shouldn’t hesitate to ask your anesthesiologist before and after your procedure.

What is your training and experience? 

Patients should ask whether their anesthesiologist is a medical doctor or a Certified Registered Nurse Anesthetist (CRNA). Some states allow CRNAs to administer anesthesia on their own, while other states require an anesthesiologist’s supervision.  Either way, patients should know what kind of training and experience the individual, who supervises their anesthesia care, has.

Allied Anesthesia only employs high quality anesthesiologists, who are among the top 1 percent in the country.  The group specializes in pediatric anesthesia and is the exclusive anesthesia provider for Children’s Hospital of Orange County.

What will you be doing during the surgery?

In short, I make sure my patients know that I will be watching every beat off their heart and every breath they take.

Many patients don’t realize that anesthesiologists are an integral component of the surgical team along with surgeons, nurses and others in the operating room. Administering anesthesia is just the first step. Anesthesiologists monitor the patient’s vital signs and are prepared to respond rapidly in case of an emergency.

What if I get nervous before surgery?

The first step is making sure you’ve got the right fit. Choosing a top quality hospital and a quality anesthesiologist will go a long way toward easing anxiety.

Once you’re in the operating room, one way to calm yourself is to think about something relaxing. For instance, think about your favorite vacation spot, your children or your favorite food. Think about things that make you happy.

If it’s not you that’s having the procedure it’s still common to be a little nervous, especially if you’re a parent with a child undergoing surgery. Make a list of questions and ask before your child has the operation to help put your mind at ease.

What should I expect when I awake?

Anesthesiologists also are pain management specialists.  They have access to a variety of medications and techniques that will help decrease a patient’s discomfort after surgery.

The physicians at Allied Anesthesia have done a lot of creative things with ultrasound guided nerve blocks for acute postoperative pain. Nerve blocks may be used as the main anesthetic technique or combined with general anesthesia to substantially reduce pain after surgery. They have proven to be invaluable to patients undergoing more invasive procedures such as joint replacement and bone fracture repair.

Because we know what we’re doing, patients get discharged quicker and are able to begin physical therapy soon after surgery.

Our specialty is to make sure that when patients wake up from surgery they are comfortable and we can handle any potential discomfort they might have.

What’s a good way to prepare myself for surgery?

A patient’s surgical experience has a lot to do with their expectations.

Those who expect to do well, generally do.

It’s important to approach the procedure with a positive attitude, confident that you have chosen the best hospital, the best surgeon and the best anesthesiologist.

After that, all that’s left is for you to do is close your eyes, relax and let it happen.




Five of Allied Anesthesia’s Doctors Have Been Awarded Super Doctors

Posted on 01/19/13 by Allied Anesthesia

We are excited to announce, this January, two regional publications recognized five physicians from Allied Anesthesia for their leadership, achievements and contributions.

Drs. Cliff Char, Ian Chait, Klane Hales, and Paul Yost were selected for inclusion on the Southern California Super Doctors 2013 list compiled by Key Professional Media and published in Los Angeles Magazine. Also, Drs. Char, and Eric Pearson were chosen by the Orange County Medical Association as “Physicians of Excellence” in Orange Coast Magazine.

“I am honored to be chosen as a Super Doc and Physician of Excellence,” Dr. Char said. “It is difficult for me to accept because I know that there are many other physicians who care and blend their skills and knowledge with excellence to provide compassionate care. I am grateful for Allied Anesthesia Medical Group to allow me to provide free anesthesia care around the world and to be able to practice the best anesthesia care that I can.”

The Super Doctors list identifies physicians, who are well respected and recognized among their peers. Each candidate undergoes an independent evaluation by research staff, a peer review by practice area and a good-standing and disciplinary check.

Candidates are evaluated on 10 indicators, including: years of experience, hospital appointments, fellowships, professional activities, leadership positions, academic achievements/positions, board certifications, publications, lectures, presentations, honors, awards and other outstanding achievements.

Applicants selected for the 2013 Physicians of Excellence honor were  required to meet at least two of the following four criteria:

  • Physician leadership
  • Teaching/mentoring
  • Humanitarian service
  • Unique contributions, significant awards and recognitions related to substantial contributions in medicine, healthcare, or on behalf of humanity.

Allied Anesthesia Contributes to Three-Star Rating at St. Joseph Hospital

Posted on 12/21/12 by Allied Anesthesia

The physicians at Allied Anesthesia are proud to be part of a team of surgeons, nurses, perfusionists and support staff at St. Joseph Hospital of Orange, who received a three-star rating (the highest rating) from the Society of Thoracic Surgeons.

The rating was based on the outcomes of coronary artery bypass grafting cases from July 1, 2011 through June 30th, 2012.

This recent rating placed the hospital among the top 10 to 15 percent of adult cardiac surgery centers for the third year in a row.

Scores were based on a combination of 11 measures of quality divided into four domains, starting with risk-adjusted mortality based on the condition of the patients prior to surgery. Another factor of the rating is the percentage of patients who are discharged without serious complications such as stroke, infection or kidney failure.

The score also considers the percentage of procedures that involve using an internal mammary artery for bypass grafting. The final domain is how often all four primary peri-operative medications are prescribed. Each participant receives a score for each of the four domains, an overall composite score and a star ranking.

Dr. Paul Yost explained, “The physicians of Allied Anesthesia are extremely proud and humble to be an integral part of the award winning St. Joseph Hospital of Orange cardiac surgery program.”

It is an honor to work with the gifted staff at St. Joseph Hospital and provide the proper care to our valued patients.

Volunteering with Operation Smile

Posted on 12/13/12 by Allied Anesthesia

Many members of Allied Anesthesia volunteer their services locally and internationally. Recently, several anesthesiologists from our team participated in the annual Access OC event, This local organization provides medical care to Orange County’s most vulnerable residents.

Another organization Allied Anesthesia is proud to work with is Operation Smile. As we’ve posted in earlier blogs, Operation Smile is a wonderful international children’s medical charity that works to repair cleft lip deformities on children in underdeveloped countries. Often children born with a cleft are unable to eat, speak, smile or socialize. Their families are unable to afford the surgery necessary to give them a normal life. In a simple one hour procedure, these problems can be solved.

I just returned from the Philippines, where I spent my fifth medical mission with Operation Smile. Our team consisted of over sixty people from eight countries. We exchanged ideas about how to help those in need, and performed over 100 surgeries.

In addition to our medical successes, this mission was especially meaningful as it was the 30th anniversary of Operation Smile, and it took place in the inaugural location, Naga City.

I was fortunate enough to spend time with the organization’s founder, Bill Magee. We enjoyed a very welcoming dinner with a special guest; a young woman with a beautiful voice sang a special song for Operations Smile. This young lady was one of Bill Magee’s first patients.

As always, the experience was very rewarding.

The Parent’s Guide to Holiday Surgery

Posted on 11/12/12 by Allied Anesthesia

The holidays are an anticipated and exciting time of year for children. It is a wonderful opportunity to make lasting memories and celebrate family.

However, many parents choose to take advantage of school and work holiday schedules and year-end savings on insurance to schedule needed surgery for their child. In addition to the fear and anxiety a child has about their surgery, they may also feel left out and angry, especially if they miss celebrations with friends and family.

No matter what the procedure, the physicians at Allied Anesthesia in Santa Ana, who provide anesthesia and pain management services at Children’s Hospital of Orange County (CHOC), are committed to ensuring every pediatric patient is as comfortable and unafraid as possible. To help parents with their child’s experience, we have complied a list of tips that will be especially useful during the holiday season.

Helpful Tips for Holiday Surgery

Keep a Positive Attitude

  • Children take cues from their parents; with that in mind, it is important to remain calm and reassuring.
  •  Focus on the outcome instead of the surgery itself. For example, “After knee surgery, you can play baseball again”

Keep Your Child Informed

Bibliotherapy can be very useful. There are several age appropriate books that help children prepare for their surgery.  Wrap the book in gift-wrap and give it to the child before their surgery so you can read it together.

  • Curious George Goes to the Hospital –H.A and Margaret Rey 
  • My Brother Needs an Operation –Anna Marie Jaworski
  • Goodbye Tonsils -Craig Hatkoff
  • A Visit to the Sesame Street Hospital

Younger children might want to become familiar with what a doctor does by playing with a toy doctor’s kit. They can learn how the instruments work by using the tools on stuffed animals and dolls.

Older children may want to tour the hospital facilities prior to their surgery date. They can meet the staff, and become familiar with the equipment and procedures.

Include Your Child As Much As Possible

For children staying overnight at the hospital or longer:

  • See if Santa makes bedside visits or if the hospital offers special holiday meals and events.
  • If the hospital allows, bring some festive items to decorate the room.
  • Should a holiday gathering happen while your child is away, take lots of photos or ask everyone to write a little get well note.
  • Although it’s the holidays, hospital space is limited. Keep that in mind when you bring gifts. Also, check with your doctor about special diets that may restrict candy and baked goodies.

Above all, be honest and reassuring.