Clinical Focus

  • Anesthesia

Academic Appointments

Honors & Awards

  • Honorarium Member, Paranaense Society of Anesthesiology (2008)
  • Stanford Anesthesia Teaching Scholar, Anesthesia Department, Stanford University School of Medicine (2009)
  • The H. B. Fairley, MBBS, Teaching excellence award, Department of Anesthesia, Stanford University School of Medicine (2009)
  • Outstanding contribution and commitment, Indonesia Society of Obstetric Anesthesia and Indonesian Society of Regional Anesthesia (2010)

Professional Education

  • Residency:Universidade Federal Do Parana (1994) Brazil
  • Residency:Faculdade Evangelica De Parana (1992) Brazil
  • Medical Education:Faculdade Evangelica De Parana (1988) Brazil
  • PhD, Federal University of Parana, Anesthesia (1999)
  • Master, Federal University of Parana, Anesthesia (1996)
  • MD, Evangelica School of Medicine, Medicine (1988)

Research & Scholarship

Clinical Trials

  • Noninvasive and Continuous Hemoglobin Monitoring for Surgical Blood Management Not Recruiting

    This is a multi-center cluster-randomized trial with the following Specific Aims: - To evaluate if continuous noninvasive hemoglobin monitoring will reduce the RBC transfusions in patients undergoing surgeries associated with a significant risk of bleeding. - To evaluate if patients monitored with continuous noninvasive hemoglobin experience less frequent complications and shorter hospital stay compared with patients who are not being monitored with continuous noninvasive hemoglobin. Accordingly, the study hypotheses are defined as follows: - The primary null hypothesis is that continuous noninvasive hemoglobin monitoring will not reduce the RBC transfusions in patients undergoing surgeries associated with a significant risk of bleeding. - The secondary hypothesis is that in patients monitored with continuous noninvasive hemoglobin, there will be earlier warning of critical drops in hemoglobin, and thus, there will be less frequent complications compared with patients who are not being monitored with continuous noninvasive hemoglobin.

    Stanford is currently not accepting patients for this trial.

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  • Desflurane or Propofol Anesthesia in Elderly Obese Patients Undergoing Total Knee Replacement Recruiting

    You are invited to participate in a research study assessing your mental status in the first days after your surgery and how you will be doing in the 2 years following the surgery. The investigators hope to learn more about the incidence of postoperative confusion and a possible relation with 2 anesthesia techniques that are routinely used. The first one is an anesthesia technique that uses the inhaled anesthetic gas desflurane and the second one is an anesthesia technique that uses the anesthetic propofol administered by infusion in a vein. The investigators are also looking to see if there is a relationship between anesthesia technique and cardiovascular outcomes. You were selected as a possible participant in this study because at your age this phenomenon appears to have a greater incidence.

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2016-17 Courses


All Publications

  • Mapping of Primary Instructional Methods and Teaching Techniques for Regularly Scheduled, Formal Teaching Sessions in an Anesthesia Residency Program. A & A case reports Vested Madsen, M., Macario, A., Yamamoto, S., Tanaka, P. 2016; 6 (11): 343-347


    In this study, we examined the regularly scheduled, formal teaching sessions in a single anesthesiology residency program to (1) map the most common primary instructional methods, (2) map the use of 10 known teaching techniques, and (3) assess if residents scored sessions that incorporated active learning as higher quality than sessions with little or no verbal interaction between teacher and learner. A modified Delphi process was used to identify useful teaching techniques. A representative sample of each of the formal teaching session types was mapped, and residents anonymously completed a 5-question written survey rating the session. The most common primary instructional methods were computer slides-based classroom lectures (66%), workshops (15%), simulations (5%), and journal club (5%). The number of teaching techniques used per formal teaching session averaged 5.31 (SD, 1.92; median, 5; range, 0-9). Clinical applicability (85%) and attention grabbers (85%) were the 2 most common teaching techniques. Thirty-eight percent of the sessions defined learning objectives, and one-third of sessions engaged in active learning. The overall survey response rate equaled 42%, and passive sessions had a mean score of 8.44 (range, 5-10; median, 9; SD, 1.2) compared with a mean score of 8.63 (range, 5-10; median, 9; SD, 1.1) for active sessions (P = 0.63). Slides-based classroom lectures were the most common instructional method, and faculty used an average of 5 known teaching techniques per formal teaching session. The overall education scores of the sessions as rated by the residents were high.

    View details for DOI 10.1213/XAA.0000000000000317

    View details for PubMedID 27243580

  • Analysis of Resident Case Logs in an Anesthesiology Residency Program. A & A case reports Yamamoto, S., Tanaka, P., Madsen, M. V., Macario, A. 2016; 6 (8): 257-262


    Our goal in this study was to examine Accreditation Council for Graduate Medical Education case logs for Stanford anesthesia residents graduating in 2013 (25 residents) and 2014 (26 residents). The resident with the fewest recorded patients in 2013 had 43% the number of patients compared with the resident with the most patients, and in 2014, this equaled 48%. There were residents who had 75% more than the class average number of cases for several of the 12 case types and 3 procedure types required by the Accreditation Council for Graduate Medical Education. Also, there were residents with fewer than half as many for some of the required cases or procedure types. Some of the variability may have been because of the hazards of self-reporting.

    View details for DOI 10.1213/XAA.0000000000000248

    View details for PubMedID 26517235

  • Comparative-Effectiveness of Simulation-Based Deliberate Practice Versus Self-Guided Practice on Resident Anesthesiologists' Acquisition of Ultrasound-Guided Regional Anesthesia Skills. Regional anesthesia and pain medicine Udani, A. D., Harrison, T. K., Mariano, E. R., Derby, R., Kan, J., Ganaway, T., Shum, C., Gaba, D. M., Tanaka, P., Kou, A., Howard, S. K. 2016; 41 (2): 151-157


    Simulation-based education strategies to teach regional anesthesia have been described, but their efficacy largely has been assumed. We designed this study to determine whether residents trained using the simulation-based strategy of deliberate practice show greater improvement of ultrasound-guided regional anesthesia (UGRA) skills than residents trained using self-guided practice in simulation.Anesthesiology residents new to UGRA were randomized to participate in either simulation-based deliberate practice (intervention) or self-guided practice (control). Participants were recorded and assessed while performing simulated peripheral nerve blocks at baseline, immediately after the experimental condition, and 3 months after enrollment. Subject performance was scored from video by 2 blinded reviewers using a composite tool. The amount of time each participant spent in deliberate or self-guided practice was recorded.Twenty-eight participants completed the study. Both groups showed within-group improvement from baseline scores immediately after the curriculum and 3 months following study enrollment. There was no difference between groups in changed composite scores immediately after the curriculum (P = 0.461) and 3 months following study enrollment (P = 0.927) from baseline. The average time in minutes that subjects spent in simulation practice was 6.8 minutes for the control group compared with 48.5 minutes for the intervention group (P < 0.001).In this comparative effectiveness study, there was no difference in acquisition and retention of skills in UGRA for novice residents taught by either simulation-based deliberate practice or self-guided practice. Both methods increased skill from baseline; however, self-guided practice required less time and faculty resources.

    View details for DOI 10.1097/AAP.0000000000000361

    View details for PubMedID 26866296

  • Response from author to the editor. Journal of clinical monitoring and computing Tanaka, P. 2016; 30 (1): 127-128

    View details for DOI 10.1007/s10877-016-9825-9

    View details for PubMedID 26823287

  • Impact of an Innovative Classroom-Based Lecture Series on Residents' Evaluations of an Anesthesiology Rotation. Anesthesiology research and practice Tanaka, P., Yanez, D., Lemmens, H., Djurdjulov, A., Scotto, L., Borg, L., Walker, K., Bereknyei Merrell, S., Macario, A. 2016; 2016: 8543809-?


    Introduction. Millennial resident learners may benefit from innovative instructional methods. The goal of this study is to assess the impact of a new daily, 15 minutes on one anesthesia keyword, lecture series given by faculty member each weekday on resident postrotation evaluation scores. Methods. A quasi-experimental study design was implemented with the residents' rotation evaluations for the 24-month period ending by 7/30/2013 before the new lecture series was implemented which was compared to the 14-month period after the lecture series began on 8/1/2013. The primary endpoint was "overall teaching quality of this rotation." We also collected survey data from residents at clinical rotations at two other different institutions during the same two evaluation periods that did not have the education intervention. Results. One hundred and thirty-one residents were eligible to participate in the study. Completed surveys ranged from 77 to 87% for the eight-question evaluation instrument. On a 5-point Likert-type scale the mean score on "overall teaching quality of this rotation" increased significantly from 3.9 (SD 0.8) to 4.2 (SD 0.7) after addition of the lecture series, whereas the scores decreased slightly at the comparison sites. Conclusion. Rotation evaluation scores for overall teaching quality improved with implementation of a new structured slide daily lectures series.

    View details for DOI 10.1155/2016/8543809

    View details for PubMedID 26989407

  • Detection of respiratory compromise by acoustic monitoring, capnography, and brain function monitoring during monitored anesthesia care JOURNAL OF CLINICAL MONITORING AND COMPUTING Tanaka, P. P., Tanaka, M., Drover, D. R. 2014; 28 (6): 561-566


    Episodes of apnea in sedated patients represent a risk of respiratory compromise. We hypothesized that acoustic monitoring would be equivalent to capnography for detection of respiratory pauses, with fewer false alarms. In addition, we hypothesized that the patient state index (PSI) would be correlated with the frequency of respiratory pauses and therefore could provide information about the risk of apnea during sedation. Patients undergoing sedation for surgical procedures were monitored for respiration rate using acoustic monitoring and capnography and for depth of sedation using the PSI. A clinician blinded to the acoustic and sedation monitor observed the capnograph and patient to assess sedation and episodes of apnea. Another clinician retrospectively reviewed the capnography and acoustic waveform and sound files to identify true positive and false positive respiratory pauses by each method (reference method). Sensitivity, specificity, and likelihood ratio for detection of respiratory pause was calculated for acoustic monitoring and capnography. The correlation of PSI with respiratory pause events was determined. For the 51 respiratory pauses validated by retrospective analysis, the sensitivity, specificity, and likelihood ratio positive for detection were 16, 96 %, and 3.5 for clinician observation; 88, 7 %, and 1.0 for capnography; and 55, 87 %, and 4.1 for acoustic monitoring. There was no correlation between PSI and respiratory pause events. Acoustic monitoring had the highest likelihood ratio positive for detection of respiratory pause events compared with capnography and clinician observation and, therefore, may provide the best method for respiration rate monitoring during these procedures.

    View details for DOI 10.1007/s10877-014-9556-8

    View details for Web of Science ID 000345768500008

  • Simulation-based mastery learning with deliberate practice improves clinical performance in spinal anesthesia. Anesthesiology research and practice Udani, A. D., Macario, A., Nandagopal, K., Tanaka, M. A., Tanaka, P. P. 2014; 2014: 659160-?


    Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents' next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P < 0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P < 0.03). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

    View details for DOI 10.1155/2014/659160

    View details for PubMedID 25157263

  • The stanford anesthesia faculty teaching scholars program: summary of faculty development, projects, and outcomes. Journal of graduate medical education Macario, A., Tanaka, P. P., Landy, J. S., Clark, S. M., Pearl, R. G. 2013; 5 (2): 294-298


    The Stanford Anesthesia Teaching Scholars Program was launched in 2007 to further pedagogic training of faculty and improve residency education.The goals of this article are to describe the program intervention and improvements made based on participant feedback, summarize the characteristics of the faculty enrolled and projects undertaken, and report on program outcomes tracked to date.THE TEACHING SCHOLARS PROGRAM HOUSED WITHIN THE DEPARTMENT OF ANESTHESIA SUPPORTS FACULTY IN THESE AREAS: (1) attending education-related meetings; (2) engaging in a monthly seminar on core topics paired with independent study reading; and (3) undertaking a project to improve resident education. Structured interviews with all graduates (n  =  19; 47% women) were conducted using a pilot-tested questionnaire.A total of 15 of 19 Scholars (79%) were instructors/assistant professors. Sixteen Scholars (84%) attended an off-site education meeting. The Scholars pursued a variety of projects, including curriculum (53%), teaching (26%), administration (11%), assessment (5%), and advising/mentoring (5%). Projects were fully completed by 13 of 19 participants (68%), and 12 of 19 projects (63%) are currently integrated into the residency. Completed projects were published/presented at conferences by 4 of 13 participants (31%), and education grants were received by 3 of 19 participants (16%).This is the first description of a faculty development (education) program in an anesthesiology department. The program has been well accepted by participants and resulted in increased educational products, some of which have become a permanent part of the residency curriculum. This educational innovation can be replicated in other departments of anesthesiology provided that funding is available for faculty time and meeting expenses.

    View details for DOI 10.4300/JGME-D-12-00246.1

    View details for PubMedID 24404276

  • Use of Tablet (iPad (R)) as a Tool for Teaching Anesthesiology in an Orthopedic Rotation REVISTA BRASILEIRA DE ANESTESIOLOGIA Tanaka, P. P., Hawrylyshyn, K. A., Macario, A. 2012; 62 (2): 214-222


    The goal of this study was to compare scores on house staff evaluations of "overall teaching quality" during a rotation in anesthesia for orthopedics in the first six months (n=11 residents were provided with curriculum in a printed binder) and in the final six months (n=9 residents were provided with the same curriculum in a tablet computer (iPad, Apple®, Inc, Cupertino, Ca)).At the beginning of the two-week rotation, the resident was given an iPad containing: a syllabus with daily reading assignments, rotation objectives according to the ACGME core competencies, and journal articles. Prior to the study, these curriculum materials had been distributed in a printed binder. The iPad also provided peer reviewed internet sites and direct access to online textbooks, but was not linked to the electronic medical record. At the end of the rotation, residents anonymously answered questions to evaluate the rotation on an ordinal scale from 1 (unsatisfactory) to 5 (outstanding). All residents were unaware that the data would be analyzed retrospectively for this study.The mean global rating of the rotation as assessed by "overall teaching quality of this rotation" increased from 4.09 (N=11 evaluations before intervention, SD 0.83, median 4, range 3-5) to 4.89 (N=9 evaluations after intervention, SD 0.33, median 5, range 4-5) p=0.04.Residents responded favorably to the introduction of an innovative iPad based curriculum for the orthopedic anesthesia rotation. More studies are needed to show how such mobile computing technologies can enhance learning, especially since residents work at multiple locations, have duty hour limits, and the need to document resident learning in six ACGME core competencies.

    View details for Web of Science ID 000301768500007

    View details for PubMedID 22440376