Clinical Focus

  • Anesthesia
  • Pediatric anesthesia
  • Regional analgesia
  • Anesthesia for solid organ transplant
  • Pediatric Difficult Airway

Administrative Appointments

  • Clinical Director, Pediatric Anesthesia (2006 - 2013)
  • Co-Chair, Stanford University Pediatric Regional Anesthesia (SUPRA) program (2015 - Present)
  • Director, Pediatric Anesthesia Resource Center (2013 - 2015)

Professional Education

  • Board Certification: The Royal College of Anaesthetists, Anesthesia (1997)
  • Medical Education: University of Madras (1998)
  • Residency: Basildon General Hospital (1995) UK
  • Internship: Madras University Medicine (1987) India
  • Residency: Walsgrave Hospitals (2000) United Kingdom
  • FRCA, Royal College of Anaes.,UK, Anesthesiology (1997)
  • MD, DR MGR Medical Univ.,India, Anesthesiology (1992)
  • Dip NB, National Board of Examinations, Anesthesiology (1991)
  • MBBS, University of Madras,India, Medicine (1988)

Community and International Work

  • Destination Hope, San Jose Mindoro, Philippines



    Ongoing Project


    Opportunities for Student Involvement


  • HUGS, Antigua, Guatemala

    Partnering Organization(s)

    Help Us Give Smiles Foundation Inc



    Ongoing Project


    Opportunities for Student Involvement



  • Radhamangalm Ramamurthi. "United States Patent 13/041,387 Indwelling Nerve Block Catheters", SRI, Stanford University, Sep 8, 2011

Research & Scholarship

Current Research and Scholarly Interests

Prospective collection of pediatric regional block procedures and complications on to a national database

Clinical Trials

  • Multicenter Perioperative Opioid Pharmacogenetic Study Not Recruiting

    The purpose of this research study is to identify factors and genes (the DNA material that determines the makeup of the human body) that may be associated with how children respond to pain medication. Specifically, the investigators want to study factors that may be associated with pain sensitivity, morphine requirement after surgery and side-effects from morphine and other pain medications. The investigators expect that the information obtained in this research study will help us to develop more effective, safe, and tailored treatment options in the future.

    Stanford is currently not accepting patients for this trial. For more information, please contact R J Ramamurthi, (650) 776 - 6297.

    View full details


2020-21 Courses


All Publications

  • Laparoscopic versus ultrasound-guided visualization of transversus abdominis plane blocks. Journal of pediatric surgery Diyaolu, M., Taylor, J., Austin, J., Gibson, M., Ramamurthi, R. J., Tsui, B., Chao, S. 2021


    BACKGROUND: Ultrasound-guided (US) transversus abdominis plane (TAP) block is commonly utilized as part of a multi-modal approach for postoperative pain management. This study seeks to determine whether laparoscopic-guided TAP blocks are as effective as US-guided TAP blocks among pediatric patients.METHOD: In this prospective, randomized controlled trial, pediatric patients undergoing laparoscopic procedures were randomly assigned to one of two treatment arms: US-guided TAP block (US-arm) or laparoscopic-guided TAP block (LAP-arm). Primary outcome was PACU pain scores. Secondary outcomes included PACU opioid consumption, block completion time and block accuracy.RESULTS: Twenty-five patients were enrolled in each arm. In the LAP-arm, 59% of blocks were in the transversus abdominis plane compared to 74% of TAP blocks in the US-arm (p=0.18). Blocks were completed faster in the LAP-arm (2.1±1.9vs. 7.9±3.4min, p<0.001). The average highest PACU pain score was 3.4±3.1 for the LAP-arm and 4.3±3.8 for the US-arm (p=0.37). Overall PACU pain scores and opioid consumption were similar between the groups (1.2±1.3vs. 1.6±1.6, p=0.24; 2.2±5.8vs. 0.9±1.4MME, p=0.26).CONCLUSION: Laparoscopic TAP blocks have equivalent efficacy in post-operative pain scores, narcotic use, and tissue plane accuracy as compared to US-guided TAP blocks. They are also completed faster and may result in less operating room and general anesthetic time for the pediatric patient.

    View details for DOI 10.1016/j.jpedsurg.2021.02.025

    View details for PubMedID 33771368

  • Tools for Assessing the Performance of Pediatric Perioperative Teams During Simulated Crises: A Psychometric Analysis of Clinician Raters' Scores SIMULATION IN HEALTHCARE-JOURNAL OF THE SOCIETY FOR SIMULATION IN HEALTHCARE Watkins, S. C., de Oliveira Filho, G. R., Furse, C. M., Muffly, M. K., Ramamurthi, R. J., Redding, A. T., Maass, B., McEvoy, M. D. 2021; 16 (1): 20–28
  • Variation in pediatric local anesthetic dosing for peripheral nerve blocks: an analysis from the Pediatric Regional Anesthesia Network (PRAN). Regional anesthesia and pain medicine Taenzer, A. H., Herrick, M., Hoyt, M., Ramamurthi, R. J., Walker, B., Flack, S. H., Bosenberg, A., Franklin, A., Polaner, D. M., PRAN investigators, PRAN investigator, Bosenberg, A., Flack, S., Polaner, D., Fernandez, P., Taenzer, A., Birmingham, P., Ramamurthi, R. J., Anderson, A., Kastner, G., Lozano, S., Matuszczak, M., Sethna, N., Petersen, T., Wyat, K., Pineda, J., Walker, B., Hutchins, J., Shah, A., Sathyamoorthy, M., Venable, C., Yalamanchili, V., Dong, N., Pizzo, K. D., Chaudhari, R., Franklin, A., Ando, A., Patel, N., Pestieau, S., Rosenbloom, J., Bradford, V. 2020


    BACKGROUND: Variation of local anesthetic dosing has been reported for adult peripheral nerve blocks (PNBs) and infant caudal blocks. As higher doses of local anesthetics (LA) are potentially associated with increased risk of complications (eg, local anesthetic systemic toxicity), it is important to understand the source of LA dose variation. Using the Pediatric Regional Anesthesia Network (PRAN) database, we aimed to determine if variation in dosing exists in pediatric single-injection PNBs, and what factors influence that variation.The primary aim of this study was to determine the factors associated with dosing for the 10 most commonly performed PNBs, with the secondary aim of exploring possible factors for variation such as number of blocks performed versus geographic location.METHODS: The PRAN database was used to determine the 10 most common pediatric PNBs, excluding neuraxial regional anesthetics. The 10 most common pediatric PNBs in the PRAN database were analyzed for variation of LA dose and causes for variation.RESULTS: In a cohort of 34514 children receiving PNBs, the mean age was 10.38 (+/-5.23) years, average weight was 44.88 (+/-26.66) kg and 61.8% were men. The mean bupivacaine equivalent (BE) dose was 0.86 (+/-0.5) mg kg-1 and ropivacaine was used in 65.4% of blocks. Dose decreases with age (estimate -0.016 (-0.017, -0.015; p<0.001)). In all blocks for all age groups, the range of doses that make up the central 80% of all doses exceeds the mean BE dose for the block. Variation is not related to the number blocks performed at an institution (p=0.33 (CI -0.42 to 0.15)). The dose administered for a PNB is driven in order of impact by the institution where the block was performed (Cohen's F=0.45), then by weight (0.31), type of block (0.27), LA used (0.15) and age (0.03).CONCLUSIONS: Considerable variation in dosing exists in all age groups and in all block types. The most impactful driver of local anesthetic dose is the institution where the block was performed, indicating the dosing of a potentially lethal drug is more based on local culture than on evidence.

    View details for DOI 10.1136/rapm-2020-101720

    View details for PubMedID 33004653

  • Complications in Pediatric Regional Anesthesia: An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network. Anesthesiology Walker, B. J., Long, J. B., Sathyamoorthy, M., Birstler, J., Wolf, C., Bosenberg, A. T., Flack, S. H., Krane, E. J., Sethna, N. F., Suresh, S., Taenzer, A. H., Polaner, D. M., Martin, L., Anderson, C., Sunder, R., Adams, T., Martin, L., Pankovich, M., Sawardekar, A., Birmingham, P., Marcelino, R., Ramarmurthi, R. J., Szmuk, P., Ungar, G. K., Lozano, S., Boretsky, K., Jain, R., Matuszczak, M., Petersen, T. R., Dillow, J., Power, R., Nguyen, K., Lee, B. H., Chan, L., Pineda, J., Hutchins, J., Mendoza, K., Spisak, K., Shah, A., DelPizzo, K., Dong, N., Yalamanchili, V., Venable, C., Williams, C. A., Chaudahari, R., Ohkawa, S., Usljebrka, H., Bhalla, T., Vanzillotta, P. P., Apiliogullari, S., Franklin, A. D., Ando, A., Pestieau, S. R., Wright, C., Rosenbloom, J., Anderson, T., Pediatric Regional Anesthesia Network Investigators 2018


    WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children's hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children.METHODS: This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy.RESULTS: There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%).CONCLUSIONS: The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.

    View details for PubMedID 30074928

  • Early experience with PECS 1 block for Port-a-Cath insertion or removal in children at a single institution. Journal of clinical anesthesia Munshey, F., Ramamurthi, R. J., Tsui, B. 2018; 49: 63–64

    View details for DOI 10.1016/j.jclinane.2018.06.010

    View details for PubMedID 29894919

  • Bilateral continuous erector spinae plane blocks for sternotomy in a pediatric cardiac patient. Journal of clinical anesthesia Wong, J., Navaratnam, M., Boltz, G., Maeda, K., Ramamurthi, R. J., Tsui, B. C. 2018; 47: 82–83

    View details for DOI 10.1016/j.jclinane.2018.03.020

    View details for PubMedID 29631111

  • Nusinersen versus Sham Control in Later-Onset Spinal Muscular Atrophy NEW ENGLAND JOURNAL OF MEDICINE Mercuri, E., Darras, B. T., Chiriboga, C. A., Day, J. W., Campbell, C., Connolly, A. M., Iannaccone, S. T., Kirschner, J., Kuntz, N. L., Saito, K., Shieh, P. B., Tulinius, M., Mazzone, E. S., Montes, J., Bishop, K. M., Yang, Q., Foster, R., Gheuens, S., Bennett, C. F., Farwell, W., Schneider, E., De Vivo, D. C., Finkel, R. S., CHERISH Study Grp 2018; 378 (7): 625–35


    Nusinersen is an antisense oligonucleotide drug that modulates pre-messenger RNA splicing of the survival motor neuron 2 ( SMN2) gene. It has been developed for the treatment of spinal muscular atrophy (SMA).We conducted a multicenter, double-blind, sham-controlled, phase 3 trial of nusinersen in 126 children with SMA who had symptom onset after 6 months of age. The children were randomly assigned, in a 2:1 ratio, to undergo intrathecal administration of nusinersen at a dose of 12 mg (nusinersen group) or a sham procedure (control group) on days 1, 29, 85, and 274. The primary end point was the least-squares mean change from baseline in the Hammersmith Functional Motor Scale-Expanded (HFMSE) score at 15 months of treatment; HFMSE scores range from 0 to 66, with higher scores indicating better motor function. Secondary end points included the percentage of children with a clinically meaningful increase from baseline in the HFMSE score (≥3 points), an outcome that indicates improvement in at least two motor skills.In the prespecified interim analysis, there was a least-squares mean increase from baseline to month 15 in the HFMSE score in the nusinersen group (by 4.0 points) and a least-squares mean decrease in the control group (by -1.9 points), with a significant between-group difference favoring nusinersen (least-squares mean difference in change, 5.9 points; 95% confidence interval, 3.7 to 8.1; P<0.001). This result prompted early termination of the trial. Results of the final analysis were consistent with results of the interim analysis. In the final analysis, 57% of the children in the nusinersen group as compared with 26% in the control group had an increase from baseline to month 15 in the HFMSE score of at least 3 points (P<0.001), and the overall incidence of adverse events was similar in the nusinersen group and the control group (93% and 100%, respectively).Among children with later-onset SMA, those who received nusinersen had significant and clinically meaningful improvement in motor function as compared with those in the control group. (Funded by Biogen and Ionis Pharmaceuticals; CHERISH number, NCT02292537 .).

    View details for PubMedID 29443664

  • Anaesthesia for Intestinal Obstruction in children Ramamurthi R J, Wilson C M
  • Nusinersen versus Sham Control in Infantile-Onset Spinal Muscular Atrophy. The New England journal of medicine Finkel, R. S., Mercuri, E. n., Darras, B. T., Connolly, A. M., Kuntz, N. L., Kirschner, J. n., Chiriboga, C. A., Saito, K. n., Servais, L. n., Tizzano, E. n., Topaloglu, H. n., Tulinius, M. n., Montes, J. n., Glanzman, A. M., Bishop, K. n., Zhong, Z. J., Gheuens, S. n., Bennett, C. F., Schneider, E. n., Farwell, W. n., De Vivo, D. C. 2017; 377 (18): 1723–32


    Spinal muscular atrophy is an autosomal recessive neuromuscular disorder that is caused by an insufficient level of survival motor neuron (SMN) protein. Nusinersen is an antisense oligonucleotide drug that modifies pre-messenger RNA splicing of the SMN2 gene and thus promotes increased production of full-length SMN protein.We conducted a randomized, double-blind, sham-controlled, phase 3 efficacy and safety trial of nusinersen in infants with spinal muscular atrophy. The primary end points were a motor-milestone response (defined according to results on the Hammersmith Infant Neurological Examination) and event-free survival (time to death or the use of permanent assisted ventilation). Secondary end points included overall survival and subgroup analyses of event-free survival according to disease duration at screening. Only the first primary end point was tested in a prespecified interim analysis. To control the overall type I error rate at 0.05, a hierarchical testing strategy was used for the second primary end point and the secondary end points in the final analysis.In the interim analysis, a significantly higher percentage of infants in the nusinersen group than in the control group had a motor-milestone response (21 of 51 infants [41%] vs. 0 of 27 [0%], P<0.001), and this result prompted early termination of the trial. In the final analysis, a significantly higher percentage of infants in the nusinersen group than in the control group had a motor-milestone response (37 of 73 infants [51%] vs. 0 of 37 [0%]), and the likelihood of event-free survival was higher in the nusinersen group than in the control group (hazard ratio for death or the use of permanent assisted ventilation, 0.53; P=0.005). The likelihood of overall survival was higher in the nusinersen group than in the control group (hazard ratio for death, 0.37; P=0.004), and infants with a shorter disease duration at screening were more likely than those with a longer disease duration to benefit from nusinersen. The incidence and severity of adverse events were similar in the two groups.Among infants with spinal muscular atrophy, those who received nusinersen were more likely to be alive and have improvements in motor function than those in the control group. Early treatment may be necessary to maximize the benefit of the drug. (Funded by Biogen and Ionis Pharmaceuticals; ENDEAR number, NCT02193074 .).

    View details for DOI 10.1056/NEJMoa1702752

    View details for PubMedID 29091570

  • The Role of Sugammadex in Symptomatic Transient Neonatal Myasthenia Gravis: A Case Report. A & A case reports Rubin, J. E., Ramamurthi, R. J. 2017; 9 (9): 271–73


    We describe the case of a 3-week-old boy with pyloric stenosis who presented for laparoscopic pyloromyotomy in the setting of symptomatic transient neonatal myasthenia gravis. The patient received muscle relaxation with rocuronium, and neuromuscular blockade was successfully reversed with sugammadex with recovery guided by train-of-four monitoring. He was extubated uneventfully without complications. Because sugammadex binds directly to rocuronium rather than interfering with acetylcholine metabolism, it might provide a good option for reversal of neuromuscular blockade in transient neonatal myasthenia gravis.

    View details for PubMedID 28691986

  • Improving prediction of surgery duration using operational and temporal factors. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium Kayis, E., Wang, H., Patel, M., Gonzalez, T., Jain, S., Ramamurthi, R. J., Santos, C., Singhal, S., Suermondt, J., Sylvester, K. 2012; 2012: 456-462


    Inherent uncertainties in surgery durations impact many critical metrics about the performance of an operating room (OR) environment. OR schedules that are robust to natural variability in surgery durations require surgery duration estimates that are unbiased, with high accuracy, and with few cases with large absolute errors. Earlier studies have shown that factors such as patient severity, personnel, and procedure type greatly affect the accuracy of such estimations. In this paper we investigate whether operational and temporal factors can be used to improve these estimates further. We present an adjustment method based on a combination of these operational and temporal factors. We validate our method with two years of detailed operational data from an electronic medical record. We conclude that while improving estimates of surgery durations is possible, the inherent variability in such estimates remains high, necessitating caution in their use when optimizing OR schedules.

    View details for PubMedID 23304316

    View details for PubMedCentralID PMC3540440

  • Improving electrical safety for patients with Epidermolysis bullosa PEDIATRIC ANESTHESIA Edler, A. A., Ramamurthi, R. J., Valenzuela, G. A. 2008; 18 (11): 1107-1109
  • The use of dexmedetomidine during laryngoscopy, bronchoscopy, and tracheal extubation following tracheal reconstruction PEDIATRIC ANESTHESIA Seybold, J. L., Ramamurthi, R. J., Hammer, G. B. 2007; 17 (12): 1212-1214


    We report the use of dexmedetomidine for laryngoscopy, rigid bronchoscopy, and tracheal extubation in the operating room in two children who had undergone tracheal reconstruction 1 week previously. Dexmedetomidine in combination with propofol provided appropriately deep anesthesia during these brief but stimulating procedures without cardiovascular or respiratory depression.

    View details for DOI 10.1111/j.1460-9592.2007.02346.x

    View details for PubMedID 17986042

  • Local anesthetic pharmacology in pediatric anesthesia Techniques in Regional Anesthesia and Pain Management R J Ramamurthi, Elliot J Krane 2007; 11 (4): 229-234
  • Clonidine for the prevention of emergence agitation in young children: efficacy and recovery profile PEDIATRIC ANESTHESIA Malviya, S., Voepel-Lewis, T., Ramamurthi, R. J., Burke, C., Tait, A. R. 2006; 16 (5): 554-559


    Emergence agitation (EA) is a common postoperative problem in young children who have received sevoflurane and isoflurane for general anesthesia. This randomized, double-blinded study evaluated the efficacy of intraoperative clonidine in reducing EA, and describes its recovery profile.With Institutional Review Board approval and informed consent, children undergoing brief, minimally painful procedures were studied. All children received preemptive analgesia with acetaminophen and ketorolac, sevoflurane for induction, and isoflurane for maintenance of anesthesia. Children received either 2 clonidine or placebo intravenously (i.v.) following induction of anesthesia. Children were observed postoperatively for behavior and side effects, and their parents were telephoned the next day to determine postdischarge recovery characteristics.One hundred and twenty children were included in this study: 59 of whom received clonidine, and 61 placebo; 41% of those in the placebo group exhibited moderate-severe EA compared with only 22% of those in the clonidine group (P < 0.03). Compared with those who received placebo, children who received clonidine awakened more slowly (22 min vs 14 min), had a longer postanesthesia care unit stay (57 min vs 46 min), and experienced sleepiness more frequently after discharge (75% vs 39%; all comparisons significant at P < 0.03). There were no adverse cardiorespiratory events in either group.Findings demonstrate that i.v. clonidine administered after induction of anesthesia significantly reduces the incidence of EA in young children, but is associated with sleepiness postoperatively.

    View details for DOI 10.1111/j.1460-9592.2006.01818

    View details for Web of Science ID 000236769600009

    View details for PubMedID 16677266

  • Acute gastric distension: a lesson from the classics HOSPITAL MEDICINE Ramamurthi, R. J., Tatman, A. 2001; 62 (3): 187-187

    View details for Web of Science ID 000167622000019

    View details for PubMedID 11291475

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