About

Warwick Aubrey Ames is a Professor of Anesthesiology and an Associate Professor in Pediatrics at Duke University. He is based at the 2905 Children’s Health Center in Durham, North Carolina. His professional roles involve both academic teaching and clinical responsibilities within the Duke Department of Pediatrics and Anesthesiology. The page does not provide specific details about his research focus, background, or key contributions.

Research topics

• Medicine
• Anesthesia
• Surgery
• Internal medicine
• Intensive care medicine

Selected publications

• In Response

  Anesthesia & Analgesia · 2026-03-02

  articleSenior author
  PublisherDOI

• Correction to: Identifying performance differences between two pulse oximetry systems in simulated critical neonatal conditions

  Journal of Perinatology · 2025-09-18

  erratumOpen access
  PublisherOA PDFDOI

• Combined Pecto-intercostal Fascial Plane and Rectus Sheath Blocks Versus Local Infiltration for Pain Management Following Pediatric Cardiac Surgery: A Randomized Clinical Trial

  Anesthesia & Analgesia · 2025-10-01 · 5 citations

  articleSenior author

  BACKGROUND: Previous studies have shown that regional anesthesia (RA) use versus placebo control is associated with less postsurgical opioid requirements and improved pain scores. This trial compared a novel combination of bilateral pecto-intercostal fascial plane and unilateral rectus sheath blocks to an active comparator of surgeon-administered local anesthetic wound infiltration in children undergoing septal defect repair. The study tested the hypothesis that RA use would result in less opioid use and lower pain intensity compared to wound infiltration. METHODS: This double-blind, randomized, parallel group, single-center trial included children (<18 years) undergoing primary atrial septal defect (ASD) or ventricular septal defect (VSD) repair. Participants were randomized to RA consisting of ultrasound-guided pecto-intercostal fascial plane and rectus sheath blocks or no-block, consisting of local anesthetic wound infiltration. Both groups received 1.5 mL/kg of ropivacaine 0.2% for the intervention. The primary outcome was opioid use (oral morphine milligram equivalents [MME]/kg) 0-12 hours after surgery. Secondary outcomes were opioid use at additional time points, pain (0-10 scale) between 0 and 48 hours (area under the curve [AUC]), and hospital length of stay (LOS). RESULTS: Data analysis included 42 children (24 RA, 18 infiltration), age 3.3 ± 2.7 years (mean ± standard deviation [SD]; median, 3; range, 4 months-10 years). Opioid use (MME/kg mean ± SD) 0-12 hours after surgery was 0.44 ± 0.19 in the RA group compared to 0.83 ± 0.39 in the infiltration group (mean difference -0.39; 95% confidence interval [CI], -0.59 to -0.18; P = .001). Total postoperative opioid use from 0 to 48 hours after surgery was 0.95 ± 0.40 in the RA group compared to 1.57 ± 0.75 in the infiltration group (mean difference -0.64; 95% CI, -1.02 to -0.22, P = .004). Pain intensity AUC (0-48 hours) was 45.0 ± 26.8 in the RA group compared to 94.5 ± 55.7 in the infiltration group (mean difference -49.5 [-78.9 to -20.1]; P = .002). Opioid use between 12 and 48 hours and hospital LOS was not different between groups. CONCLUSIONS: This single-center study showed that the combined pecto-intercostal fascial plane and rectus sheath blocks were opioid-sparing and provided superior pain control compared to contemporary practice of local anesthetic infiltration in children following septal defect repair. This investigation strengthens the evidence to support RA use to improve postoperative pain in this population.

  PublisherDOI

• Identifying performance differences between two pulse oximetry systems in simulated critical neonatal conditions

  Journal of Perinatology · 2025-07-30 · 1 citations

  articleOpen access

  Abstract Objective Pulse oximetry is used to guide critical clinical decisions in neonatology. We used a vital signs simulator to compare performance of two pulse oximetry systems in conditions not tested in standardized clinical verification studies. Study design We devised a set of simulated tissue translucency, perfusion, peripheral oxygen saturation (SpO 2 ) , and heart rate (HR) parameters to mimic challenging real-world neonatal data and applied them to two marketed pulse oximetry systems (Nellcor™ and Masimo®). At each combination of input parameters, we used the response from both systems to assess SpO 2 error. Results The mean SpO 2 error for Nellcor™ was below 1.1% across all parameters explored, while Masimo® showed significantly higher ( p &lt; 0.005) error at lower translucencies. Conclusion Significant performance differences can be observed when comparing pulse oximeters at low translucency and perfusion conditions. Patient simulators cannot replace clinical testing but provide a safe and cost-effective method for additional performance profiling.

  PublisherDOI

• Surgical and Anesthesia-Related Concerns forRobot-Assisted Pediatric Cardiac Surgery

  Journal of Cardiothoracic and Vascular Anesthesia · 2025-11-08

  article
  PublisherDOI

• Characterizing Peri-procedural Care for Pediatric Patients with Williams Syndrome Undergoing General Anesthesia at a Tertiary Pediatric Hospital

  AANA journal · 2025-07-29

  article

  Williams syndrome is a rare congenital disorder affecting connective tissue and the cardiovascular and central nervous systems. Pediatric patients diagnosed with Williams syndrome face significant risk for cardiac collapse and death when undergoing anesthesia. We sought to evaluate our institution's historical practices, evaluate individual risk stratification, and create detailed standardized perianesthesia guidelines for management of this population, particularly during noncardiac procedures. The study included a retrospective chart review of pediatric patients with Williams syndrome who received anesthesia over a 10-year period at a single institution. A total of 23 patients underwent 46 procedures. At time of procedure, median age was 5.8 years (range, 0.4-17.6 yr), and the majority (n = 19) had a "low" Williams syndrome risk category and required anesthesia for noncardiac procedures. Most (61%) had no cardiac involvement beyond mild supravalvar or branch pulmonary artery stenosis. No intraprocedure adverse cardiac events were identified. One patient experienced an adverse cardiac event approximately 60 minutes postanesthesia emergence which included ST segment depression and development of refractory ventricular fibrillation, necessitating deployment of venoarterial extracorporeal membrane oxygenation. This patient was eventually stabilized and was taken to the operating room 3 days later for definitive severe supravalvar aortic stenosis repair. Patients with Williams syndrome have a reported risk for sudden cardiac death that is 25 to 100 times greater than that of the age-matched general population. The incidence of adverse cardiac events in our cohort of patients with Williams syndrome undergoing anesthesia was lower compared with previous studies, which reported rates ranging from 4.2% to 11%. These findings support the idea that risk stratification and institutional practice guidelines can aid anesthesia providers in making informed decisions, and standardization of pre-, intra-, and postprocedural care according to existing guidelines may further reduce risks. Our review offers valuable insight into historical anesthesia management and contributes to a broader interdisciplinary understanding of care provision for this high-risk group.

  PublisherDOI

• National practice patterns for the use of regional anesthesia for pediatric cardiac surgery: An analysis of the Society of Thoracic Surgeons congenital heart surgery database

  Journal of Clinical Anesthesia · 2025-02-08 · 2 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Analgesic Effects of a Novel Combination of Regional Anesthesia After Pediatric Cardiac Surgery: A Retrospective Cohort Study

  Journal of Cardiothoracic and Vascular Anesthesia · 2022-07-14 · 14 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Postanesthesia Care Unit Management

  2020-03-20

  other1st authorCorresponding

  In infants, perioperative anesthetic morbidity is higher than in other age groups, which underscores the importance of the dedicated pediatric postanesthesia care unit (PACU). The pediatric PACU environment requires careful planning and ongoing maintenance in order to provide a safe, efficient environment for the recovering pediatric patient. This chapter indicates the widespread knowledge of basic principles of postanesthetic recovery and the publication of general national standards, and specific practices that are dictated by institutional experience and preference. It discusses the design, equipment, staffing, transport, handover and assessment, monitoring and patient safety, parental presence, and discharge criteria of the PACU. The chapter discusses several potential postanesthesia problems and complications related to respiratory and cardiovascular systems, and some specific conditions such as hypothermia and hyperthermia, emergence agitation or delirium, seizures and myoclonus, pain, postoperative nausea and vomiting, urinary retention, and medication errors.

  PublisherDOI

• Evidence-Based Medicine in the Time of COVID: We Have a Problem

  Journal of Cardiothoracic and Vascular Anesthesia · 2020-11-05 · 4 citations

  editorialOpen accessSenior author

  A baby with D-transposition of the great arteries, intact ventricular septum, and restrictive atrial septal communication was born to a coronavirus disease 2019 (COVID-19)–positive mother. Urgent intervention was warranted, but balancing quality care with testing constraints and local logistical factors created a safety quagmire. Perinatal transmission of COVID-19 virus is unlikely, and if it occurs likely is due to close contact between the infected mother and baby; vertical transmission is unlikely and has not yet been reported.1Faraoni D Caplan LA DiNardo JA et al.Considerations for pediatric heart programs during COVID-19: Recommendations from the Congenital Cardiac Anesthesia Society.Anesth Analg. 2020; 131: 403-409Crossref PubMed Scopus (11) Google Scholar This baby had no contact with his mother after birth and the chance of a positive test was not high; early repair would improve the baby's postoperative course and outcomes. At the same time, a complex congenital cardiac surgery on a neonate with COVID-19 infection is potentially dangerous for the baby, as well as the staff who risk exposure. This scenario has played out for many of us over the last months in trying to balance the risk of infection with the urgency of a given child's surgical condition. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has highlighted innovation and resilience, but also has called attention to many deficiencies and inconsistencies in the healthcare system, both in the United States and worldwide. The need for information about this new virus has outstripped the ability to conduct evidence-based research. Case series and even case reports are taking on elevated importance as practitioners share data and make medical decisions. Evidence-based medicine (EBM) is purportedly the gold standard but in reality is not widely practiced. EBM is defined as the “use of best evidence with current expertise and patient values to guide healthcare decisions.”2Every-Palmer S Howick J. How evidence-based medicine is failing due to biased trials and selective publication.J Eval Clin Pract. 2014; 20: 908-914Crossref PubMed Scopus (119) Google Scholar Systematic reviews and randomized controlled trials form the apex of the EBM pyramid, but these types of studies are also subject to corruption. To be useful, randomized trials must ask the correct question, be designed to answer that question, and have adequate sample size, methodology, and follow-up. To be useful in the situation of a particular patient, that patient must be similar to study patients. Inappropriately applied evidence may cause harm. Given all of these caveats to the gold standard of applied research, it is not surprising that there is no proof that EBM improves outcomes. Large randomized trials are particularly lacking in pediatric populations, in which target groups are smaller and research dollars harder to obtain. Attempting to apply EBM in pediatric congenital cardiac surgery and anesthesia further underscores the problems with holding EBM as the gold standard. Systematic reviews and metanalyses in the adult cardiac population are often considered a homogeneous population, with a higher ratio of randomized trial to observational or retrospective studies. In contrast, pediatric congenital cardiac patients are a heterogeneous population with high complexity, and it is difficult to prove outcomes benefits for a given strategy for a particular subpopulation. Database research has helped answer many clinical questions in congenital cardiac anesthesia and surgery. Database research is resource heavy, but not as resource heavy as randomized trials. The Society for Thoracic Surgeons Congenital Heart Database (STS CHDB) is a repository for perioperative information on children and adults with congenital heart disease; in 2010 the Congenital Cardiac Anesthesia Society began adding anesthetic data to the database. Currently, the STS CHDB collects information worldwide, capturing data on nearly all congenital cardiac surgery programs; anesthetic contribution is present in about 50% of programs.3Vener DF Abbasi RK Brown M et al.The Congenital Cardiac Anesthesia Society-Society of Thoracic Surgeons Cardiac Anesthesia Database Collaboration.World J Pediatr Congenit Heart Surg. 2020; 11: 14-21Crossref PubMed Scopus (7) Google Scholar Database research is hindered, however, by the quality of the data. The STS CHDB is only one of more than 40 registries addressing congenital heart disease; all of these registries must contend with issues of data integrity, including missing values, risk adjustments, varied validation, oversight and data usage, and privacy concerns.4Vener DF Gaies M Jacobs JP Pasquali SK Clinical databases and registries in congenital and pediatric cardiac surgery, cardiology, critical care, and anesthesiology worldwide.World J Pediatr Congenit Heart Surg. 2017; 8: 77-87Crossref PubMed Scopus (32) Google Scholar A secondary problem with using data obtained in registries is the time necessary to examine and report trends. For example, an analysis of the STS CHD from 2010 to 2014 was published in 20185Jacobs JP Mayer Jr., JE Pasquali SK et al.The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2019 update on outcomes and quality.Ann Thorac Surg. 2019; 107: 691-704Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar; with the rapid pace of changes in clinical medicine, this time lag means that some data will be too old to be useful by the time it is published. The global pandemic due to SARS-CoV-2 infection requires rapid information sharing to learn how to deal with all aspects of the disease. In a one-year period from October 2019 through October 2020, more than 48,000 articles on coronavirus/COVID-19 were introduced on the National Institutes of Health, National Library of Medicine's PubMed; about 7,000 were review articles, and fewer than 300 were randomized or therapeutic trials. Only about 3,200 articles pertained to pediatric patients. Most articles were observational studies, guideline papers, or expert opinion pieces. These observational studies are crucial to understanding of the COVID-19 virus. In particular, the hyperinflammatory condition that some children develop after SARS-CoV-2 infection, termed “multiorgan inflammatory syndrome in children” (MIS-C) in the United States, has been characterized by anecdotal evidence only—a mixture of case reports, case series, and expert opinions. Anecdotal data sharing taught us that children are far less affected than adults in the COVID-19 global pandemic, but a subset of children may be susceptible to severe disease from the virus. In April 2020, the UK National Health Service issued an alert regarding a hyperinflammatory syndrome in children with recent SARS-CoV-2 infection or exposure; they termed it “pediatric inflammatory multisystem syndrome”—temporarily associated with SARS-CoV-2. Since that alert from the United Kingdom, this constellation of signs and symptoms has been identified in children worldwide. Three definitions—one each from the World Health Organization, the United States Centers for Disease Control and Prevention (CDC), and the United Kingdom Royal College of Pediatrics—describe the syndrome.6World Health Organization. (2020). Multisystem inflammatory syndrome in children and adolescents with COVID-19: scientific brief, 15 May 2020. World Health Organization. https://apps.who.int/iris/handle/10665/332095. License: CC BY-NC-SA 3.0 IGO. Accessed November 16, 2020.Google Scholar, 7Centers for Disease Control and Prevention. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Available at: https://www.cdc.gov/mis-c/hcp/. Accessed October 29, 2020.Google Scholar, 8Royal College of Paediatrics and Child Health. Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. Available at: https://www.rcpch.ac.uk/resources/paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19-pims-guidance. Accessed November 16, 2020.Google Scholar Common to all three definitions are presence of fever, multiorgan involvement, laboratory evidence of elevated inflammatory markers (eg, erythrocyte sedimentation rate, c-reactive protein, fibrinogen), lack of evidence of other infections that would explain symptoms, and either recent SARS-CoV-2 infection or significant exposure.9Nijman RG De Guchtenaere A Koletzko B et al.Pediatric inflammatory multisystem syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics.Front Pediatr. 2020; 8: 490Crossref PubMed Scopus (22) Google Scholar Many children present in vasoplegic shock that is responsive to vasopressor and inotropic support; few have respiratory failure requiring ventilatory support.10Riphagen S Gomez X Gonzalez-Martinez C et al.Hyperinflammatory shock in children during COVID-19 pandemic.Lancet. 2020; 395: 1607-1608Abstract Full Text Full Text PDF PubMed Scopus (1426) Google Scholar The World Health Organization, CDC, and UK Royal College of Pediatrics did not develop these guidelines and recommendations based on randomized trials or meta-analyses. Rather, a look at the references for each publication shows that small case series, retrospective studies, and even case reports were used to gather the data to paint a picture of this syndrome. Moreover, the definitions of this hyperinflammatory condition rapidly are evolving as understanding of the disease advances, and more studies describing symptomology, treatment, and outcomes are published. The first report summarizing the experience of children in the United States with MIS-C examined characteristics of 186 children across 20 states who met CDC definitions of MIS-C. This report, published in the New England Journal of Medicine in June 2020, described the epidemiology, presenting signs and symptoms, and outcomes of these initial infections.11Feldstein LR Rose EB Randolph AG Multisystem inflammatory syndrome in children in the United States.Reply. N Engl J Med. 2020; 383: 1-13Crossref PubMed Scopus (1382) Google Scholar Such anecdotal evidence and retrospective research on pediatric hyperinflammatory reaction after SARS-CoV-2 infection have been critical to understanding of this disease complex, but lives at the bottom of the EBM pyramid. Its importance in clinical decision-making and offering support to patients and their families does not jibe with this position. There are many scenarios in medicine when clinical disease processes evolve at a pace faster than can be scrutinized and determined scientifically. Databases and registries processes move too slowly to inform bedside decisions for an individual patient who needs urgent surgery. EBM fails us in the current global pandemic, and in many cases of unique diseases. Continuous quality improvement initiatives provide valuable opportunities to rapidly assess new interventions and strategies in patient care. Case reports and retrospective reviews should not be eschewed as poor evidence. Practitioners should encourage informal communication and facilitate real-time discussion of patient problems and creative solutions. While there should be caution over fake news, practitioners must remain open-minded as to the challenges of abrupt changes in clinical disease. Anecdotal and retrospective evidence is having a well-deserved moment in the spotlight. This should be remembered when the pandemic is over and there is a temptation to fall back into old patterns of evidence judging. None.

  PublisherOA PDFDOI

Frequent coauthors

• Edmund H. Jooste

  Duke University

  36 shared

• Kelly A. Machovec

  23 shared

• Frederick S. Sherman

  University of Pittsburgh

  13 shared

• Manuel C. Vallejo

  13 shared

• Wendy A. Haft

  Veterans Health Administration

  13 shared

• H. Mayumi Homi

  Duke University Hospital

  13 shared

• Robert D.B. Jaquiss

  The University of Texas Southwestern Medical Center

  10 shared

• Andrew J. Lodge

  Advocates for Youth

  9 shared