DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT
DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT
DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT
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<strong>DEPARTMENT</strong> <strong>OF</strong> <strong>ANESTHESIOLOGY</strong><br />
Duke University Medical Center<br />
2000<br />
<strong>ANNUAL</strong><br />
<strong>REPORT</strong>
Duke University Medical Center<br />
Department of Anesthesiology
This issue is dedicated to the memory of<br />
WILLIAM JAMES MURRAY,M.D.,PH.D.<br />
1933 – 2000<br />
Dr. Murray served on our faculty from 1972, when he was recruited from the University of Michigan, until the morning of his<br />
death December 6. In fact, Dr. Murray died on his way to attend the Grand Rounds at which Dr. Bruno Urban was honored on<br />
the occasion of his retirement. This faithful attendance at all Departmental meetings and interest in all Departmental matters<br />
characterized Dr. Murray. There has never been anyone who paid so much attention to the broad spectrum of activities of our<br />
department’s many activities and publications as Dr. Murray. During his long academic career at UNC, Michigan, and Duke he<br />
touched countless numbers of students, medical and anesthesiology residents. All can recall the attention to detail he gave to<br />
every patient he cared for, to every anesthetic he administered, to every committee he served on and to every task he so willingly<br />
undertook. The last several years of Dr. Murray’s service were spent representing our department at the various committees<br />
that make hospitals and medical centers work. His work in these accounted for many of the institutional changes and improvements<br />
in such areas as Pharmacy, Curriculum and Resuscitation. Despite the heavy committee obligations, he maintained a<br />
keen interest in patients and patient care at Duke Hospital. These interests inevitably led to improved patient care: this, in fact,<br />
was the work of his whole life—finding and implementing better ways to care for our patients. Dr. Murray will be greatly<br />
missed by his family, our department and his church—to whom he was immensely loyal and committed—and all of whom<br />
benefited immeasurably from this full devotion.
FOREWORD<br />
Upon reflection, the year 2000 has been much like those of the last ten years for the Department of<br />
Anesthesiology of Duke University. Everywhere one looks one sees commitment—not self-absorbed<br />
egomaniacal, but individual work that reaches beyond the corpus of all who learn and labor here—<br />
there is a more grand aim, a collective spirit of determination to reach goals of excellence in all that<br />
we do. And we have reached and exceeded even our own expectations—those most high among<br />
all others.<br />
How have we done it? We have remarkable people, professionals in the best sense of the word,<br />
who put their patients and their colleagues first among all priorities. We have created a team named<br />
the Anesthesiology Department that succeeds in patient care, teaching, research administration and<br />
tolerance of the many ideas, personalities and diverse interests of our diverse Departmental members.<br />
We are a mature Department now, secure in the knowledge that we know how to succeed. We have<br />
learned, we have grown in statue and are a national leader—others follow our example. Lessons we<br />
have learned are not forgotten they live in us all and we use them every day to continue our quest<br />
for even greater achievement.<br />
It has been a privilege to watch this metamorphosis from the sidelines—occasionally entering into<br />
the fray, but more often consulting, cheering, consoling, and exhorting—always knowing that we would<br />
exceed our loftiest goals because we had that intangible gift to succeed as a great department, not<br />
as great individuals. Of course,it takes great individuals to accomplish these things, but it is the teamwork<br />
that has allowed us to do it all so well. The future is bright and secure as long as this spirit<br />
is preserved.<br />
My 17 years at Duke have been gratifying, because of the achievements of everyone. In a recent<br />
interview I was asked what has been “your most satisfying accomplishment”and the answer came<br />
reflexly:“My greatest joy has been watching those around me grow and accomplish things they didn't<br />
think they could do.” As I leave Duke I will always look back on the best group I have ever been<br />
associated with—you made us all look so good! And I will forever cherish this time together. I’m<br />
confident that next year’s annual report will contain even better works than all that have gone before.<br />
This is the progress that Duke Anesthesiology stands for. Congratulations and Godspeed.
DUKE <strong>DEPARTMENT</strong> <strong>OF</strong> <strong>ANESTHESIOLOGY</strong><br />
MISSION<br />
The Mission of this Department is to provide the highest quality patient care and engage<br />
in superior academic pursuits through excellence in teaching and research. Aspiring to our<br />
goal is a team of skilled anesthesia professionals with different educational backgrounds and<br />
unique abilities who embrace collaborative, collegial and complementary relationships.<br />
Specific Departmental goals are:<br />
To deliver first rate patient care in operating, labor and delivery rooms, postanesthetic<br />
and intensive care units, the hyperbaric center and perioperative activities (including surgical<br />
screening clinic and acute pain management).<br />
To provide consultant services for preoperative and postoperative care.<br />
To coordinate a multidisciplinary approach in diagnosis and treatment of acute<br />
and chronic pain disorders.<br />
To provide leadership and administrative support in organizing operating rooms,<br />
intensive care units, ambulatory surgery, transesophageal echocardiography service,<br />
hyperbaric and heart centers.<br />
To determine methods to assess quality care assurance, develop programs to facilitate<br />
cost effectiveness and enhance operating room efficiency.<br />
To promote an environment supportive of learning and growth,in which each departmental<br />
member serves as an appropriate professional role model.<br />
To enlarge knowledge through vigorous investigative laboratory and clinical<br />
research programs.<br />
To conduct all professional matters in an ethical manner in order to bring pride and honor<br />
to the Anesthesia Department and fellow Duke Medical Center colleagues.
Department of Anesthesiology Mission . . . . . . . . . . . . . 4<br />
Faculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5<br />
Past Anesthesiology Chairs . . . . . . . . . . . . . . . . . . . . . . . 19<br />
Affiliated Faculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20<br />
Anesthesiology Scholars . . . . . . . . . . . . . . . . . . . . . . . . 24<br />
Anesthesiology Residents . . . . . . . . . . . . . . . . . . . . . . . 26<br />
Interns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26<br />
CA-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27<br />
CA-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28<br />
CA-3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30<br />
Anesthesiology Fellows . . . . . . . . . . . . . . . . . . . . . . . 31<br />
Certified Registered Nurse Anesthesia Staff . . . . . . . . . 32<br />
Anesthesia Chairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40<br />
Clinical Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41<br />
Ambulatory Anesthesiology . . . . . . . . . . . . . . . . . . . . 41<br />
Cardiac Anesthesiology . . . . . . . . . . . . . . . . . . . . . . . 44<br />
Certified Registered Nurse Anesthesia . . . . . . . . . . . 47<br />
Critical Care Medicine . . . . . . . . . . . . . . . . . . . . . . . . 49<br />
General, Vascular, Urology and Transplant . . . . . . . 52<br />
Environmental Physiology<br />
and Hyperbaric Medicine . . . . . . . . . . . . . . . . . . . . 53<br />
Orthopaedics, Plastics and Regional<br />
Anesthesiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58<br />
Otolaryngology, Head, Neck and<br />
Neuroanesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . 60<br />
Pain and Pain Management . . . . . . . . . . . . . . . . . . . 62<br />
Pediatric Anesthesia and<br />
Pediatric Critical Care Medicine . . . . . . . . . . . . . . 65<br />
Veterans Affairs Anesthesia<br />
and Perioperative Medicine . . . . . . . . . . . . . . . . . . 67<br />
Women’s Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . 70<br />
Biostatistics and Clinical Outcomes . . . . . . . . . . . . . . . .72<br />
Divers Alert Network . . . . . . . . . . . . . . . . . . . . . . . . . . . 73<br />
CONTENTS<br />
Departmental Committees . . . . . . . . . . . . . . . . . . . . . . . 75<br />
Division Chiefs and Committee Chairpersons . . . . . . . . 77<br />
Thirteenth Duke University Medical Center<br />
Anesthesiology Alumni Reception -<br />
San Francisco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78<br />
Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80<br />
Lectures, Conferences and Didactics . . . . . . . . . . . . 84<br />
Eighth Academic Evening . . . . . . . . . . . . . . . . . . . . . 98<br />
Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99<br />
Support Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100<br />
Clinical Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108<br />
Laboratory Research . . . . . . . . . . . . . . . . . . . . . . . . . . .113<br />
Research Grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114<br />
Laboratory Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . 118<br />
Gerontological Research in Anesthesiology<br />
and Surgery Program (GRASP) . . . . . . . . . . . . . . . 125<br />
Research Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126<br />
Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129<br />
Editorial Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141<br />
Anesthesiology in the News . . . . . . . . . . . . . . . . . . . . . 142<br />
History of Anesthesiology . . . . . . . . . . . . . . . . . . . . . . 144<br />
GRAPHS<br />
Cases by Divisions/Sections . . . . . . . . . . . . . . . . . . . . . . 45<br />
Anesthesiology Research Dollars . . . . . . . . . . . . . . . . 112<br />
NIH Grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116<br />
Dollar Amounts . . . . . . . . . . . . . . . . . . . . . . . . . . . .116<br />
Ranking from #1 Position . . . . . . . . . . . . . . . . . . . . 116
FACULTY, RESIDENTS, FELLOWS, AND CRNAS<br />
<strong>DEPARTMENT</strong> <strong>OF</strong> <strong>ANESTHESIOLOGY</strong>, DUKE UNIVERSITY MEDICAL CENTER, 2000<br />
(First Row Left to Right) Cathleen L. Peterson-Layne, M.D., Ph.D.; Julie Z.Woosley, M.D.; Russel L. Jacobe, M.D.;Tarsha V. Garvin, M.D.; G. Burkhard Mackensen, M.D.; Robert R. Panten, M.D.; Gayle P.Moyer,<br />
CRNA, BSN, MS (Second Row Left to Right) Peter S. Baek, M.D.; Christopher M. Kerr, M.D.; David A. Lubarsky, M.D., M.B.A.; J.G. Reves, M.D.; Merel H. Harmel, M.D.; Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP; William J. Murray, M.D., Ph.D.; Jacques Somma, M.D., FRCP(C); Madan M. Kwatra, Ph.D. (Third Row Left to Right) Ivan T. Demchenko, D.Sc.; Dana N.Wiener, M.D.; John C. Keifer,<br />
M.D.; Bruno J. Urban, M.D., Dr.med.; Billy K. Huh, M.D., Ph.D.; Karen C. Nielsen, M.D.; Narda D. Croughwell, CRNA; Kerri M. Robertson, M.D., FRCP(C); George N. Djaiani, M.D., D.A., DEAA, FRCA; Lian K.Ti,<br />
M.B., B.S. (Fourth Row Left to Right) Alina M. Grigore, M.D.; John T. Moloney, M.B., B.S.; Mark Stafford Smith, M.D., C.M., FRCP, DABA; Catherine K. Lineberger, M.D.; Elizabeth A. Bell, M.D., MPH; Kathryn<br />
P. King, M.D., MSN; Adeyemi J. Olufolabi, M.B., B.S., FRCA; Allison K. Ross, M.D.; David B. MacLeod, M.B., B.S., FRCA; H. David Hardman, M.D., M.B.A.; Janet E. Gorel, CRNA (Fifth Row Left to Right) Allan<br />
B.Shang,M.D.; Daniel D.DeMeyts,M.D.;Thomas O.Erb,M.D.,F.M.H.; Peter D.Dwane,M.D.,C.M.,FRCP(C); Christopher C.Young,M.D.;Andrew K.Hilton,M.B.,B.S.,FANZCA;Yoazhi Wang,M.D.; Huaxin Sheng,<br />
M.D.; Mark F. Newman, M.D.; Paula D.Alford, CRNA; Leslie A. Cline, CRNA; Mack E. Haddock, CRNA; Jonathan B. Mark, M.D. (Sixth Row Left to Right) Donald K.Thomas, CRNA; Eugene W. Moretti, M.D.;<br />
Deborah J.Ferrero-Conover,CRNA,MSN; Holly A.Muir,M.D.,FRCP(C); John R.Schultz,M.D.; David H.Gleason,CRNA; Robert E.Foy,CRNA; David R.Wright,M.B.,Ch.B.; John A.C.Murdoch,M.B.,Ch.B.,B.Sc.;<br />
John F. Pierce, CRNA;Timothy O. Stanley, M.D.; John B. Eck, M.D.; David B. Schinderle, M.D. (Seventh Row Left to Right) Bo Wu, M.D.; James M.Temo, CRNA, MSN, M.B.A.; Dianne L. Scott, M.D.; David D.<br />
Lee,CRNA,BSN;Terrence W.Breen,M.D.,FRCPC; Ronald P.Olson,M.D.,CCFP (Eighth Row Left to Right) Ellen M.Lockhart,M.D.; Laura J.Kihlstrom,M.D.; Matthew T.Taylor,M.D.;William P.Norcross,M.D.;<br />
Garrett W.Scales,M.D.; Donald H.Penning,M.Sc.,M.D.; Laura E.Niklason,M.D.,Ph.D.; B.Will Curtis,M.D.; Scott E.Helsley,M.D.,Ph.D.; Marcella J.Lauzinger,M.D.; Jeffery M.Taekman,M.D.; Kurt J.Knauth,M.D.;<br />
Randy P. Brewer, M.D.; James R. McCurdey, M.D.; Chiedozie I. Udeh, M.B., B.S.; Thomas E. Buchheit, M.D.; Alison Taylor, P.A.C.; Lisa J. Schwetschenau, CRNA, MNA (Ninth Row Left to Right) John T. Sum<br />
Ping, M.B., Ch.B., FRCA; Holly A.Williams-Davis, M.D.; Anne Marie Fras, M.D.; Evelyn M. DeRoche, CRNA; Dale Potter; Jason R. Burke, M.D.
Nadia M. Agopyan, Ph.D.<br />
Assistant Research Professor in<br />
Anesthesiology<br />
Elizabeth A. Bell, M.D., M.P.H.<br />
Assistant Professor of Anesthesiology<br />
Associate in the Department of Obstetrics<br />
and Gynecology<br />
John V. Booth, M.B., Ch.B., FRCA<br />
Assistant Professor of Anesthesiology<br />
FACULTY<br />
Barry W. Allen, Ph.D.<br />
Assistant Research Professor in<br />
Anesthesiology<br />
Peter B. Bennett, Ph.D., D.Sc.<br />
Professor of Anesthesiology<br />
Cecil O. Borel, M.D.<br />
Associate Professor of Anesthesiology<br />
Associate Professor in Surgery<br />
(Neurosurgery)<br />
Daniel T. Bainbridge, M.D., B.Sc.Med.<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
Helene D. Benveniste, M.D., Ph.D.<br />
Associate Professor of Anesthesiology<br />
Assistant Professor of Neurobiology<br />
Assistant Research Professor of Radiology<br />
Terrence W. Breen M.D., FRCPC<br />
Assistant Professor of Anesthesiology<br />
FACULTY 5
FACULTY<br />
Thomas E. Buchheit, M.D.<br />
Clinical Associate in the Department of<br />
Anesthesiology<br />
Robert L. Coleman, M.D.<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Francine J. D’Ercole, M.D.<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
6 FACULTY<br />
Alexis C. Carmer, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
Guy deLisle Dear, M.B., FRCA<br />
Associate Clinical Professor of<br />
Anesthesiology<br />
Peter D. Dwane, M.D., C.M., FRCP(C)<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Associate in the Department of Obstetrics<br />
and Gynecology<br />
Fiona M. Clements, M.D.<br />
Clinical Professor of Anesthesiology<br />
Assistant Clinical Professor of Medicine<br />
Norbert P. DeBruijn, M.D.<br />
Clinical Professor of Anesthesiology<br />
Associate Clinical Professor of Surgery<br />
Assistant Clinical Professor in Medicine<br />
John B. Eck, M.D.<br />
Assistant Professor of Anesthesiology
John G. Ellingham, M.B., B.S., FANZCA<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
Anne Marie Fras, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
Charles R. Garcia-Rodriguez, M.B., B.S.<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
Thomas O. Erb, M.D., F.M.H.<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
Maribel G. Gamoso, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
Sheila F. Gardner, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
Jennifer T. Fortney, M.D.<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
FACULTY<br />
T. J. Gan, M.B., B.S., FRCA<br />
Associate Professor of Anesthesiology<br />
Brian Ginsberg, M.B., Ch.B.<br />
Associate Professor of Anesthesiology<br />
FACULTY 7
FACULTY<br />
Joel S. Goldberg, M.D.<br />
Assistant Professor of Anesthesiology<br />
Roy A. Greengrass, M.D., FRCP(C)<br />
Associate Clinical Professor of<br />
Anesthesiology<br />
Hilary P. Grocott, M.D., FRCP(C)<br />
Assistant Professor of Anesthesiology<br />
8 FACULTY<br />
Veerainder Goli, M.D., FAAPM, BCFE<br />
Associate in the Department of<br />
Anesthesiology<br />
Assistant Professor of Psychiatry and<br />
Behavioral Sciences<br />
Katherine P. Grichnik, M.D., MS<br />
Assistant Professor of Anesthesiology<br />
Ashraf S. Habib, M.B., B.Ch., MSc.,<br />
FRCA<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
Stuart Alan Grant, M.B., Ch.B.<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
Alina M. Grigore, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
H. David Hardman, M.D., M.B.A.<br />
Assistant Clinical Professor of<br />
Anesthesiology
Andrew J. Hartle, M.B., Ch.B., FRCA<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
Lewis R. Hodgins, M.D.<br />
Assistant Professor of Anesthesiology<br />
Assistant Professor of Surgery<br />
Brian M. Ilfeld, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
Steven E. Hill, M.D.<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Billy K. Huh, M.D., Ph.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
Richard J. Ing, M.B., Ch.B., FA(SA)<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
FACULTY<br />
Andrew K. Hilton, M.B., B.S., FANZCA<br />
Assistant Professor of Anesthesiology<br />
Assistant Professor of Surgery<br />
Peter C. Huttemeier, M.D., Ph.D., M.B.A.<br />
Associate Clinical Professor of<br />
Anesthesiology<br />
Assistant Clinical Professor in<br />
Ophthalmology<br />
Francis J. Keefe, Ph.D.<br />
Professor in Anesthesiology<br />
Professor of Psychiatry and Behavioral<br />
Sciences<br />
FACULTY 9
FACULTY<br />
John C. Keifer, M.D.<br />
Associate Clinical Professor of<br />
Anesthesiology<br />
Stephen M. Klein, M.D.<br />
Assistant Professor of Anesthesiology<br />
Madan M. Kwatra, Ph.D.<br />
Associate Professor in Anesthesiology<br />
Assistant Professor of Pharmacology and<br />
Cancer Biology<br />
10 FACULTY<br />
Frank H. Kern, M.D., FCCM<br />
Professor of Anesthesiology<br />
Professor of Pediatrics<br />
Nancy W. Knudsen, M.D.<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Assistant Clinical Professor in Surgery<br />
Daniel T. Laskowitz, M.D.<br />
Assistant Professor in Anesthesiology<br />
Assistant Professor of Medicine<br />
Kathryn E. King, M.D., MSN<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Shashidhar H. Kori, M.D.<br />
Associate Clinical Professor in<br />
Anesthesiology<br />
Associate Professor of Medicine<br />
David R. Lindsay, M.D.<br />
Associate in the Department of<br />
Anesthesiology
Catherine K. Lineberger, M.D.<br />
Associate Professor of Anesthesiology<br />
David A. Lubarsky, M.D., M.B.A.<br />
Associate Professor of Anesthesiology<br />
Raman Madan, M.B., B.S., D.A., FFARCS,<br />
MRCP(I)<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
Lieju Liu, M.D., M.B., MS<br />
Assistant Research Professor in<br />
Anesthesiology<br />
G. Burkhard Mackensen, M.D.<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
Jonathan B. Mark, M.D.<br />
Associate Professor of Anesthesiology<br />
Assistant Professor in Medicine<br />
Ellen M. Lockhart, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
FACULTY<br />
David B. MacLeod, M.B., B.S., FRCA<br />
Associate in the Department of<br />
Anesthesiology<br />
Gavin Martin, M.B., Ch.B., FRCA<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
FACULTY 11
FACULTY<br />
Joseph P. Mathew, M.D.<br />
Associate Professor of Anesthesiology<br />
Andrew F. Meyer, M.D., M.B.A.<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Assistant Clinical Professor of Surgery<br />
(Urology)<br />
Eugene W. Moretti, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
12 FACULTY<br />
Brian J. McCreath, M.B., Ch.B.<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
Gregory A. Michelotti, Ph.D.<br />
Assistant Research Professor of<br />
Anesthesiology<br />
Holly A. Muir, M.D., FRCP(C)<br />
Assistant Professor of Anesthesiology<br />
Associate in the Department of Obstetrics<br />
and Gynecology<br />
Jonathan M. Meliones, M.D., FCCM<br />
Associate Professor in Anesthesiology<br />
Associate Professor of Pediatrics<br />
Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP<br />
Professor of Anesthesiology<br />
Associate Professor of Medicine<br />
John A.C. Murdoch, M.B., Ch.B., B.Sc.<br />
Visiting Associate in the Department of<br />
Anesthesiology
William J. Murray, M.D., Ph.D.<br />
Professor of Anesthesiology<br />
Laura E. Niklason, M.D., Ph.D.<br />
Assistant Professor of Anesthesiology<br />
Assistant Professor of Biomedical<br />
Engineering<br />
Assistant Professor in Surgery<br />
Robert R. Panten, Jr., M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
Mark F. Newman, M.D.<br />
Professor of Anesthesiology<br />
Associate Professor of Medicine<br />
Ronald P. Olson, M.D., CCFP<br />
Assistant Clinical Professor in<br />
Anesthesiology<br />
Assistant Professor of Community and<br />
Family Medicine<br />
Stephen J. Parrillo, M.D.<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Karen C. Nielsen, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
FACULTY<br />
Adeyemi J. Olufolabi, M.B., B.S., FRCA<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Donald H. Penning, M.Sc., M.D.<br />
Associate Professor of Anesthesiology<br />
Assistant Professor in Obstetrics and<br />
Gynecology<br />
FACULTY 13
FACULTY<br />
Claude A. Piantadosi, M.D.<br />
Assistant Professor of Anesthesiology<br />
Professor of Medicine<br />
James D. Reynolds, Ph.D.<br />
Assistant Professor of Anesthesiology<br />
Iain C. Sanderson, B.M., B.Ch., M.A.,<br />
M.Sc., FRCA<br />
Associate in the Department of<br />
Anesthesiology<br />
14 FACULTY<br />
Ziaur Rahman, M.B., B.S.<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Assistant Clinical Professor of Surgery<br />
(Neurosurgery)<br />
Kerri M. Robertson, M.D., FRCP(C)<br />
Associate Clinical Professor of<br />
Anesthesiology<br />
Scott R. Schulman, M.D.<br />
Associate Professor of Anesthesiology<br />
Associate Professor of Pediatrics<br />
J. G. Reves, M.D.<br />
Professor and Chairman of Anesthesiology<br />
Allison K. Ross, M.D.<br />
Assistant Professor of Anesthesiology<br />
John R. Schultz, M.D.<br />
Associate in the Department of<br />
Anesthesiology
Debra A. Schwinn, M.D.<br />
Professor of Anesthesiology<br />
Professor in Surgery<br />
Professor of Pharmacology and Cancer<br />
Biology<br />
Peter Sebestyen, D.V.M.<br />
Associate in Research in Anesthesiology<br />
Thomas F. Slaughter, M.D.<br />
Assistant Professor of Anesthesiology<br />
Dianne L. Scott, M.D.<br />
Associate Clinical Professor of<br />
Anesthesiology<br />
Huaxin Sheng, M.D.<br />
Assistant Research Professor in<br />
Anesthesiology<br />
Jacques Somma, M.D., FRCP(C)<br />
Assistant Professor of Anesthesiology<br />
Mark W. Sebastian, M.D.<br />
Assistant Professor in Anesthesiology<br />
Assistant Professor of Surgery<br />
FACULTY<br />
Sidney A. Simon, Ph.D.<br />
Associate Professor in Anesthesiology<br />
Professor of Neurobiology<br />
Guatam M. Sreeram, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
FACULTY 15
FACULTY<br />
Mark Stafford-Smith, M.D., C.M., FRCP,<br />
DABA<br />
Associate Professor of Anesthesiology<br />
Bryant W. Stolp, M.D., Ph.D.<br />
Assistant Professor of Anesthesiology<br />
Associate in the Department of Cell Biology<br />
Madhav Swaminathan, M.D.<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
16 FACULTY<br />
Timothy O. Stanley, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
Hagir B. Suliman, D.V.M., M.V.Sc., Ph.D.<br />
Assistant Research Professor of<br />
Anesthesiology<br />
Jeffrey M. Taekman, M.D.<br />
Assistant Professor of Anesthesiology<br />
Susan M. Steele, M.D.<br />
Associate Clinical Professor of<br />
Anesthesiology<br />
John T. Sum Ping, M.B., Ch.B., FRCA<br />
Associate Professor of Anesthesiology<br />
Barbara E. Tardiff, M.D., MS, M.Phil.<br />
Assistant Professor of Anesthesiology
Edward D. Thalmann, M.D.<br />
Assistant Clinical Professor in<br />
Anesthesiology<br />
Assistant Clinical Professor of Community<br />
and Family Medicine<br />
Steven N. Vaslef, M.D., Ph.D.<br />
Assistant Professor in Anesthesiology<br />
Assistant Professor of Surgery and<br />
Biomedical Engineering<br />
Dana N. Wiener, M.D.<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Bruno J. Urban, M.D., Dr.med.<br />
Professor of Anesthesiology<br />
Associate Professor in the Department of<br />
Psychiatry and Behavioral Sciences<br />
Assistant Professor of Surgery (Neurosurgery)<br />
David S. Warner, M.D.<br />
Professor of Anesthesiology<br />
Professor in Neurobiology<br />
Professor of Surgery<br />
David R. Wright, B.M., FRCA<br />
Visiting Associate in the Department of<br />
Anesthesiology<br />
Richard D. Vann, Ph.D.<br />
Assistant Research Professor of<br />
Anesthesiology<br />
FACULTY<br />
Ian J. Welsby, M.B.B.S., BSc., FRCA<br />
Associate in the Department of<br />
Anesthesiology<br />
Bo Wu, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
FACULTY 17
FACULTY<br />
Christopher C. Young, M.D., FCCM<br />
Assistant Professor of Anesthesiology<br />
Assistant Professor of Surgery<br />
McGovern-Davison Children’s Health Center<br />
18 FACULTY<br />
NOT PICTURED<br />
George N. Djaiani, M.D., FRCA<br />
Visiting Associate in the Department<br />
of Anesthesiology<br />
Adeyemi J. Olufolabi, M.B., B.S., FRCA and<br />
J. G. Reves, M.D.
<strong>DEPARTMENT</strong> <strong>OF</strong> <strong>ANESTHESIOLOGY</strong>, DUKE UNIVERSITY<br />
MEDICAL CENTER CHAIRS<br />
Sara J. Dent, M.D.<br />
Professor and Chair of Anesthesia, Duke Hospital<br />
1968-1971<br />
W. David Watkins, M.D., Ph.D.<br />
Professor and Chair, Department of Anesthesiology<br />
1983-1990<br />
Merel H. Harmel, M.D.<br />
Professor and Chair, Department of Anesthesiology<br />
1971-1983<br />
J. G. Reves, M.D.<br />
Professor and Interim Chair, Department of Anesthesiology<br />
1990-1991<br />
Professor and Chair, Department of Anesthesiology<br />
1991-2001<br />
19
20 FACULTY<br />
DUKE UNIVERSITY HEALTH SYSTEM<br />
AFFILIATED MEDICAL FACULTY<br />
Richard L. Jacobs II, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
Person County Memorial Hospital<br />
Roxboro, North Carolina<br />
Person County Memorial Hospital<br />
Roxboro, North Carolina
David S. Bacon, M.D.<br />
Consulting Associate in the Department of<br />
Anesthesiology<br />
Durham Regional Hospital<br />
Durham, North Carolina<br />
Randall L. Carpenter, M.D.<br />
Adjunct Associate Professor of<br />
Anesthesiology<br />
ASTRA USA, Inc.<br />
Westborough, Massachusetts<br />
James M. Chimiak, M.D.<br />
Consulting Associate in the Department of<br />
Anesthesiology<br />
Naval Aerospace, an Operational Institute<br />
Pensacola, Florida<br />
AFFILIATED FACULTY<br />
John D. Buckwalter, M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Durham Regional Hospital<br />
Durham, North Carolina<br />
James L. Caruso, M.D.<br />
Consulting Associate in the Department of<br />
Anesthesiology<br />
U.S. Naval Hospital<br />
Pensacola, Florida<br />
John J. Freiberger, M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Chapel Hill, North Carolina<br />
Frederick J. Carpenter, Jr., M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Durham Regional Hospital<br />
Durham, North Carolina<br />
Kwen-Jen Chang, Ph.D.<br />
Adjunct Professor in Anesthesiology<br />
Delta Pharmaceutical, Inc.<br />
Research Triangle Park, North Carolina<br />
Wayne A. Gerth, Ph.D.<br />
US Navy Experimental Diving Unit<br />
Panama City, Florida<br />
FACULTY 21
AFFILIATED FACULTY<br />
Scott T. Howell, MS, M.D.<br />
Assisting Consultant Professor of<br />
Anesthesiology<br />
Scranton, Pennsylvania<br />
Fritz F. Klein, Ph.D.<br />
Adjunct Assistant Professor of<br />
Anesthesiology<br />
Duke University Medical Center<br />
Durham, North Carolina<br />
Gerald A. Maccioli, M.D., FCCM<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Raleigh Community Hospital<br />
Raleigh, North Carolina<br />
22 AFFILIATED FACULTY<br />
James R. Jacobs, M.D., Ph.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Carolinas Medical Center<br />
Charlotte, North Carolina<br />
Judith O. Margolis, M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
North Carolina Eye and Ear Institute<br />
Durham, North Carolina<br />
Edward B. McKenzie, Jr., M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Durham Regional Hospital<br />
Durham, North Carolina<br />
Moyra E. Kileff, M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Durham Regional Hospital<br />
Durham, North Carolina<br />
Mohammad Maroof, M.B., B.S., FFARCSI<br />
Adjunct Assistant Professor of<br />
Anesthesiology<br />
University of North Carolina, Chapel Hill<br />
Chapel Hill, North Carolina<br />
C. P. Reddy Parvata, M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Durham Regional Hospital<br />
Durham, North Carolina
Gary L. Pellom, M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Durham Regional Hospital<br />
Durham, North Carolina<br />
Thomas E. Stanley, III, M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Memorial Mission Hospital<br />
Asheville, North Carolina<br />
Timothy J. H. Webb, M.D., Ph.D.<br />
Adjunct Assistant Professor of<br />
Anesthesiology<br />
University of Cincinnati Medical Center<br />
Cincinnati, Ohio<br />
Edward G. Sanders, M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Durham Regional Hospital<br />
Durham, North Carolina<br />
Cathy W. Thomas, M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Durham Regional Hospital<br />
Durham, North Carolina<br />
AFFILIATED FACULTY<br />
Paul V. Stankus, M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Durham Regional Hospital<br />
Durham, North Carolina<br />
Rolf B. Wallin, M.D.<br />
Assistant Consulting Professor of<br />
Anesthesiology<br />
Cape Fear Valley Medical Center<br />
Fayetteville, North Carolina<br />
AFFILIATED FACULTY 23
Edmond C. Bloch, M.B., Ch.B.<br />
Associate Professor Emeritus of<br />
Anesthesiology<br />
Duke University Medical Center<br />
Durham, North Carolina<br />
24 SCHOLARS<br />
SCHOLARS<br />
David A. Davis, M.D.<br />
Professor Emeritus of Anesthesiology<br />
Duke University Medical Center<br />
Durham, North Carolina<br />
Elisabeth J. Fox, M.B.<br />
Associate Clinical Professor Emeritus of<br />
Anesthesiology<br />
Duke University Medical Center<br />
Durham, North Carolina<br />
Merel H. Harmel, M.D.<br />
Professor Emeritus of Anesthesiology<br />
Duke University Medical Center<br />
Durham, North Carolina<br />
Joannes H. Karis, M.D.<br />
Professor Emeritus of Anesthesiology<br />
Duke University Medical Center<br />
Durham, North Carolina
Lloyd F. Redick, M.D.<br />
Professor Emeritus of Anesthesiology<br />
Duke University Medical Center<br />
Durham, North Carolina<br />
Stanley W. Weitzner, M.D.<br />
Professor Emeritus of Anesthesiology<br />
Duke University Medical Center<br />
Durham, North Carolina<br />
Kenneth Sugioka, M.D.<br />
Professor Emeritus of Anesthesiology<br />
Duke University Medical Center<br />
Durham, North Carolina<br />
Ingeborg H. Talton, M.D.<br />
Associate Professor Emeritus of<br />
Anesthesiology<br />
Duke University Medical Center<br />
Durham, North Carolina<br />
SCHOLARS<br />
SCHOLARS 25
INTERNS<br />
Atilio Barbeito, M.D.<br />
Abigail H. Melnick, M.D<br />
26 RESIDENTS<br />
RESIDENTS<br />
Aaron A. Ali, M.D.<br />
Timothy M. Grant, M.D.<br />
John V. Morreale, M.D.<br />
Genevieve S. Ali, M.D.<br />
Christopher G. Gunn, M.D.<br />
Paul R. Shook, M.D.
CA-1<br />
Daniel D. DeMeyts, M.D.<br />
Daphne M. Jones, M.D.<br />
Shazia M. Choudry, M.D.<br />
Ellen M. Flanagan, M.D.<br />
Patricia D. Macha, M.D.<br />
William B. Corkey, M.D.<br />
Richard C. Griggs, M.D.<br />
Eric M. Miller, M.D.<br />
RESIDENTS<br />
RESIDENTS 27
RESIDENTS<br />
John D. Mitchell, M.D.<br />
CA-2<br />
Keith D. Hanson, M.D.<br />
28 RESIDENTS<br />
Trenton L. Pierce, M.D.<br />
Peter S. Baek, M.D.<br />
Scott E. Helsley, M.D., Ph.D.<br />
Adam J. Schow, M.D.<br />
Anthony J. Colantonio, M.D.<br />
Russel L. Jacobe, M.D.
Laura J. Kihlstrom, M.D.<br />
Matthew T. Taylor, M.D.<br />
Residents at ASA, San Francisco, CA.<br />
William P. Norcross, M.D.<br />
Adrienne J. Wells, M.D.<br />
RESIDENTS<br />
Cathleen L. Peterson-Layne, M.D., Ph.D.<br />
RESIDENTS 29
RESIDENTS<br />
CA-3<br />
Tarsha V. Garvin, M.D.<br />
Marcella J. Lanzinger, M.D.<br />
30 RESIDENTS<br />
Jason R. Burke, M.D.<br />
Jon-Paul Harmer, M.D.<br />
Graham G. Lashley, M.D.<br />
Peter DeBalli, III, M.D.<br />
Kurt J. Knauth, M.D.<br />
James R. McCurdy, M.D.
David B. Schinderle, M.D.<br />
FELLOWS<br />
Mihai V. Podgoreanu, M.D.<br />
Cardiothoracic<br />
Holly A. Williams-Davis, M.D.<br />
Maher J. Albahrani, M.B., Ch.B.<br />
Cardiothoracic<br />
Lian K. Ti, M.B., B.S.<br />
Cardiothoracic<br />
Julie Z. Woosley, M.D.<br />
Adil S. Kamal, M.D.<br />
Pain Management<br />
Jay McCurdy, M.D.<br />
RESIDENTS<br />
RESIDENTS 31
Paula D. Alford, B.A., CRNA<br />
Beatrice I. Baldwin, CRNA<br />
Cynthia R. Black, CRNA<br />
32 CRNA<br />
CRNA<br />
Patricia M. Allushuski, CRNA, MSN<br />
Maurice L. Begin, CRNA<br />
Carolyn E. Burgess, CRNA, Ph.D.<br />
Carleen E. Bagnall, BSN, CRNA<br />
Sandra L. Bennett, CRNA<br />
Eleanor W. Carter, CRNA
Debra S. Clements, CRNA,MSN<br />
Jeanne M. Crabtree, CRNA<br />
Evelyn M. DeRoche, CRNA<br />
Leslie A. Cline, CRNA, MSN<br />
Narda D. Croughwell, CRNA<br />
Thomas E. Diamond, CRNA<br />
Ann M. Connell, CRNA, MSN<br />
E. Susan Crumpler, CRNA<br />
Terry W. English, CRNA, MS<br />
CRNA<br />
CRNA 33
CRNA<br />
Deborah J. Ferrero-Conover, CRNA, MS,<br />
MSN<br />
Julie T. Fritz, CRNA, MSN<br />
34 CRNA<br />
Fred Fesel, CRNA<br />
Daniel J. Geniton, CRNA, MSN<br />
Russel T. Giesler, BSN, CRNA<br />
Robert E. Foy, CRNA<br />
Russell T. Giesler, BSN, CRNA
David H. Gleason, CRNA, BHS<br />
Mack E. Haddock, CRNA<br />
Shelley T. Hilliard, BSN, CRNA<br />
Janet E. Goral, BSN, CRNA<br />
Janet M. Hall, CRNA<br />
Donalie P. Guin, CRNA<br />
Pegge L. Hall, CRNA, MSN<br />
Ronald C. Iacone, CRNA Sarah O. Jinwright, CRNA<br />
CRNA<br />
CRNA 35
CRNA<br />
Carolyn C. Knoop, CRNA, MSN<br />
David R. Marion, CRNA<br />
Meredith L. Muncy, CRNA, MHS<br />
36 CRNA<br />
David D. Lee, CRNA, BSN<br />
Donald R. Moede, CRNA, MSN<br />
Mary K. Murphy, CRNA<br />
Janet L. Margeson, CRNA<br />
Gayle P. Moyer, CRNA, BS, BSN, MS<br />
Flora C. O’Brien, CRNA
John F. Pierce, CRNA Dale F. Potter, CRNA MaryAnn L. Romero, CRNA<br />
David B. Salzer, CRNA<br />
Louis Semrad, CRNA<br />
Lisa J. Schwetschenau, CRNA, MNA<br />
Marsha A. Seaton, CRNA<br />
Bruno J. Urban, M.D., Dr.Med. and Francis R. Smith, CRNA<br />
CRNA<br />
CRNA 37
CRNA<br />
Kena B. Sigman, CRNA, MSN<br />
Tede E. Spahn, CRNA<br />
38 CRNA<br />
Janet E. Goral, CRNA<br />
Grace A. Simpson, CRNA, MSN<br />
G. Lynn Stockbridge, CRNA<br />
Craig E. Shanewise, CRNA, MNA<br />
Francis R. Smith, CRNA<br />
James M. Temo, CRNA, MSN, MBA
Donald K. Thomas, CRNA Henry J. Walker, CRNA, M.B.A., MS P. Elaine Wallace, CRNA<br />
Helen Walston, CRNA Yolanda G. Wright, CRNA Stephen A. Ziegler, CRNA<br />
E. Susan Crumpler, CRNA Deborah J. Ferrero-Conover, CRNA, MSW<br />
CRNA<br />
CRNA 39
40<br />
DUKE ANESTHESIA FACULTY<br />
WHO BECAME <strong>ANESTHESIOLOGY</strong> CHAIRS<br />
1968<br />
SARA J. DENT, M.D.<br />
Duke Hospital<br />
Durham, North Carolina<br />
1981<br />
PHILIP R. BROMAGE, M.B., B.S., FRCA<br />
University of Colorado<br />
Health Sciences Center<br />
Denver, Colorado<br />
1983<br />
JOHN N. MILLER, M.D.<br />
University of South Alabama<br />
Mobile,Alabama<br />
1989<br />
ENRICO M. CAMPORESI, M.D.<br />
State University of New York<br />
Health Science Center at Syracuse<br />
Syracuse, New York<br />
1991<br />
JOSEPH GERALD REVES, M.D.<br />
Duke University Medical Center<br />
Durham, North Carolina<br />
1996<br />
WILLIAM J. GREELEY, M.B.A., M.D.<br />
The Children’s Hospital<br />
of Philadelphia<br />
Philadelphia, Pennsylvania<br />
1999<br />
PETER S.A. GLASS, M.B., CH.B., FFA(SA)<br />
State University of New York<br />
Stony Brook, New York<br />
2000<br />
DONALD H. PENNING, M.SC., M.D.<br />
University of Toronto<br />
Sunnybrook and Women’s Health Sciences Center<br />
Toronto, Canada<br />
1971<br />
C. RONALD STEPHENS, M.D.<br />
Washington University<br />
School of Medicine<br />
St. Louis, Missouri<br />
1983<br />
LENNART FAGRAEUS, M.D., PH.D.<br />
University of Oklahoma<br />
College of Medicine<br />
Oklahoma City, Oklahoma<br />
1987<br />
LENNART FAGRAEUS, M.D., PH.D.<br />
Christiana Care Health Services<br />
Newark, Delaware<br />
1989<br />
PHILIP D. LUMB, M.B., B.S.<br />
Albany Medical College<br />
Albany, New York<br />
1994<br />
DAVID H. CHESTNUT, M.D.<br />
University of Alabama at Birmingham<br />
Birmingham,Alabama<br />
1998<br />
PHILIP D. LUMB, M.B., B.S.<br />
Penn State University<br />
College of Medicine<br />
Hershey, Pennsylvania<br />
2000<br />
CARLOS U. ARANCIBIA, M.D.<br />
Virginia Commonwealth University<br />
Health System<br />
Richmond,Virginia
AMBULATORY<br />
<strong>ANESTHESIOLOGY</strong><br />
Susan M. Steele, M.D.<br />
Chief, Division of Ambulatory<br />
Anesthesia<br />
Medical Director of the<br />
Ambulatory Surgery Center<br />
Director of Ambulatory and<br />
Regional Anesthesia<br />
Associate Clinical Professor of<br />
Anesthesiology<br />
MEMBERS<br />
Roy A. Greengrass, M.D., FRCP(C)<br />
Stephen M. Klein, M.D.<br />
Karen C. Nielsen, M.D.<br />
CRNA COORDINATOR FOR<br />
AMBULATORY ANESTHESIA<br />
Paula D. Alford, CRNA<br />
CRNA STAFF<br />
Narda D. Croughwell, CRNA<br />
Fred Fesel, CRNA<br />
Robert E. Foy, CRNA<br />
Ronald C. Iacone, CRNA<br />
Carolyn C. Knoop, CRNA, MSN<br />
David D. Lee, CRNA<br />
Mary K. Murphy, CRNA<br />
Flora C. O’Brien, CRNA<br />
Frances R. Smith, CRNA<br />
CLINICAL ACTIVITIES<br />
RESEARCH NURSE<br />
Aliki H. Martin, RN<br />
SUPPORT STAFF:<br />
LuAnne C. Latta, Staff Assistant<br />
Kathy K. Clifton, Administrative<br />
Secretary<br />
Linda B. Rocker, Data Entry<br />
The Division of Ambulatory Anesthesia<br />
was established on September 1, 1997<br />
and assumed daily operations at the<br />
Ambulatory Surgery Center in the North<br />
Pavilion in May 1998.<br />
Clinical Service<br />
The Division of Ambulatory Anesthesia<br />
is responsible for the delivery of all<br />
anesthesia services at Ambulatory<br />
Surgery Center (ASC) which opened<br />
to patients on July 13, 1998 in the North<br />
Pavilion. The center has nine operating<br />
rooms with seven presently functional.<br />
From July 13, 1998 through December<br />
2000, our Division provided anesthesia<br />
coverage to 12,620 patients and postoperative<br />
acute pain management services<br />
to 2203 overnight patients in our<br />
eight bed 23-hour Recovery Care Center<br />
(RCC).<br />
The Division of Ambulatory Anesthesia<br />
offers availability of a wide variety<br />
of novel regional anesthesia techniques.<br />
These ambulatory regional anesthesia<br />
techniques greatly enhance the options<br />
available to patients for both their intraoperative<br />
experience and for the management<br />
of post-operative pain.<br />
Approximately 56% of our patients<br />
had surgery under regional anesthesia<br />
or regional anesthesia/combined technique<br />
(7074 of 12,620 patients). See<br />
Table 1 for the description of the wide<br />
variety of Regional Anesthesia techniques<br />
done at the ASC. Most notably is<br />
our emphasis on the predominant use<br />
of non-central neuraxial regional techniques<br />
for both extremity and truncal<br />
surgery when possible. The peripheral<br />
nerve regional anesthesia techniques<br />
allow the most flexibility and facilitate<br />
early, stress free recovery for our ambulatory<br />
surgery patients. The excellent<br />
postoperative analgesia afforded by<br />
the use of single shot and continuous<br />
catheter peripheral nerve blockade<br />
is unparalleled. 89.2% of the patient<br />
population at our Center rate their<br />
experience with anesthesia and pain<br />
management as very satisfied 24 hours<br />
postoperatively and 89.1% 7 days postoperatively.<br />
See Table 2 for the extraordinary<br />
patient satisfaction ratings.<br />
The Duke ASC successfully implemented<br />
the Saturn Anesthesia Information<br />
System on September 13, 1999.<br />
With 28 units in our network covering<br />
the entire peri-operative event, it is one<br />
of the largest and most ambitious installations<br />
of its type in the world. The<br />
ultimate goal is to create a paperless<br />
peri-operative record.<br />
Education<br />
The Division of Ambulatory Anesthesia<br />
provides one month rotations at the ASC<br />
for CA3 and CA2 Residents. Our Division<br />
offers fellowship in Regional and<br />
Ambulatory Anesthesia. The fellowship<br />
involves peri-operative clinical patient<br />
care: Preoperative Patient Evaluation,<br />
Operative Ambulatory Regional and<br />
General Anesthesia and Acute Pain<br />
Management in the RCC. Upon completion<br />
of their fellowship training our<br />
fellows may expect to have a broad<br />
expertise in regional and ambulatory<br />
anesthesia.<br />
Our Division hosts a traineeship in<br />
Regional Anesthesia that has been very<br />
successful in establishing Duke Medical<br />
Center as a forerunner in this science.<br />
This training involves a one to two-day<br />
training opportunity in the performance<br />
of regional anesthesia techniques. This<br />
training includes OR observation and<br />
individually designed workshops for<br />
practicing board certified physicians.<br />
The response to this educational opportunity<br />
has been excellent and identifies<br />
the division as being on the cutting edge<br />
in offering didactic opportunities in<br />
regional anesthesia. This training initiative<br />
has expanded in conjunction with<br />
an AstraZeneca unrestricted educational<br />
grant. The Division of Ambulatory<br />
CLINICAL ACTIVITIES 41
CLINICAL ACTIVITIES<br />
Infraclavicular 15<br />
Caudal 21<br />
Wrist 21<br />
Artificial cervical plexus 24<br />
Epidural 62<br />
IV regional 85<br />
Ankle 240<br />
Supraclavicular 387<br />
Axillary 492<br />
Fem oral 536<br />
Continuous catheter 807<br />
Spinal 899<br />
Anesthesia has been instrumental in our<br />
center being distinguished as a “Center<br />
of Excellence” in Regional Anesthesia.<br />
Our Center is one of five centers across<br />
the nation with this distinction.<br />
As the Ambulatory Surgery Center<br />
continues its recognition as a leader<br />
in regional anesthesia techniques, the<br />
Ambulatory Anesthesia division is frequented<br />
by international physicians who<br />
come here to study the techniques of<br />
regional anesthesia as well as the clinical<br />
operations of an ambulatory surgical<br />
center. Of special interest to our international<br />
guests is the outcomes database.<br />
Educational exchanges have<br />
been experienced this year with<br />
Jamaica, Australia and Great Britain.<br />
This cultural as well as educational<br />
exchange has provided an exciting<br />
opportunity for our division.<br />
The faculty of the Division of<br />
Ambulatory Anesthesia working collaboratively<br />
have published in the year<br />
2000: Interscalene Brachial Plexus<br />
Block With a Continuous Catheter<br />
Insertion System and a Disposable<br />
Infusion Pump. Anesth Analg 2000;<br />
Thromboelastography as a Perioperative<br />
Measure Of Anticoagulation Resulting<br />
From Low Molecular Weight Heparin: A<br />
Comparison with Anti-Xa Concentrations.<br />
42 CLINICAL ACTIVITIES<br />
TABLE 1<br />
Regional Techniques<br />
Ambulatory Surgery Center<br />
July 13, 1998–December 31, 2000<br />
Lumbar plexus 982<br />
Paravertebral 1145<br />
Interscalene 1567<br />
Sciatic 1656<br />
500 1000 1500 2000<br />
Anesth Analg 2000; Thoracic Paravertebral<br />
Block for Breast Surgery. Anesth<br />
Analg 2000; Thoracic Paravertebral<br />
Block for Breast Surgery. Anesth Analg<br />
2000; Continuous Interscalene Brachial<br />
Plexus Blockade at Home After Major<br />
Shoulder Surgery (abstract) Anesthesiology<br />
2000; Continuous Peripheral<br />
Nerve Blocks For Ambulatory Surgery<br />
(abstract). Anesthesiology 2000;<br />
Continuous Ambulatory Brachial Plexus<br />
Block with a New Catheter Insertion<br />
System and a Disposable Infusions<br />
Pump (abstract). Anesthesiology 2000;<br />
Paravertebral Somatic Nerve Block<br />
Versus Local Infiltration for Outpatient<br />
Inguinal Herniorrhaphy (abstract).<br />
Anesthesiology 2000.<br />
Research<br />
Marcella J. Lanzinger, M.D., and Karen C. Nielsen, M.D.<br />
A major project in the Division of<br />
Ambulatory Anesthesia continues to be<br />
the Outcomes Database for Ambulatory<br />
Anesthesia. This database has consistently<br />
provided us with an excellent<br />
cross section of information that clearly<br />
elucidates our accomplishments and<br />
achievements at the Ambulatory Surgery<br />
Center as evidenced in the patient satisfaction<br />
statistics quoted earlier. We<br />
know from this data that over 96.9%<br />
of our patients would choose the same<br />
anesthesia again 24 hours postoperatively<br />
and 96.3% 7 days postoperatively.<br />
Our database provides information that<br />
enables the constant tracking of our<br />
performance and patient satisfaction.<br />
We have added technology to enhance<br />
and improve the collection of our data<br />
as well as achieve its integration with<br />
the Saturn Information Systems. This<br />
improved technology will improve the<br />
integrity of the data as well as save time<br />
in processing the information. This<br />
database is also an integral part of the<br />
educational opportunities within the<br />
division as cited above.
Goals for the Future<br />
The Ambulatory Surgery Center is in<br />
the third year of operation and we continue<br />
to have exciting goals for the<br />
future. Our statistics continue to reveal<br />
that we are achieving excellent patient<br />
satisfaction and that remains our first<br />
and foremost goal.<br />
We are already delivering regional<br />
anesthesia to nearly 60% of our patient<br />
population at the Ambulatory Surgery<br />
Center. It is our goal to continue to offer<br />
a wide variety of anesthesia options<br />
to our patients with special focus on<br />
Regional Anesthesia. Our status as a<br />
Center of Excellence in regional and<br />
ambulatory techniques has allowed us<br />
to offer training to fellow anesthesiologists<br />
throughout the country. We will<br />
continue to develop the Division of<br />
Ambulatory Anesthesia at Duke as a<br />
guiding force in education and training<br />
for Regional Anesthesia both nationally<br />
and internationally.<br />
We continue to integrate our outcomes<br />
data with patient satisfaction<br />
and are expanding it to look at the cost<br />
of care delivery. As we broaden and<br />
hone the outcomes database we are<br />
establishing a model in the field of outcomes<br />
for ambulatory surgical centers.<br />
Our improved technologic enhancement<br />
to our database systems will improve the<br />
deliverance of vital information regarding<br />
ambulatory surgery and patient satisfaction.<br />
The Division of Ambulatory Anesthesia<br />
is working to develop a protocol<br />
for home catheter infusion system for<br />
the management of post-operative pain.<br />
Drs. Susan Steele and Karen Nielsen<br />
have worked collaboratively with this<br />
protocol and have visited in patient’s<br />
home after surgery allowing first hand<br />
investigation of the efficacy of home<br />
catheter infusion. The results have been<br />
overwhelming. The patients who have<br />
participated in this protocol have been<br />
extremely satisfied with their pain con-<br />
00 100%<br />
80 80%<br />
60 60%<br />
40 40%<br />
20 20%<br />
0% 0<br />
Very<br />
Satisfied<br />
trol and with the convenience of managing<br />
their pain at home.<br />
The Ambulatory Surgery Center<br />
is working with a team of surgeons,<br />
administrators and other key personnel<br />
to develop a Breast Care Center of<br />
Excellence at our facility. This would<br />
greatly enhance patient convenience<br />
Ambulatory Surgery Center<br />
CLINICAL ACTIVITIES<br />
TABLE 2<br />
Patient Satisfaction with Anesthesia Techniques<br />
Ambulatory Surgery Center<br />
July 13, 1998–July 13, 2000<br />
Somewhat<br />
Satisfied<br />
Neutral Somewhat<br />
Dissatisfied<br />
Very<br />
Dissatisfied<br />
24 Hours<br />
7 Days<br />
and satisfaction in allowing diagnostic<br />
procedures of the breast as well as surgical<br />
procedures to be accomplished<br />
in one location. This would be a great<br />
improvement to our present protocol<br />
for breast procedures. This is certainly<br />
one of the most promising initiatives<br />
on our horizon. We remain dedicated<br />
to providing the highest level of patient<br />
satisfaction of any ambulatory surgery<br />
in the nation.<br />
Our division is initiating an innovative<br />
pilot study on patients undergoing<br />
total knee arthroplasty. These procedures<br />
will be performed under continuous<br />
peripheral nerve blocks on an ambulatory<br />
basis. Patients will be discharge<br />
from our 23 hour recovery care unit to<br />
a rehabilitation unit. Continuous peripheral<br />
nerve blockade will be used during<br />
the first 72 hours allowing excellent<br />
postoperative analgesia, aggressive<br />
physical therapy, and early recovery.<br />
CLINICAL ACTIVITIES 43
CLINICAL ACTIVITIES<br />
CARDIOTHORACIC<br />
ANESTHESIA AND<br />
CRITICAL CARE<br />
MEDICINE<br />
Mark F. Newman, M.D.<br />
Chief, Division of Cardiothoracic<br />
Anesthesiology and Critical<br />
Care Medicine<br />
Director, Neurologic Outcome<br />
Research Group<br />
Professor and Vice-Chair of<br />
Anesthesiology<br />
Associate Professor in Medicine<br />
MEMBERS<br />
John V. Booth, M.B., Ch.B., FRCA<br />
Fiona M. Clements, M.D.<br />
Norbert P. deBruijn, M.D.<br />
Katherine P. Grichnik, M.D., M.S.<br />
Hilary P. Grocott, M.D., FRCP(C)<br />
Steven E. Hill, M.D.<br />
Andrew K. Hilton, M.B., B.S., FANZCA<br />
Joseph P. Mathew, M.D.<br />
J.G. Reves, M.D.<br />
Debra A. Schwinn, M.D.<br />
Mark Stafford Smith, M.D., C.M., FRCP,<br />
DABA<br />
Ian J. Welsby, M.B., B.S., B.Sc., FRCA<br />
FELLOWS<br />
Maher J. Albhrani, M.B., Ch.B.<br />
Daniel T. Bainbridge, M.D.<br />
George N. Djaiani, M.D., DA, DEAA,<br />
FRCA<br />
John G. Ellingham, M.D.<br />
44 CLINICAL ACTIVITIES<br />
Maribel G. Gamoso, M.D.<br />
Alina M. Grigore, M.D.<br />
G. Burkhard Mackensen, M.D.<br />
Brian J. McCreath, M.B., Ch.B.<br />
Madhav Swaminathan, M.B.,B.S.<br />
Miahi V. Podgoreau, M.D.<br />
Ajeet Sharma, M.D.<br />
Timothy O. Stanley, M.D.<br />
Lian K. Ti, M.B., B.S.<br />
Bo Wu, M.D.<br />
CRNA<br />
Beatrice I. Baldwin, CRNA<br />
RESEARCH COORDINATORS:<br />
Aimee M. Butler, B.S.<br />
Wayne M. Cohen, RN, M.B.A.<br />
Kelli L. Cozart, RN<br />
Bonita L. Funk, RN<br />
Vincent E. Gaver, BA<br />
Malissa J. Harris, RN<br />
Jason F. Hawkins, B.S.N<br />
Jerry L. Kirchner, B.S.<br />
RESEARCH TECHNICIANS<br />
Chonna S. Campbell<br />
Amanda S. Cheek<br />
Mary H. Currier<br />
E. D. Derilus<br />
Tanya R. Kagarise<br />
Satarah K. Latiker<br />
Erich M. Lawff<br />
Kenya S. Lee<br />
Scott E. Lee<br />
Colin E. Macdonnell<br />
Terri C. Moore<br />
Beverly J. Perry<br />
Melanie K. Tirronen<br />
Erin E. Ward<br />
Jonathan E. Williams<br />
SUPPORT STAFF<br />
Cheryle E. Davis<br />
Marilyn L. Helms<br />
Teri-Lynne Kulik<br />
Brenda S. Mickley<br />
LaTanya M. Rhames<br />
Nineteen ninety-nine presented an outstanding<br />
opportunity to the cardiothoracic<br />
division, with additional continued<br />
increases in the cardiac and thoracic<br />
procedures during the year. This<br />
opportunity further strengthened the<br />
group's productivity and research<br />
opportunities. The introduction of minimally<br />
invasive techniques and “OP-<br />
CAB” further defined our course. In<br />
addition, we have expanded to provide<br />
critical care in the Acute Cardiac Unit<br />
as an additional resource in the perioperative<br />
care of patients.<br />
Clinical Activity<br />
The practice of cardiothoracic anesthesia<br />
has broadened markedly at Duke<br />
and across the nation. The trend continues<br />
toward less invasive mechanism<br />
to treat cardiothoracic disease including<br />
video-assisted thoracoscopic procedures,<br />
as well as midCAB (coronary<br />
artery bypass) and OPCAB (off bypass<br />
coronary artery bypass) beating heart<br />
revascularization procedures. The<br />
Cardiothoracic Division led an initiative<br />
for the development of an interventional<br />
suite in the operating room to allow<br />
combined cardiology, cardiac surgery<br />
and vascular surgery procedures to be<br />
performed in a cost-effective multidisciplinary<br />
manner. The Division is at the<br />
forefront of evaluating these minimally<br />
invasive technologies, and how they<br />
affect both short and long-term outcome.<br />
It remains inherently important<br />
due to the risk of reoperation that our<br />
patients receive the best therapy for<br />
long-term survival and quality of life.<br />
The Cardiothoracic Division is a<br />
world leader in the measurement and<br />
understanding of perioperative complications<br />
in many organ systems. We are<br />
now using this evidence to further<br />
improve the safety for our patients and<br />
protect their long-term quality of life.<br />
Research<br />
Duke Heart Center Division of<br />
Cardiothoracic Anesthesia is the top<br />
cardiac anesthesia research division in
the country. The division added two<br />
active NIH grants during the year, for a<br />
combined total of 8 NIH grants within<br />
the division. The research efforts of the<br />
division are supported by our entire faculty<br />
and eight full-time research coordinators<br />
Aimee Butler, Wayne Cohen,<br />
Kelli Cozart, Bonnie Funk, Vince Gaver,<br />
Malissa Harris, Jason Hawkins and Jerry<br />
Kirchner. Additionally, research technicians<br />
Chonna Campbell, Amanda<br />
Cheek, Mary Currier, E. D. Derilus,<br />
Tanya Kagarise, Satarah (Torie) Latiker,<br />
Erich Lauff, Kenya Lee, Scott Lee, Colin<br />
Macdonnell, Terri Moore, Beverly Perry,<br />
Melanie Tirronen, Erin Ward, and<br />
Jonathan Williams have significantly<br />
extended the capabilities of divisional<br />
research.<br />
Clinical Research<br />
The Neurologic Outcome Research<br />
Group added one National Institutes of<br />
Health grant, for a total of 5 NIH grants<br />
supporting ongoing work as well as<br />
receiving the first American Heart<br />
Association Roundtable grants awarded<br />
at Duke. Under the direction of Drs.<br />
Mark Newman, Jerry Reves, and Jim<br />
Blumenthal, with the assistance of all<br />
cardiac division members, the division<br />
is continuing to investigate neurologic<br />
and neuropsychologic outcome after<br />
cardiac surgery, as well as interventions<br />
to improve these perioperative complications.<br />
The group recently published<br />
studies in the New England Journal of<br />
Medicine and Stroke documenting the<br />
long-term impact of perioperative cognitive<br />
decline on long-term cognitive<br />
function. This is a first hopeful step<br />
in prevention or treatment of these<br />
untoward events. The group has also<br />
continued its investigation of the association<br />
of Apolipoprotein ε4 and cognitive<br />
dysfunction and stroke after cardiac<br />
surgery. This research has led to an<br />
important collaboration with the Department<br />
of Neurology to further assess<br />
a patient's genetic predisposition to<br />
neuronal injury or potential recovery<br />
from neuronal injury.<br />
In conjunction with the Department<br />
of Neurology and Duke Clinical<br />
Research Institute, the newest focus<br />
of the neurologic outcomes research<br />
group is the development of the Multicenter<br />
"Perioperative Organ Protection<br />
Consortium." This is a collection of 25<br />
Academic Sites in the United States and<br />
Canada. The group is submitting two<br />
multicenter interventional NIH grants<br />
in early 2000 evaluating the impact<br />
of clinical practice on neurocognitive<br />
outcome.<br />
Laboratory and<br />
Translational Research<br />
The cardiac anesthesiology division has<br />
spent considerable resources, time, and<br />
energy over the last 5-10 years developing<br />
physician scientists and basic<br />
researchers in areas related to cardiovascular<br />
medicine. Examples of individuals<br />
include Debra Schwinn, M.D.,<br />
Hilary Grocott, M.D., FRCP(C) and<br />
Madan Kwatra, Ph.D. We are now<br />
pleased to report that basic science<br />
projects originating from each of these<br />
investigator's laboratories have resulted<br />
in publications in major scientific journals<br />
and national peer reviewed funding<br />
(NIH, FAER, AHA).<br />
The Molecular Pharmacology<br />
Laboratory, under the direction of Dr.<br />
Debra Schwinn has continued its investigation<br />
of adrenergic receptors, with an<br />
additional NIH RO1 grant awarded this<br />
year. In addition, translational research<br />
has also begun, with investigators bridging<br />
clinical and basic science areas<br />
with new hypothesis-driven research<br />
projects designed to elucidate mechanisms<br />
underlying acute myocardial<br />
beta-adrenergic receptor desensitization,<br />
G protein-coupling in human<br />
heart, and mechanisms underlying<br />
brain injury during cardiopulmonary<br />
bypass.<br />
Dr. Debra Schwinn initiated a NIH<br />
sabbatical in January of 2000 to gather<br />
additional expertise into genetic and<br />
genetic translational research. Our goal<br />
is to develop a perioperative outcome<br />
CLINICAL ACTIVITIES<br />
and genetics database that will be a<br />
resource for the entire world.<br />
A new laboratory initiative was<br />
begun in 1999 in the Cardiothoracic<br />
Anesthesia division. A laboratory<br />
focused on the pathophysiology and<br />
adverse outcomes (particularly neurologic)<br />
after cardiopulmonary bypass<br />
(CPB) was established under the direction<br />
of Dr. Hilary Grocott. This laboratory,<br />
The Anesthesiology Cardiopulmonary<br />
Bypass Laboratory, used a pig CPB<br />
model to investigate intermediate cerebral<br />
outcomes (glial and neuronal<br />
derived proteins released into the CSF<br />
and serum following brain injury) after<br />
CPB. In order to make the most of a relatively<br />
expensive animal preparation as<br />
well as to capitalize on other expertise<br />
in the division and department, the<br />
model was also used to examine issues<br />
related to myocardial (-adrenergic<br />
desensitization and renal ultrasound<br />
imaging employing intravenous contrast.<br />
Concurrent with the pig CPB<br />
model, a second, more economical<br />
CPB model was developed in the rat.<br />
This work, performed with the collaborative<br />
support of cardiothoracic anesthesia<br />
fellow Dr. Burkhard Mackensen,<br />
took place in the neuroanesthesia laboratory<br />
with space generously donated<br />
by Dr. David Warner. This new laboratory<br />
has been unique, thus far in the<br />
field, with its ability to successfully perform<br />
complete CPB in rats with subsequent<br />
recovery. The coming year’s<br />
focus will continue with the further<br />
development of a model of neurocognitive<br />
impairment after CPB in the rat<br />
in order to investigate both the mechanisms<br />
of injury as well as potential pharmacologic<br />
neuroprotection. In conjunction<br />
with Dr. Warner, neurology,<br />
neurosciences and other related fields,<br />
the Duke Multidisciplinary Neuroprotection<br />
Laboratory has been developed to<br />
facilitate these important investigations.<br />
CLINICAL ACTIVITIES 45
CLINICAL ACTIVITIES<br />
Goals for 2000<br />
Enhancing fellow and resident education<br />
is one of the major goals of the<br />
division for 2000. The clinical caseload<br />
has obviously given the division the<br />
opportunity to do outstanding clinical<br />
teaching of both residents and fellows.<br />
The addition of a written examination<br />
to ongoing oral examination allows residents<br />
and fellows to assess their ongo-<br />
Cases by Divisions/Sections<br />
Ambulatory Surgical Center** 5691<br />
Cardiothoracic 3099<br />
Eye Center 3983<br />
General 5243<br />
Gynecological 1987<br />
Hematology/Oncology 32<br />
Neurosurgical 2452<br />
Obstetrical 2188<br />
Orthopaedic 5802<br />
Otolaryngology, Head, Neck 1567<br />
Pediatric* 6107<br />
Plastics 1066<br />
Urological 1809<br />
VA Medical Center 3511<br />
Vascular 1533<br />
*Includes all patients under the age of 18<br />
46 CLINICAL ACTIVITIES<br />
ing learning. We will also take a leadership<br />
role in the ACU, with Cardiac<br />
Anesthesiology Intensivist directed by<br />
Dr. Steve Hill. The goals of this program<br />
will be improved quality of care, and<br />
enhanced educational and research<br />
opportunities.<br />
The group has developed a national<br />
continuing medical education presence<br />
to allow the showcase of ongoing<br />
clinical and research work within the<br />
division. The “Fourth Annual Duke<br />
Cardiothoracic Update” will take place<br />
in Hilton Head, SC, June 23-26, 2001.<br />
We continue to appreciate the<br />
leadership that Dr. Reves provided to<br />
Duke Heart Center and the division<br />
over the last ten years and thank him<br />
for his support, as we try to aggressively<br />
pursue a leadership role in cardiothoracic<br />
anesthesia for the next century.<br />
0 1000 2000 3000 4000 5000 6000<br />
**Includes Orthopedic, General, Gynecology, Plastics, OHN, Pediatric Urology and Vascular patients previously tabulated within Divisions/Sections
CERTIFIED<br />
REGISTERED<br />
NURSE ANESTHETISTS<br />
Russell T. Giesler, CRNA<br />
Chair, Clinical Leads<br />
CLINICAL LEAD COMMITTEE<br />
Paula D. Alford, BA, CRNA<br />
Ambulatory Surgical Center<br />
Patricia M. Allushuski, BSNA, CRNA<br />
Ortho-plastics<br />
Beatrice I. Baldwin, CRNA<br />
Cardiac<br />
Eleanor W. Carter, CRNA<br />
Eye Center<br />
Russell T. Giesler, BSN, CRNA<br />
Chair of Clinical Leads, Neuro-OHN<br />
Janet M. Hall, CRNA<br />
Pediatrics Cardiac<br />
Meredith L. Muncy, CRNA, MHS -<br />
General, Vascular, Transplant<br />
Grace A. Simpson, CRNA, MSN<br />
Scheduling Coordinator<br />
Tede E. Spahn, CRNA<br />
Obstetrics<br />
Lisa J. Schwetschenau, CRNA, MNA<br />
Pediatrics<br />
Donald K. Thomas, CRNA<br />
Urology-Gynecology<br />
PERIOPERATIVE PEDIATRIC<br />
COORDINATOR<br />
Janet E. Goral, BSN, CRNA.<br />
NEW NURSE ANESTHETISTS<br />
ARRIVALS<br />
Dale F. Potter, CRNA<br />
Wake Forest University Baptist<br />
Medical Center in Winston-Salem,<br />
NC<br />
Daniel J. Geniton, CRNA<br />
Doctors Hospital of Augusta, GA.<br />
Steven A. Ziegler, CRNA<br />
Ronald C. Iacone, CRNA<br />
The millennium has brought with it a<br />
continuing evolution by the Duke Nurse<br />
Anesthetists to the organizational structure<br />
of Divisions. The apprehension, at<br />
first, of going to Divisions has melted<br />
away. Now Certified Registered Nurse<br />
Anesthetists (CRNA) prefer to be<br />
assigned within their Divisions. These<br />
Divisions were established to promote<br />
an increase in clinician involvement, to<br />
foster teams and teamwork and to provide<br />
a high quality of anesthesia care<br />
efficiently and economically. This environment<br />
of change will continue for the<br />
foreseeable future as the Divisions<br />
evolve and even the physical layout of<br />
the OR suite is to be altered, which will<br />
take a few years to complete.<br />
In June the new automated anesthesia<br />
record, SATURN, was introduced<br />
to Duke North Hospital after first being<br />
applied at the Ambulatory Surgical<br />
Center and Eye Center. Jeanne M.<br />
Crabtree, CRNA; Frances R. Smith,<br />
CRNA and Donald R. Moede, CRNA,<br />
MSN were responsible for the training<br />
of anesthesia providers. There is still<br />
much the SATURN system has to offer<br />
us and only the future can tell us how<br />
far we will go with this new system.<br />
To improve the flow of communication<br />
among the CRNAs, Anesthesiologists,<br />
and other disciplines, a Chair<br />
of the Clinical Leads was established<br />
in July. Russell T. Giesler, CRNA was<br />
selected to this position. The Clinical<br />
CLINICAL ACTIVITIES<br />
Lead Committee was redefined with<br />
Clinical Leads assuming a more supervisory<br />
role in assisting in the facilitation<br />
of the daily OR schedule through the<br />
CRNA charge responsibilities. Donald K.<br />
Thomas, CRNA assumed the position of<br />
Clinical Lead of GYN. This combined<br />
GYN and GU under one Clinical Lead<br />
thus helping to redistribute the number<br />
of CRNAs responsible to any one<br />
Clinical Lead. Tede E. Spahn, CRNA<br />
was named Clinical Lead of OB. Paula<br />
D. Alford, CRNA was chosen Clinical<br />
Lead of ASC. Finally, with Meredith L.<br />
Muncy, CRNA assuming her new role in<br />
the Duke School of Nurse Anesthesia,<br />
Grace A. Simpson, CRNA has accepted<br />
the Clinical Lead position for the GVT<br />
Division. With the Clinical Lead<br />
Committee established it was able to<br />
proceed with pending issues.<br />
September brought the new evaluation<br />
form for the Performance Partnership<br />
System as redesigned by the<br />
Clinical Lead Committee to be used<br />
beginning July, 2001. It took a great<br />
deal of energy and time commitment<br />
to finalize the new form and it is still<br />
recognized that in the future this evaluation<br />
form can and will change to meet<br />
our needs.<br />
October brought the final accreditation<br />
of the new Duke School of Nurse<br />
Anesthesia. The Director of the school<br />
will be Mary C. Karlet, CRNA, Ph.D.<br />
with James Temo, CRNA, MSN, M.B.A.<br />
as Assistant Director. The first class is<br />
scheduled to begin January 2001.<br />
With the year drawing to a close,<br />
the CRNA group completed a survey in<br />
October with regards to CRNA recruitment<br />
and retention issues. Committees<br />
have been established and five areas<br />
have been identified and are being<br />
addressed. These committees will complete<br />
their individual tasks and report<br />
back to the CRNA group with constructive<br />
recommendations to move forward.<br />
We in medicine understand we<br />
work in a dynamic environment where<br />
change is always present. I believe<br />
there are a number of people who have<br />
CLINICAL ACTIVITIES 47
CLINICAL ACTIVITIES<br />
Narda D. Croughwell, CRNA<br />
worked very hard this last year and are<br />
still working very hard to accomplish<br />
tasks at hand that will help us meet the<br />
challenges of 2001. They should all<br />
be commended for their efforts. Again<br />
we end the year with guarded but optimistic<br />
anticipation of things to come.<br />
RETIRED<br />
Louis Semrad, CRNA<br />
Jeanne M. Crabtree, CRNA<br />
DEPARTURES<br />
Terry W. English, CRNA, M.S.<br />
Flavia P. Blackburn, CRNA<br />
Mary Ann L. Romero, CRNA<br />
David B. Salzer, CRNA<br />
Pegge L. Hall, CRNA, MSN<br />
James M. Temo, CRNA, M.S.N., M.B.A.<br />
48 CLINICAL ACTIVITIES<br />
Notables 2000<br />
Cynthia R. Black, CRNA serves on<br />
the Public Relations Committee and<br />
Resolutions Committee for the AANA.<br />
Lisa J. Schwetschenau, CRNA, MNA<br />
was elected Secretary for the NCANA<br />
and District 1.<br />
Donald R. Moede, CRNA, MSN and<br />
Leslie A. Cline, CRNA, MSN were elected<br />
as District 1 Educational Directors.<br />
Shelley T. Hilliard, BSN, CRNA<br />
was elected District 1 Director.<br />
James M. Temo, CRNA, MSN,<br />
M.B.A. was named Assistant Director<br />
of Duke’s School of Nurse Anesthesia<br />
Program beginning January, 2001.<br />
Meredith L. Muncy, CRNA, MHS<br />
was named Clinical Coordinator for<br />
Duke's School of Nurse Anesthesia<br />
beginning January, 2001.<br />
Janet E. Goral, BSN, CRNA is still<br />
instrumental in the on-going latex safe<br />
initiative for the Children’s Health<br />
Center.<br />
Deborah J. Ferrero, CRNA, MS,<br />
MSN is working with Dr. T.J. Gan on<br />
research to determine whether the<br />
active metabolites of the nondepolorizer<br />
rapacuronium effect the duration of<br />
other nondepolorizers. Deborah is also<br />
our liaison to Abbott Laboratory's preceptor<br />
program.<br />
Donald R. Moede, CRNA, MSN,<br />
Frances R. Smith, CRNA and Jeanne M.<br />
Crabtree, CRNA were the Consultants/<br />
Trainers for the new automated anesthesia<br />
record, SATURN, and assisted in<br />
the training of the anesthesia providers<br />
at Duke. Don also redesigned the manual<br />
anesthesia record.<br />
Carleen E. Bagnall, BSN, CRNA<br />
received the Medical Student Recognition<br />
Award, Department of<br />
Anesthesiology.<br />
Janet M. Hall, CRNA submitted an<br />
abstract at the academic evening and<br />
presented a poster on “Forane vs.<br />
Propofol Anesthesia: Comparison of<br />
PONV in Pediatric Patients Undergoing<br />
Radiofrequency Ablation.”<br />
David H. Gleason, CRNA, BHS presented<br />
at the Sixth World Congress for<br />
Nurse Anesthetists in August. His presentations<br />
were on “PONV Strategies for<br />
Prevention” and “Physiology of Pain"<br />
David is also a member of the Abbott<br />
CRNA advisory board.<br />
Russell T. Giesler, BSN, CRNA was<br />
selected Chair of the Clinical Lead<br />
Committee.<br />
Maurice L. Begin, CRNA is working<br />
with ORBIS in China, Burma and India,<br />
to name a few sites, delivering quality<br />
anesthesia care to eye patients.<br />
Henry J. Walker, CRNA, MS, M.B.A.<br />
served on the Advisory Committee for<br />
the Duke School of Nurse Anesthesia.
ADULT CRITICAL<br />
CARE MEDICINE<br />
Christopher C. Young, M.D.<br />
FCCM<br />
Chief, Division of Critical Care<br />
Medicine<br />
Associate Clinical Professor<br />
of Anesthesiology and<br />
Surgery<br />
Members<br />
Cecil O. Borel, M.D.<br />
Guy deLisle Dear, M.B., FRCA<br />
Lewis R. Hodgins, M.D.<br />
Frank H. Kern, M.D., FCCM<br />
Nancy W. Knudsen, M.D.<br />
Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP<br />
Eugene W. Moretti, M.D.<br />
Laura E. Niklason, M.D., Ph.D.<br />
James A. L. Pittman, M.B., B.S., B.Sc.,<br />
FRCA<br />
Scott R. Schulman, M.D.<br />
John T. Sum-Ping, M.D., Ch.B., FRCA<br />
Bryant W. Stolp, M.D., Ph.D.<br />
Fellow<br />
Patrick J. Neligan, M.D. (Anesthesiology)<br />
Members of the Division of Critical Care<br />
perform patient care, teaching and<br />
research in adult critical care in several<br />
intensive care units: The Surgical Intensive<br />
Care Unit (SICU) at Duke, the SICU<br />
at the Veterans Affairs Medical Center<br />
(VAMC) and the Neuroscience ICU at<br />
Duke. Divisional faculty also provide<br />
medical care in the Hyperbaric Center<br />
and the Pediatric ICU. Reports from the<br />
Neurosciences ICU, Hyperbaric Center,<br />
and Pediatric ICU are listed elsewhere<br />
in this publication. In June of 2000, Dr.<br />
Reves, at the recommendation of the<br />
Departmental Executive Committee,<br />
announced a name change of several<br />
of the Divisions within the Department<br />
of Anesthesiology to reflect their<br />
involvement in Critical Care Medicine.<br />
This involvement is clinical, educational,<br />
and investigative. The changed<br />
names of our divisions are:<br />
Cardiothoracic Anesthesia and<br />
Critical Care Medicine<br />
General, Vascular, Transplant<br />
Anesthesia and Surgical Critical<br />
Care Medicine<br />
Pediatric Anesthesia and Critical<br />
Care Medicine<br />
Women’s Anesthesia and Critical<br />
Care Medicine.<br />
The matrix Division of Critical Care<br />
Medicine remains responsible for the<br />
overall education of fellows in Critical<br />
Care Medicine and continues to coordinate<br />
our department's multiple<br />
specialty-specific critical care programs.<br />
Surgical Intensive Care<br />
Units<br />
Clinical Activities<br />
Patient care is provided in the Surgical<br />
Intensive Care Units at Duke and the<br />
VAMC under the Co-Directorship of faculty<br />
of the Department of Anesthesiology.<br />
The Duke University Hospital SICU<br />
is a 16 bed, Level One trauma unit. In<br />
addition, it serves as a site for care of<br />
a variety of postoperative general and<br />
subspecialty surgical patients. Attending<br />
CLINICAL ACTIVITIES<br />
staff from the Departments of Medicine,<br />
Surgery, and Anesthesiology provide<br />
twenty-four hour a day, seven day per<br />
week coverage. Dr. William Fulkerson,<br />
Dr. Joseph Govert (Medicine), Dr. Mark<br />
Sebastian, Dr. Betsy Tuttle-Newhouse,<br />
Dr. Steven Vaslef (Surgery), Dr. Nancy<br />
Knudsen, Dr. Gene Moretti, Dr. Laura<br />
Niklason and Dr. Christopher Young<br />
(Anesthesiology) share attending responsibilities.<br />
The Durham VA Medical<br />
Center's 12-bed unit emphasizes the<br />
management of postoperative open<br />
heart patients, as well as patients from<br />
general, orthopedic, urologic, plastic,<br />
and other subspecialty surgical services<br />
who require critical care. Dr. Lewis<br />
Hodgins, Dr. John Sum-Ping, Dr. Laura<br />
Niklason, and Dr. Christopher Young<br />
share attending responsibilities in this<br />
unit.<br />
Attending Staff<br />
Dr. Eugene Moretti, Dr. Laura Niklason,<br />
Dr. Nancy Knudsen, and Dr. Christopher<br />
Young continue to participate in the<br />
24 hour per day coverage in the Duke<br />
North Surgical ICU. Dr. James Pittman<br />
joined the VA faculty this past year as<br />
a Visiting Associate (from the United<br />
Kingdom) and shares attending responsibility<br />
in the VA ICU with Drs. Sum-<br />
Ping, Hodgins, Niklason, and Young.<br />
Dr. Frank Kern and Dr. Scott Schulman<br />
practice in the Pediatric Intensive Care<br />
Unit. Dr. Cecil Borel serves as the Medical<br />
Director of the Neurointensive Care<br />
Unit. Dr. Richard Moon is the Medical<br />
Director of the Hyperbaric Center and<br />
is involved in research, teaching, and<br />
patient care there with Drs. Bret Stolp<br />
and Guy Dear. During the past year, we<br />
bid farewell to two esteemed colleagues<br />
from the Critical Care Division.<br />
Dr. Andrew Hilton returned home to<br />
Australia to pursue further training and<br />
practice opportunities in Critical Care<br />
Medicine. Andrew and family (Ingrid,<br />
Max, and Ziggy) are living happily in<br />
Melbourne and look forward to welcoming<br />
any visitors to the “land down<br />
under.” Dr. Charles Garcia-Rodriguez<br />
CLINICAL ACTIVITIES 49
CLINICAL ACTIVITIES<br />
returned home this year as well after<br />
securing a consultant position in the UK.<br />
Fellows<br />
2000 is the seventh year the ACGME<br />
accredited Fellowship in Critical Care<br />
Medicine has been offered by the<br />
Department of Anesthesiology. On May<br />
10, 2000, the ACGME conducted a site<br />
survey of the fellowship program in<br />
conjunction with the residency program<br />
review. Based on the visit, interviews<br />
with fellows, and review of documents,<br />
the Residency Review Committee for<br />
Anesthesiology of the ACGME awarded<br />
the program continued accreditation.<br />
The program continues to attract a<br />
number of applicants despite decreased<br />
federal support for postgraduate medical<br />
education. Two fellows have accepted<br />
positions for academic year 2001 from<br />
within the residency program in Anesthesiology.<br />
Previous Anesthesiology/<br />
Critical Care fellows continue to be successful.<br />
Dr. Chiedozie Udeh has spent<br />
the past six months in locum tenens<br />
positions in Australia. Dr. Angela<br />
Joseph has been practicing Anesthesiology<br />
and Critical Care Medicine in<br />
Michigan. Both will be taking the ABA<br />
examination for added qualifications<br />
in Critical Care Medicine later this year.<br />
John T. Sum Ping, M.B., Ch.B., FRCA<br />
50 CLINICAL ACTIVITIES<br />
Former fellows include: Dr. Albert<br />
Hasson (South Carolina), Dr. Kevin<br />
Patrick (Western North Carolina), Dr.<br />
Eugene Moretti (Duke), Dr. Faisal Masud<br />
(Houston, TX), Dr. Elliott Bennett-<br />
Guerrero (New York, NY), Dr. Nancy<br />
Knudsen (Duke), and Dr. Tony Huggins<br />
(Raleigh, NC).<br />
Residents<br />
CA-1 residents in anesthesiology are<br />
introduced to Critical Care Medicine<br />
at the VAMC SICU. In addition, the<br />
Departments of General Surgery,<br />
Orthopedic Surgery, and Obstetrics /<br />
Gynecology require their residents to<br />
gain critical care experience during residency.<br />
This requirement is met with<br />
rotations in the Surgical ICU at the<br />
Durham VAMC. The residents and<br />
interns rate this experience highly and<br />
they regard the VA ICU Anesthesiologists<br />
/ Intensivists as contributing an<br />
important component to their training.<br />
Additional training in Critical Care<br />
Medicine for senior residents in Anesthesiology<br />
and Surgery is provided in<br />
the SICU at Duke University Medical<br />
Center (2200). Residents gain additional<br />
proficiency in managing complex patients<br />
in this busy trauma/post surgical<br />
unit. The clinical and didactic components<br />
of this rotation are maintained at<br />
high levels with the input of the Critical<br />
Care fellows and attending staff.<br />
Medical Students<br />
Instruction to medical students in intensive<br />
care medicine is offered through<br />
the Duke University School of Medicine.<br />
A month long rotation in surgical intensive<br />
care (Surgical Intensive Care:<br />
Anesthesiology 241/Surgery 241) has<br />
continued to be popular with fourth<br />
year medical students. Students from<br />
Duke as well as other institutions (both<br />
national and international) enroll in the<br />
course to gain valuable experience in<br />
patient care. Students are assigned to<br />
the SICU at Duke University Medical<br />
Center and/or the VA Medical Center.<br />
They participate in the care of critically<br />
ill patients, evaluate and present patients<br />
on SICU rounds, and take inhouse<br />
call with the residents. The students<br />
frequently cite the experience in<br />
managing complex medical problems<br />
and enthusiastic teaching by residents,<br />
fellows, and attendings as strong positives<br />
of this course.<br />
Accomplishments<br />
The missions of the Division—excellence<br />
in patient care, education, and<br />
research—have been well served this<br />
past year. The Surgical Intensive Care<br />
Unit at the VAMC continues to be valued<br />
as an outstanding educational experience<br />
in residency training. Attending<br />
physician coverage at night in the Duke<br />
Surgical ICU has expanded the missions<br />
of resident education and excellence<br />
in patient care.<br />
The Critical Care Division continues<br />
to be recognized as a leader in the<br />
provision of adult Critical Care services<br />
at both the VA and Duke Medical<br />
Centers. Drs. Sum-Ping and Knudsen,<br />
as co-directors of their respective units,<br />
continue to improve the process of<br />
healthcare delivery in the ICU setting.<br />
Other members of the division are to be
commended for their support of these<br />
processes. Multidisciplinary Critical<br />
Care Rounds continue biweekly under<br />
the direction of Dr. Young. These conferences<br />
provide the opportunity for<br />
health care professionals from various<br />
backgrounds to meet and discuss<br />
Critical Care topics of mutual interest.<br />
Goals for Critical Care<br />
at Duke<br />
The goal of the Division is to build<br />
upon recent accomplishments and<br />
continue to improve in all aspects of<br />
patient care, teaching, and research.<br />
Patient care continues to be the<br />
highest priority of the Division. Every<br />
member of the Division deserves accolades<br />
for the continued enthusiasm and<br />
skillful patient care being provided in<br />
the face of the growing financial constraints<br />
on the practice of Critical Care<br />
Medicine. These contributions are recognized<br />
by hospital administration, our<br />
patients, and their families.<br />
All members of the Division are<br />
involved in the teaching of Critical Care<br />
Medicine to medical students, residents,<br />
and others. Biweekly Critical Care Conference<br />
continues to attract students,<br />
residents, nurses, and physicians from<br />
all departments.<br />
The research potential of the Division<br />
continues to expand. Dr. Eugene<br />
Moretti has been extremely successful<br />
in bringing research protocols to the<br />
clinical arena and in enrolling patients<br />
in several important studies. He has protocols<br />
investigating magnesium flux in<br />
critically ill patients, infection risk with<br />
Nancy W. Knudson, M.D.<br />
a new anti-bacterial bonded central<br />
venous catheter, and a novel therapy<br />
for the treatment of sepsis. In addition,<br />
he is pursuing a Masters Degree in<br />
Clinical Research and Statstics, and will<br />
bring these newly developed skills to<br />
the division’s research efforts. Several<br />
members of the division (Drs. Moretti,<br />
Sum-Ping, and Young) work in the<br />
Human Pharmacology Laboratory<br />
under the direction of Dr. Jacques<br />
Somma. Their interests are in investigating<br />
the pharmacokinetics and pharmacodynamics<br />
of sedative drugs and Dr.<br />
Somma has obtained several corporate<br />
CLINICAL ACTIVITIES<br />
and governmental grants to continue<br />
this ground-breaking work. In the<br />
future, the techniques of measurement<br />
developed in this lab will be brought<br />
to the patients' bedside in the intensive<br />
care unit to further delineate the pharmacology<br />
of these drugs in the critically<br />
ill. Dr. Niklason continues to gain<br />
national and international prominence<br />
for her investigations into engineered<br />
arterial grafts and the mechanisms of<br />
vasospasm following subarachnoid<br />
hemorrhage. Drs. Sum-Ping and Young<br />
presented the results of their work on<br />
non-invasive cardiac output measurement<br />
(LidCO) at the annual meeting<br />
of the American Society of Anesthesiologists,<br />
and continue their investigations<br />
with a newer version of the device<br />
(PulseCO). Drs. Sum-Ping and Pittman<br />
continue to be engaged in the study<br />
of a new sedative agent, dexmedetomidine,<br />
in the intensive care unit. Additional<br />
research accomplishments are<br />
listed in the sections for Pediatrics,<br />
Neurosciences, and Hyperbaric Medicine.<br />
Additional protocols and publications<br />
are anticipated in the areas of<br />
sedation and evaluation of new, noninvasive<br />
monitoring devices in the<br />
intensive care unit.<br />
The dedication of the Critical Care<br />
faculty has produced success in our varied<br />
endeavors—patient care, research,<br />
and education. In all these missions,<br />
our goal is continued excellence.<br />
CLINICAL ACTIVITIES 51
CLINICAL ACTIVITIES<br />
GENERAL, VASCULAR,<br />
HIGH-RISK, TRAUMA,<br />
TRANSPLANT AND<br />
SURGICAL CRITICAL<br />
CARE <strong>ANESTHESIOLOGY</strong><br />
David A. Lubarsky, M.D.,<br />
M.B.A.<br />
Chief, Division of General,<br />
Vascular, High-Risk, Trauma,<br />
Transplant and Surgical Critical<br />
Care Anesthesiology<br />
Associate Professor and Vice-<br />
Chair of Anesthesiology<br />
Adjunct Associate Professor of<br />
Operations Management at the<br />
Fuqua School of Business<br />
FACULTY<br />
Tong Joo Gan, M.B., B.S., FRCA<br />
Nancy W. Knudsen, M.D.<br />
Catherine K. Lineberger, M.D.<br />
David A. Lubarsky, M.D., M.B.A.<br />
Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP<br />
Eugene W. Moretti, M.D.<br />
John A.C. Murdoch, M.B., Ch.B., B.Sc.<br />
Laura E. Niklason, M.D., Ph.D.<br />
Ronald P. Olson, M.D., CCFP<br />
Robert R. Panten, Jr., M.D.<br />
Kerri M. Robertson, M.D., FRCP(C)<br />
Iain C. Sanderson, M.B., Ch.B., FRCA<br />
Jacques Somma, M.D., FRCP(C)<br />
David R. Wright, M.B., Ch.B.<br />
Christopher C. Young, M.D., FCCM<br />
52 CLINICAL ACTIVITIES<br />
CRNA<br />
Evelyn M. DeRoche, CRNA<br />
Deborah J. Ferrero-Conover, CRNA, MS,<br />
MSN<br />
David R. Marion, CRNA<br />
Debra S. Clements, CRNA, MSN<br />
Donald R. Moede, CRNA, MSN<br />
Gayle P. Moyer, CRNA, BSN, MS<br />
Meredith L. Muncy, CRNA, MHS<br />
Grace A. Simpson, CRNA, MSN<br />
G. Lynn Stockbridge, CRNA<br />
Donald K. Thomas, CRNA<br />
Helen B. Walston, CRNA<br />
Fellow<br />
Yung-Wei Hsu, M.D.<br />
STAFF SUPPORT<br />
Barbara Blank<br />
Jennifer K. Fier<br />
Michelle Harward<br />
Tonya Meadows<br />
Thomas Pafford<br />
Angela Rogers<br />
Melina Shabani<br />
Karen Francis-McWhite<br />
Sharon Skeeter<br />
Ella Smith<br />
Regina Williams<br />
RESEARCH SUPPORT<br />
Aaron K. Harrison, B.S., Clinical Trial<br />
Research Associate<br />
Karen W. Ramsey RN, BSN, M.B.A.,<br />
MHA, Non-Cardiac Clinical Research<br />
Coordinator<br />
The GVT and Surgical Critical Care divisions<br />
were combined in July 2000 to<br />
form the GVTCCM Division of Anesthesiology<br />
under the leadership of David<br />
Lubarsky, M.D., M.B.A. as Chief and<br />
Associate Directors Kerri M. Robertson,<br />
M.D., FRCP(C) and Christopher Young,<br />
M.D., FCCCM. The combination of the<br />
previously independent sections was<br />
accomplished in order to bring a full<br />
perioperative medicine approach to the<br />
care of our patients. Our responsibilities<br />
range from directing the preoperative<br />
screening clinic, to running multiple<br />
operating rooms for a tertiary care practice,<br />
to medically supervising the PACU,<br />
to providing the anesthesia faculty for<br />
and co-directing the SICU. This allows<br />
our division to impact the entire perioperative<br />
experience to maximize<br />
patient health outcomes and minimize<br />
procedural imperfections. The division’s<br />
clinical faculty are a “seasoned”<br />
and productive group who have a variety<br />
of clinical and research interests<br />
which are detailed below.<br />
David Lubarsky, as Chief of the<br />
Division, holds an academic rank of<br />
Associate Professor, is Vice Chairman<br />
for the department and Adjunct<br />
Associate Professor in the Health Sector<br />
Management Program of the Fuqua<br />
School of Business. He combines a<br />
high-energy style with his experience<br />
and expertise in both the world of medicine<br />
and business to illuminate economic<br />
concepts and define cost effective<br />
patient care. He published four articles<br />
this past year, three related to<br />
healthcare economics, and one clinical<br />
study on post-operative ischemia and<br />
coagulation profiles. His teaching interests<br />
this year included mentoring medical<br />
students in their Cost Effective Care<br />
Clerkship, teaching a full course<br />
(Informatics, the Internet, and<br />
Healthcare) at the MBA program<br />
at Fuqua, writing and editing the 2nd<br />
Edition of Board Stiff (an oral review<br />
book that sold 12,000 copies in its first<br />
edition), and serving as chair of the<br />
editorial board of AnesthesiaWeb (the<br />
largest anesthesia e-magazine in the<br />
world). In the near future, look for the<br />
first anesthesiology textbook written<br />
exclusively for the Internet with emedicine.com<br />
for which Dr. Lubarsky is the<br />
co-project manager with Dr. Charles<br />
Cote of Northwestern University and<br />
one of the editors-in-chief as well.<br />
Kerri Robertson is a Canadian graduate,<br />
with two years of fellowship training<br />
in Liver Transplant Anesthesia, and<br />
15 years of subsequent clinical and<br />
research experience in all areas of subspecialty<br />
anesthesia practice. Following<br />
an extensive search, due to both her<br />
clinical and leadership skills, Dr.<br />
Robertson was selected as the Chief<br />
of the GVT section of the GVTCCM<br />
Division in Anesthesiology in July 2000.
Under her leadership, the newly energized<br />
division has moved forward with<br />
several initiatives including; the Perioperative<br />
Outcomes Database, the<br />
General Surgery Pilot Study (designed<br />
to allow GVT faculty members to run<br />
the surgical schedule on a daily basis),<br />
support and participation in the Human<br />
Pharmacology Laboratory and development<br />
of a strategic plan for improving<br />
the process and patient flow in the<br />
PACU. The first annual GVTCCM retreat<br />
was a huge success, and with participation<br />
from our M.D. and CRNA faculty,<br />
we gained insight into the various clinical,<br />
research and teaching initiatives<br />
administrated by our divisional members.<br />
Dr. Robertson headed a Taskforce<br />
on CRNA Recruitment and Retention<br />
which successfully resolved salary and<br />
benefits issues that were impeding our<br />
recruitment of additional CRNA faculty.<br />
A consistently strong endeavor has<br />
been the high quality of perioperative<br />
care that the Liver Transplant Faculty<br />
have provided to transplant recipients,<br />
and the enthusiasm with which the residents<br />
now actively participate in this<br />
program. As Chief of Transplant<br />
Services, Dr. Robertson coordinates<br />
clinical, research and teaching activities<br />
and provides the necessary liason with<br />
our surgical colleagues which make this<br />
a successful cohesive and cooperative<br />
multidisciplinary effort.<br />
T.J. Gan is an Associate Professor<br />
and Director of Clinical Research for<br />
the department. He also serves as<br />
Medical Director of the PACU. During<br />
the 2000 academic year, T.J. coordinated<br />
the activities of 18 active IRBapproved<br />
research protocols which<br />
focused on the use of physiologically<br />
balanced colloid solutions for fluid<br />
resuscitation, novel drugs and drug<br />
delivery systems and improving the<br />
care of elderly patients undergoing<br />
surgery. He is an acknowledged world<br />
expert on antiemetic drug therapies to<br />
reduce postoperative nausea and vomiting.<br />
He will soon be expanding his therapeutic<br />
strategies to include acupuncture<br />
techniques. T.J. is the driving force<br />
behind the divisional project of establishing<br />
a comprehensive postoperative<br />
database to measure perioperative outcome<br />
and ultimately establish “best<br />
practice” for patient care.<br />
Jacques Somma joined our department<br />
two years ago with a unique background<br />
in engineering, medicine and<br />
two years of fellowship training in Dr.<br />
Steven Shafer’s Pharmacology Laboratory<br />
at Stanford University. Dr. Somma<br />
is director of the Human Pharmacology<br />
Laboratory (www.pharmacokin.com)<br />
which is a fully equipped state of the art<br />
laboratory supported by a comprehensive<br />
team of Duke faculty who have the<br />
skills required to efficiently design, perform<br />
and analyze data for Phase I studies.<br />
Two protocols are currently active:<br />
“A Double Blind Randomized Study to<br />
Compare the Analgesia and Respiratory<br />
Effect of Dexmedetomidine and<br />
Remifentanil,” and “Age Effect on the<br />
Interaction between Propofol and<br />
Remifentanil.” His support staff includes<br />
Aaron Harrison (Clinical Trail Research<br />
Associate), Karen Ramsey (Non-cardiac<br />
Clinical Research Coordinator) and<br />
Yung-Wei Hsu, M.D., (Research<br />
Associate)<br />
Eugene Moretti is a Duke anesthesia<br />
graduate, who has subsequently<br />
completed his board certification in<br />
anesthesiology and critical care medicine<br />
and his first of two years towards<br />
a Master's degree of Health Sciences in<br />
Clinical Research. Gene’s participation<br />
in the clinical research training program<br />
at Duke is intimately tied to the<br />
Duke Clinical Research Institute (DCRI)<br />
and meets an existing need for formalized<br />
academic training in the quantitative<br />
and methodological principles of<br />
clinical research. In addition, Dr.<br />
Moretti’s continuing commitment to<br />
pursuing excellence in patient care<br />
finds him in the Duke North OR, as<br />
an intensivist in the surgical ICU and<br />
as an active participant on the Liver<br />
Transplant Team.<br />
The Laboratory for Tissue<br />
Engineering under Laura E. Niklason’s<br />
guidance continues to focus on topics<br />
CLINICAL ACTIVITIES<br />
related to vascular biology and design<br />
of vascular replacement tissues. Current<br />
topics of study include:<br />
1. Biochemical and theoretical<br />
modeling approaches to understanding<br />
and improving the mechanical characteristics<br />
of engineered tissues.<br />
2. Life span extension of vascular cells<br />
via over-expression of the human telomerase<br />
reverse transcriptase gene.<br />
3. Utilization of adult human pluripotent<br />
stem cells as precursor cells for<br />
engineered cardiovascular tissues.<br />
4. Effects of controlled mechanical and<br />
electrical stimuli on vascular cell function<br />
and phenotype.<br />
Additionally, the laboratory is<br />
conducting a collaborative study on a<br />
possible etiology for delayed vasospasm<br />
following subarachnoid hemorrhage.<br />
Funding for these efforts are derived<br />
from multiple sources, including the<br />
NIH, private foundations, and private<br />
corporations.<br />
Ronald P. Olson, M.D., CCFP,<br />
Medical Supervisor of the Preoperative<br />
Screening Unit (POSU) and his team<br />
continued to serve as the focal point for<br />
preoperative coordination for most surgical<br />
patients during the year 2000.<br />
They strive to offer the most complete<br />
preoperative service anywhere.<br />
Their strengths continue to be conducting<br />
a complete history and physical<br />
exam which allows accurate risk stratification<br />
and choosing of appropriate<br />
investigations. With continual feedback<br />
from anesthesiologists and surgeons,<br />
they provide consistency in investigation<br />
and education of the patients. The<br />
POSU coordinates appropriate consultation<br />
and testing and manages minor<br />
medical conditions. By the morning<br />
of surgery, the patient has already been<br />
educated on the perioperative event,<br />
and the paperwork is organized and<br />
delivered. Therefore, the POSU minimizes<br />
morning of surgery surprises.<br />
Changes during this year have<br />
been progress with the electronic<br />
record, use of the POSU for research<br />
recruitment, and initiation of billing for<br />
CLINICAL ACTIVITIES 53
CLINICAL ACTIVITIES<br />
some of the services rendered. They<br />
continue to seek consensus on appropriate<br />
education and investigation.<br />
Example of this are NPO guidelines,<br />
ASA classification, routine investigations<br />
ordered by surgeons, and body<br />
jewelery.<br />
The coming year will see some<br />
expansion in the primary care delivered<br />
in the clinic, billing, POSU services to<br />
the cardiovascular service, and establishment<br />
of a different stream for<br />
healthy patients scheduled for low risk<br />
surgery. The electronic record will continue<br />
to evolve. They expect to make<br />
advances in ease of data entry and<br />
coordination with the Saturn system.<br />
There continues to be enormous potential<br />
for research in the POSU setting,<br />
and there should be some exciting<br />
developments in this area.<br />
The name of our division reflects<br />
our intimate involvement in Critical<br />
Care issues, as we treat many of the<br />
sickest patients who come to Duke for<br />
surgery. The faculty that provide surgical<br />
critical care oversight are a uniquely<br />
qualified subset of our OR group. The<br />
Duke University Hospital Surgical<br />
Intensive Care Unit (SICU) is a 16-bed,<br />
Level One trauma unit. In addition, it<br />
serves as a site for care of a variety of<br />
postoperative general and subspecialty<br />
surgical patients. Attending staff from<br />
the Departments of Medicine, Surgery,<br />
and Anesthesiology provide twenty-four<br />
hour a day, seven day per week coverage.<br />
The Critical Care Division continues<br />
to be recognized as a leader in the provision<br />
of adult Critical Care services at<br />
Duke Medical Center. Nancy Knudsen,<br />
M.D. as co-director of the SICU, continues<br />
to improve the process of healthcare<br />
delivery in the Intensive Care Unit<br />
(ICU) setting. Multidisciplinary Critical<br />
Care Rounds continue biweekly under<br />
the direction of Christopher Young,<br />
M.D., FCCM who is the Section Chief<br />
of Critical Care Medicine within our<br />
division.<br />
The goal of the Division is to build<br />
upon recent accomplishments and<br />
continue to improve in all aspects of<br />
patient care, teaching, and research.<br />
54 CLINICAL ACTIVITIES<br />
These contributions are recognized by<br />
hospital administration, our patients,<br />
and their families. A full description of<br />
Critical Care Medicine program given<br />
by Dr. Christopher Young appears separately<br />
in this annual report.<br />
LIVER<br />
TRANSPLANTATION<br />
Kerri M. Robertson, M.D.,<br />
FRCP(C)<br />
Chief of Transplant Services<br />
Chief of GVT Section of GVTCCM<br />
Division of Anesthesiology<br />
Associate Director of of GVTCCM<br />
Division of Anesthesiology<br />
Associate Clinical Professor of<br />
Anesthesiology<br />
Members<br />
T.J. Gan, M.B., B.S., FRCA<br />
Eugene W. Moretti, M.D.<br />
Laura E. Niklason, M.D., Ph.D.<br />
Jacques Somma, M.D., FRCP(C)<br />
In 1984, Duke University Medical Center<br />
performed the first liver transplant in<br />
the Southeast. Program landmarks<br />
include approval as a Medicare facility<br />
in 1994, the first center world-wide offering<br />
an ex-vivo transgenic pig liver perfusion<br />
system for fulminant hepatic<br />
failure, initiation of the living-related<br />
program for children in 1997, and live<br />
donor right hepatectomy for adult<br />
recipients in 1999. In January 2001,<br />
we welcomed a new Surgical Director<br />
for the Liver Transplant Program, Dr.<br />
Paul Kuo, from Georgetown University<br />
in Washington, D.C, who joined Drs.<br />
Betsy Tuttle-Newhall and Bradley<br />
Collins. We are also delighted to have<br />
the experience and expertise of Dr.<br />
D. Ryan Cook, who has joined our pediatric<br />
faculty, and is the world’s leading<br />
expert in pediatric liver transplantation.<br />
Nationwide there are currently 121<br />
programs sharing a pool of 4900 cadaveric<br />
donors per year, with 17,376 patients<br />
listed as waiting recipients. The<br />
typical recipient is a male between the<br />
ages of 35 and 64, with an O or A blood<br />
type and medical urgency status 2B or<br />
3. Within our region, the NCNC-OP 1<br />
Carolina Donor Services recovers between<br />
80 and 100 cadaveric livers each<br />
year which are shared by Duke University<br />
Medical Center and UNC Hospitals.<br />
The 1-month, 1- and 3-year patient survival<br />
outcomes for liver transplants performed<br />
at Duke from January 1997 to<br />
December 1998 are 94%, 82%, and<br />
74%, compared to the UNOS-reported<br />
national averages of 94%, 86% and 81%,<br />
respectively.<br />
Anesthesia faculty members provide<br />
24-hour clinical coverage for 45<br />
to 50 cases per year, from a waiting list<br />
exceeding 200 patients. A target of 80<br />
cases per year has been set, to be<br />
achieved by 2003. With surgical preservation<br />
of the inferior vena cava, use of<br />
antifibrinolytic therapy, lowering cardiac<br />
filling pressures (low CVP anesthesia)<br />
and the infusion of octreotide for<br />
portal hypertension, blood product<br />
replacement therapy has been significantly<br />
reduced. Moments of excellence<br />
in patient care have included requirements<br />
for no blood products, fast tracking<br />
with extubation in the operating<br />
room, survival of massive intraoperative<br />
pulmonary embolism and discharge<br />
from hospital on post-operative day two.<br />
Current research interests include<br />
pharmacokinetics of muscle relaxants,<br />
defining optimum perioperative care of<br />
the living liver donor and determination<br />
of the clinical efficacy of octreotide.
CENTER FOR<br />
HYPERBARIC MEDICINE<br />
AND ENVIRONMENTAL<br />
PHYSIOLOGY<br />
Richard E. Moon, M.D.,<br />
C.M., M.Sc., FRCP(C),<br />
FACP, FCCP<br />
Medical Director,<br />
HyperbaricCenter<br />
Professor of Anesthesiologyr<br />
of Anesthesiology<br />
Associate Professor of Medicine<br />
The Center<br />
The Center for Hyperbaric Medicine<br />
and Environmental Physiology is a<br />
multi disciplinary organization involved<br />
in clinical treatment of patients with<br />
hyperbaric oxygen, research into oxygen<br />
biology and environmental physiology<br />
(especially diving and altitude<br />
physiology) and provision of information<br />
and medical services for recreational<br />
divers through the Divers Alert<br />
Network.<br />
The Center for Hyperbaric Medicine<br />
and Environmental Physiology<br />
consists of several components. The<br />
F.G. Hall Environmental Laboratory<br />
contains a seven-chamber 254 cu m<br />
complex with a 5,660 cu m compressed<br />
air storage field, three 3 cu m/min air<br />
compressors, a 2,633 cu m liquid oxygen<br />
system, two vacuum pumps, and<br />
a complete gas mixing facility. These<br />
chambers were designed to simulate<br />
environments ranging from an altitude<br />
of 47,000 m (155,000 feet) to a depth<br />
of 1,100 msw (3,600 feet of sea water).<br />
The chambers are outfitted with environmental<br />
control units, which regulate<br />
temperature, humidity, and CO 2 accumulation.<br />
The facility also incorporates<br />
the capability to conduct studies of<br />
subjects immersed in water. Electrical<br />
penetrators are installed, allowing physiological<br />
monitoring of patients undergoing<br />
treatment, human subjects and<br />
experimental animals inside the chambers.<br />
Studies have been performed in<br />
humans incorporating invasive measurement<br />
of arterial and pulmonary<br />
arterial pressures, transcranial Doppler<br />
blood velocity, precordial Doppler<br />
monitoring for vascular bubbles and<br />
in vivo near infrared spectroscopy of<br />
tissue oxygenation. In addition to the<br />
chambers, a human physiology laboratory<br />
is available for human studies at<br />
1 ATA. An electronics shop and<br />
machine shop provide in-house design<br />
and construction facilities.<br />
The Oxygen Transport Laboratory<br />
has facilities for studies of whole animal<br />
and tissues. It incorporates an operating<br />
room and facilities capable of maintaining<br />
anesthetized animals under continuous<br />
monitoring for several days.<br />
It is equipped with an environmental<br />
exposure facility, biochemistry and<br />
molecular biology laboratories and<br />
microscopy and darkroom facilities.<br />
The Divers Alert Network (DAN) is<br />
an organization devoted to promotion<br />
of recreational diving safety via accident<br />
and mortality data collection, research<br />
and education. In addition DAN<br />
provides a 24-hour phone consultation<br />
service for diving accidents (see below).<br />
Clinical Activities<br />
Twenty-four hour coverage is provided<br />
for hyperbaric emergencies and elective<br />
treatment of patients with hyperbaric<br />
oxygen. The call team consists of an<br />
intern, resident or fellow, an attending<br />
physician, a nurse and a chamber operator.<br />
The call schedule also includes<br />
“hotline” coverage of emergency diving<br />
calls from throughout the world.<br />
CLINICAL ACTIVITIES<br />
A total of 200 new patients were evaluated<br />
for hyperbaric therapy in 2000<br />
(6,721 treatment hours). There were an<br />
additional 48 patients evaluated but<br />
who did not receive treatment, including<br />
fitness-to-dive consults and patients<br />
with various wounds for whom hyperbaric<br />
oxygen therapy was not recommended.<br />
New patients included 28<br />
patients with decompression sickness, 5<br />
with air embolism, 29 with carbon<br />
monoxide poisoning and 18 with necrotizing<br />
soft tissue infections. There were<br />
95 emergency hyperbaric treatments.<br />
In addition, 7 therapeutic lung lavages<br />
for patients with pulmonary alveolar<br />
proteinosis were carried out under general<br />
anesthesia inside “C” chamber to.<br />
For this procedure hyperbaric oxygen<br />
provides a convenient mechanism for<br />
treatment of hypoxemia. Non-emergency<br />
conditions treated included<br />
refractory osteomyelitis, threatened<br />
flaps, radiation necrosis and selected<br />
ischemic problem wounds. The service<br />
relies heavily on a computerized database,<br />
designed and maintained by Dr.<br />
Guy Dear, accessible from anywhere<br />
within the Medical Center. All clinical<br />
notes are computer-generated and<br />
accessible via the Duke hospital-wide<br />
computer system.<br />
The following physicians participated<br />
in clinical activities in the<br />
Hyperbaric Center in 2000:<br />
Martha Sue Carraway, M.D.<br />
Department of Medicine<br />
Guy deLisle Dear, M.B., FRCA<br />
Department of Anesthesiology<br />
Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP<br />
Departments of Anesthesiology and<br />
Medicine, Medical Director<br />
Claude A. Piantadosi, M.D.<br />
Departments of Medicine and<br />
Anesthesiology, Center Director<br />
Bryant W. Stolp, M.D., Ph.D.<br />
Department of Anesthesiology<br />
Edward D. Thalmann, M.D.<br />
Department of Anesthesiology<br />
Since 1986 there have been 14 clinical<br />
fellows in Hyperbaric Medicine.<br />
The training, which has been up to two<br />
CLINICAL ACTIVITIES 55
CLINICAL ACTIVITIES<br />
years, has combined clinical responsibilities<br />
and research. Fellows for 2000<br />
have been David Hendricks, M.D.<br />
(January-June), Charles Gleaton, M.D.<br />
(January-June) and John Freiberger,<br />
M.D. (July-December). Klaus Torp,<br />
M.D., a visiting Fellow from Mayo Clinic<br />
for three months completed a study of<br />
the effect of simvastatin on hypoxic<br />
pulmonary vasoconstriction.<br />
The full time nursing staff are:<br />
Kevin L. Kraft, RN<br />
John H. Rice, RN (Head Nurse)<br />
Roberta E. Rose, RN<br />
A number of part time nurses also<br />
participate in patient care.<br />
Teaching<br />
For the second year, a 37-hour course<br />
in the Physiology of Extreme Environments<br />
was given (CBI206/ANE245.<br />
Duke University Graduate and Medical<br />
School. Fall Semester 2000: Richard D.<br />
Vann, Ph.D., Course Director). In addition<br />
to lectures on the physiology of<br />
high pressure, hyperoxia, hypoxia,<br />
immersion and hypothermia, the course<br />
included practical laboratories on diagnosis<br />
and management of hyperbaric<br />
and diving related emergencies. The<br />
course was made available not only for<br />
the fellows and students working in the<br />
Center, but also for faculty, residents<br />
and fellows in the Department.<br />
The Center also participates in the<br />
teaching for the Anesthesiology and<br />
Environmental Physiology section for<br />
the third year medical student curriculum.<br />
Two third year medical students<br />
(Jason Archibald and Heather<br />
Mummery) are currently working in<br />
the center on human experiments at<br />
altitude and during diving. Interns regularly<br />
rotate onto the Hyperbaric Service,<br />
as do fellows in critical care and a number<br />
of medical students. Hyperbaric<br />
Grand Rounds in 2000 included the<br />
following lectures: DAN: Beginnings –<br />
Today – Tomorrow; Australian Experience<br />
on CO Poisoning; Marine Biotoxins;<br />
Pulmonary Alveolar Proteinosis;<br />
Biochemical Markers of Tissue Damage<br />
in Response to Bubbles and Other<br />
56 CLINICAL ACTIVITIES<br />
Injuries; Bubble Trouble: Surface Tension,<br />
Surfactants and Gas Nuclei; High<br />
Altitude Expeditions on Mt. Everest.<br />
A monthly conference on diving medicine<br />
is held at the DAN building.<br />
Academic Productivity<br />
PHOTO BY STEVE BARNETT<br />
A hyperbaric technician from the<br />
Center for Hyperbaric Medicine and<br />
Environmental Physiology uses Doppler<br />
device on a DAN research volunteer<br />
after a simulated dive in the chamber.<br />
The investigators in the Hyperbaric<br />
Center are pursuing studies on the<br />
mechanisms by which investigations<br />
into the effects of altered environmental<br />
conditions (altitude and diving) affect<br />
on human physiology, and into the<br />
biology of oxygen and nitric oxide at<br />
different gas pressures. Investigators<br />
in the Center include the following:<br />
Peter B. Bennett, Ph.D., D.Sc<br />
Department of Anesthesiology<br />
Martha Sue Carraway, M.D.<br />
Department of Medicine<br />
Guy deLisle Dear, M.B., FRCA<br />
Department of Anesthesiology<br />
Ivan T. Demchenko, D.Sc.<br />
Department of Anesthesiology<br />
Petar J. Denoble, M.D., Ph.D.<br />
Department of Anesthesiology<br />
Habib El-Moalem, Ph.D.<br />
Department of Anesthesiology<br />
Wayne A. Gerth, Ph.D.<br />
Department of Anesthesiology<br />
E.N. Grayck, M.D.<br />
Deptartment of Pediatric Critical<br />
Care<br />
Y.C.T. Huang, M.D.<br />
Department of Medicine<br />
T. McMahon, M.D.<br />
Department of Medicine<br />
Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP<br />
Departments of Anesthesiology<br />
and Medicine<br />
Carl F. Pieper, D.P.H.<br />
Deptartment of Biometry<br />
Claude A. Piantadosi, M.D.<br />
Departments of Anesthesiology<br />
and Medicine<br />
Neal W. Pollock, Ph.D.<br />
Department of Anesthesiology<br />
Herbert A. Saltzman, M.D.<br />
Department of Medicine<br />
Bryant W. Stolp, M.D., Ph.D.<br />
Department of Anesthesiology<br />
and Cell Biology<br />
Hagir B. Suliman, D.V.M., Ph.D.<br />
Department of Anesthesiology<br />
Edward D. Thalmann, M.D.<br />
Department of Anesthesiology<br />
D.M. Uguccioni, M.Sc.<br />
Department of Anesthesiology<br />
Richard D. Vann, Ph.D.<br />
Department of Anesthesiology<br />
K. Welty-Wolfe, M.D.<br />
Department of Medicine<br />
The following projects were underway<br />
in 2000:<br />
Acute Lung Injury-Mechanisms and<br />
Therapy (Drs. Piantadosi, Welty-Wolf,<br />
Carraway)<br />
Animal models have been developed<br />
to study acute lung injury due<br />
to oxygen toxicity and sepsis. Methods<br />
of assessment include gas exchange<br />
(blood gases and multiple inert gas<br />
elimination), mechanics, lung morphometry<br />
and measures of the pulmonary<br />
inflammatory response.
Adjuncts to Recompression Therapy for<br />
Severe Dysbaric Diseases (Dr.<br />
Thalmann)<br />
A literature search has been conducted<br />
to identify pharmacological<br />
adjuvants, which might be useful in<br />
treating decompression illness. The<br />
focus has been on the scenario in<br />
which there is a long, unavoidable<br />
delay in obtaining recompression, in<br />
order to identify pharmacological<br />
agents that might reduce the negative<br />
effect of the long pre-treatment surface<br />
intervals on morbidity.<br />
Analysis of the Effectiveness of Hyperbaric<br />
Oxygen Treatment for Radiation<br />
Cystitis (Drs. Hendricks, Moon, Stolp,<br />
Dear, Piantadosi)<br />
Numerous published reports support<br />
the use of HBO for the treatment<br />
of radiation-induced cystitis. However,<br />
neither the optimum treatment pressure<br />
nor the optimum number of treatments<br />
are known. To determine these factors,<br />
a meta-analysis is being performed<br />
using a database that includes patients<br />
treated at Duke and published series.<br />
Biological Effects of Low Frequency<br />
Sonar Signals on Divers (Drs.<br />
Thalmann, Gerth)<br />
Low frequency sonar is a new<br />
method of communication between<br />
submarines. Theoretical concerns<br />
about possible deleterious biological<br />
effects are being investigated.<br />
Development of Efficient Oxygen Delivery<br />
Systems for Field Use (Drs. Vann,<br />
Pollock)<br />
Testing of several rebreathing<br />
circuits to determine the optimum<br />
design to maximize inspired PO 2 and<br />
minimize inspired PCO 2 at sea level and<br />
simulated altitudes of 15,000 and 30,000<br />
feet, under conditions of rest and<br />
exercise.<br />
Effect of Altitude Hypoxia and Hyperbaric<br />
Oxygenation on S-nitrosohemoglobin<br />
Concentration and Vascular Tone in<br />
Humans (Drs. Piantadosi, Moon,<br />
Stolp, Dear, Carraway, McMahon,<br />
Mr. Archibald)<br />
A joint study with members from<br />
the Department of Medicine (Drs.<br />
Piantadosi, Carraway, McMahon) has<br />
been completed to examine the<br />
hypothesis that PO 2-related changes<br />
in pulmonary and systemic vascular<br />
resistance in humans are mediated<br />
by S-nitrosohemoglobin. This will be<br />
followed by a study of prolonged exposure<br />
to 15,000 feet altitude with volunteers<br />
instrumented with arterial and<br />
pulmonary artery catheters.<br />
Effect of Ascent Rate on Venous Gas<br />
Embolism and Decompression Illness in<br />
Scuba Divers (Drs. Vann, Denoble)<br />
With support from the Divers Alert<br />
Network, a large series of chamber trials<br />
is underway to study the effect on<br />
decompression illness and venous gas<br />
embolism of ascent rates, which have<br />
in the past been recommended as low<br />
as 10 ft/min and as high as 60 ft/min.<br />
Ascent rates of 10 fpm and 60 ft/min<br />
will be tested in a series of dive profiles<br />
over a range of no-stop bottom times at<br />
a depth of 100 fsw.<br />
Establishing a Multi-Center, Multi-<br />
Disciplinary Program for Improving Diver<br />
Thermal Protection Hardware in Warm<br />
and Cold Water (Drs. Thalmann, Gerth)<br />
The goal of this project is to establish<br />
a long range, ongoing, multi-disciplinary<br />
program to address the thermal<br />
protection needs of the military diver.<br />
Current thermal protection methodology<br />
has several shortcomings; passive<br />
garments are bulky and provide inadequate<br />
protection to the hands and feet,<br />
active systems have yet to be designed,<br />
which are compatible with current mission<br />
profiles. In addition, little attention<br />
has been paid to the thermal problems<br />
encountered by divers who must dive<br />
in hot water, such as in the Persian<br />
Gulf. We will combine literature<br />
searches with direct contacts of those<br />
in the field to identify deficiencies and<br />
possible methods of addressing them.<br />
The centerpiece of this effort will be<br />
a symposium where we will invite<br />
scientists and engineers from various<br />
disciplines to discuss new cutting edge<br />
CLINICAL ACTIVITIES<br />
technology that may have current application.<br />
We will also identify any physiological<br />
areas which may not have<br />
been sufficiently investigated and<br />
which may impact on the design of protective<br />
garments. One example would<br />
be the effect or regional heating of the<br />
hand and forearm on heatflow from the<br />
rest of the body. Once we have an idea<br />
of what types of technologies are available,<br />
and which types of institutions<br />
may have a role in applying that technology<br />
to operational problems we<br />
will develop a BAA, which will solicit<br />
research proposals targeted at applying<br />
these technologies to existing problems.<br />
This BAA will be turned over to the program<br />
sponsor and form the basis of a<br />
follow on R&D program. In addition<br />
we will summarize our finding in a<br />
report for future reference.<br />
Field Measurement of Plasma Glucose in<br />
Insulin-Requiring Diabetics During Scuba<br />
Diving (Drs. Dear, Moon, Feinglos,* Ms.<br />
Uguccioni, Mr. Dovenbarger)<br />
*Division of Endocrinology, Department<br />
of Medicine<br />
Insulin-requiring diabetics have<br />
traditionally been excluded from scuba<br />
diving because of the risk of severe<br />
hypoglycemia underwater. Field studies<br />
in insulin-requiring diabetics are underway<br />
to determine the probability of<br />
hypoglycemia during recreational scuba<br />
diving under tightly controlled circumstances.<br />
A database of 500 man-dives<br />
has been established, which includes<br />
plasma glucose measurements before<br />
and after each dive.<br />
Influence of Surfactants on Bubble<br />
Formation in Gelatin (Drs. Vann,<br />
Gaskins, Mr. Hobbs)<br />
The theoretical effects of surfactants<br />
on bubble formation are widely<br />
cited with regard to the mechanisms<br />
of decompression sickness, but no data<br />
are available to test the theory. We are<br />
studying the effects of surfactant concentration<br />
on bubble formation in<br />
gelatin.<br />
CLINICAL ACTIVITIES 57
CLINICAL ACTIVITIES<br />
Molecular Biology of Anti-Oxidant<br />
Enzymes in the Lung (Drs. Suliman,<br />
Carraway, Piantadosi)<br />
The pulmonary response to oxidative<br />
stress often determines the severity<br />
of injury following acute insults to the<br />
lung. These studies are exploring the<br />
mechanisms of regulation, cellular location<br />
and effects on injury of altered<br />
expression of key pulmonary antioxidant<br />
enzymes on injury during<br />
exposure to changes in oxygen partial<br />
pressure across a wide spectrum of<br />
environments.<br />
Oxygen Acceleration of Nitrogen-Oxygen<br />
Decompression in Submarine Rescue<br />
Scenarios (Drs. Thalmann, Gerth)<br />
The aim is to develop decompression<br />
models applicable to submarine<br />
rescue scenarios in which survivors are<br />
likely to be saturated on air or air with<br />
a reduced oxygen content at ambient<br />
pressures as high as five atmospheres<br />
absolute. These models should predict<br />
how oxygen be used to decrease the<br />
decompression time so rescue is not<br />
unavoidably delayed. Manned trials<br />
have been conducted at the Navy<br />
Experimental Diving Unit in Panama<br />
City, Florida on several decompression<br />
schedules and the results suggest<br />
breathing 100% oxygen before beginning<br />
ascent is more efficient than<br />
breathing it at decompression stops.<br />
In addition, assistance was provided to<br />
investigators at the Navy Experimental<br />
Diving Unit in Panama City, Florida<br />
(NEDU) in developing decompression<br />
procedures for diving at altitude, helium<br />
oxygen decompression, and decompression<br />
table integration.<br />
Oxygen Delivery During High Altitude<br />
Moutaineering (Drs. Vann, Pollock, Mr.<br />
Natoli)<br />
Oxygen supplies are limited during<br />
high altitude expeditions. We are testing<br />
a patented system for efficient oxygen<br />
delivery during mountaineering<br />
operations. This system uses CO 2<br />
rebreathing to compensate for altitudeinduced<br />
hypocapnia.<br />
58 CLINICAL ACTIVITIES<br />
Plasma Glucose Analysis During Hyperbaric<br />
Oxygen Therapy (Drs. Vote, Moon,<br />
Freiberger)<br />
Hyperbaric oxygen therapy has<br />
been reported to induce hypoglycemia<br />
in diabetics. A study to establish the<br />
accuracy of clinical glucometers during<br />
HBO administration is being followed<br />
by a QA assessment to determine<br />
whether hypoglycemia can be precipitated<br />
by HBO.<br />
Prevention of Decompression Sickness<br />
in Space (Drs. Vann, Pollock)<br />
Efforts will continue with NASA<br />
support to develop more efficient<br />
means to prevent DCS in astronauts<br />
during extravehicular activity (EVA) in<br />
space flight and during flight in aircraft<br />
after ground-based training in neutral<br />
buoyancy pools. Our DCS risk models,<br />
for example, can now support real-time<br />
staged decompressions of the EVA suit,<br />
which could obviate need for lengthy<br />
and costly pre-EVA oxygen breathing<br />
without compromising either safety<br />
or the astronaut.<br />
Studies<br />
Project Dive Exploration (Drs. Vann,<br />
Denoble)<br />
DAN has worked with the dive<br />
computer manufacturers to develop<br />
a prospective observational study<br />
called Project Dive Exploration (PDE)<br />
that records depth/time profiles from<br />
recreational divers who volunteer to<br />
carry recording dive computers during<br />
their open-water dives. Additional data<br />
is collected on demographics, medical<br />
history, dive conditions, and medical<br />
outcome of the dives. Over the past<br />
two years, DAN has collected data on<br />
14,000 individual dives during which<br />
four divers were treated for DCI. The<br />
goal is to collect data on 1,000,000<br />
recreational dives. The data collected<br />
will better define the risks associated<br />
with different diving practices and will<br />
help establish guidelines for risk<br />
exposure.<br />
Prospective Analysis of the Effectiveness<br />
of Hyperbaric Oxygen Treatment for<br />
Radiation Necrosis of the CNS (Drs.<br />
Gleaton, Moon, Stolp, Dear, Piantadosi,<br />
Thalmann, Carraway, Friedman*,<br />
Logue‡, Dunn‡)<br />
* Dept. of Pediatrics;<br />
‡ Dept. of Psychiatry and Behavioral<br />
Science.<br />
Hyperbaric oxygen therapy has<br />
been shown to be a highly effective<br />
treatment for radiation necrosis of bone<br />
and soft tissue. Anecdotal evidence<br />
supports its efficacy in radiation injury<br />
to peripheral nerve and the central nervous<br />
system. Clinical data are being<br />
collected on a consecutive series of<br />
patients with radiation-induced CNS<br />
injury treated with HBO.<br />
Pulmonary Gas Exchange During Diving<br />
(Drs. Moon, Stolp, Dear, Ms. Mummery)<br />
A study to determine the effect<br />
of age on the increase in respiratory<br />
dead space during diving is underway.<br />
Volunteers of two age groups (20 - 40<br />
and 50 - 70) are being compared. Bohr<br />
dead space is being measured at rest<br />
and during two levels of exercise at sea<br />
level and 60 feet equivalent depth.<br />
Regulation of Cerebral Blood Flow in<br />
Hyperoxia, Hypercarbia, Hypoxia, CO<br />
Hypoxia and Oxygen Convulsions<br />
(Drs. Demchenko, Allen, Bennett,<br />
Piantadosi)<br />
Dr. Ivan Demchenko, visiting scientist<br />
from the Institute of Evolutionary<br />
Physiology and Biochemistry, St.<br />
Petersburg, Russia, performed investigations<br />
on the role of endogenous nitric<br />
oxide in the regulation of cerebral<br />
blood flow in hyperoxia, hypercarbia,<br />
hypoxia, CO hypoxia and oxygen convulsions.<br />
These studies have provided<br />
the first direct evidence that hyperoxic<br />
vasoconstriction in the brain is a result<br />
of decreased NO availability due to<br />
the overproduction of the superoxide<br />
anion.
Safe Post-Dive Surface Intervals Before<br />
Military Free-Fall Parachuting (Drs. Vann,<br />
Pollock, Thalmann)<br />
Human studies are underway for<br />
the U.S. Military Special Operations<br />
Command to determine the minimum<br />
appropriate interval between diving<br />
to depths of 60-100 feet and ascent to<br />
22,500 feet altitude followed by free<br />
fall/parachute descent to sea level.<br />
Divers Alert Network (DAN)<br />
The Divers Alert Network, a recreational<br />
diving medical safety association, was<br />
organized in 1980 in order to (1) collect<br />
data on recreational diving accidents,<br />
(2) provide 24 hour emergency consultation<br />
for scuba diving accident management,<br />
(3) provide consultation for<br />
physicians and recreational divers on<br />
medical conditions which pertain to<br />
scuba diving safety, (4) promote diving<br />
safety by research.<br />
In 1991 DAN had grown too large<br />
to be accommodated within the Hyperbaric<br />
Center, and new facilities were<br />
rented in the University Tower. In addition<br />
to providing office space for 52<br />
full-time DAN employees, there were<br />
conference rooms, a classroom and<br />
a production facility of the bimonthly<br />
DAN newsletter, Alert Diver. The construction<br />
of a new 27,000 sq ft DAN<br />
building was completed and DAN<br />
moved its now 65 staff to it in July<br />
of 1997.<br />
In 1991 DAN became international<br />
with DAN-Japan, DAN-Europe, DAN-<br />
South East Asia-Pacific and in 1997 DAN<br />
Southern Africa were organized in<br />
order to enlarge the database. During<br />
2000 DAN answered 11,452 dive medical<br />
and safety telephone calls, 2,988<br />
e-mail inquiries and responded to 2,889<br />
emergency calls. Additional accomplishments<br />
include collection of data<br />
on dive fatalities, organization of CME<br />
dive accident management courses and<br />
instruction of Medical Technicians<br />
(EMT's) in O 2 administration. DAN<br />
supports salaries of Department faculty<br />
who participate in DAN activities and<br />
provides funds for research.<br />
DAN Staff<br />
Administration: Peter B. Bennett, Ph.D.,<br />
D.Sc., President and CEO, Cindi<br />
Easterling, M.Ed. Vice President CME<br />
and Executive Assistant to CEO; Sherry<br />
Strickland, Staff Assistant; Cindi Duryea,<br />
Staff Assistant; Operations: Dan Orr,<br />
MS, Executive Vice President and COO;<br />
Jeannie Floyd, Staff Specialist; Webb<br />
Roberts, M.B.A., Vice President Operations;<br />
Brian Levering, Material Control<br />
Manager; Doris Lynch, Buyer; James<br />
Fisher, Ralph Ariail, Tommy Fowler,<br />
Larry Crabtree, Bill Terry; Shipping,<br />
James Hallmon, Shirley Fowler, Marge<br />
Rimmer, Cliff Nutt, Mailroom; Medical:<br />
Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP, Vice President<br />
and Medical Director; Bryant W. Stolp,<br />
M.D., Ph.D., Assistant Medical Director;<br />
Guy deLisle Dear, M.B., FRCA, Assistant<br />
Medical Director; Edward D. Thalmann,<br />
M.D., Assistant Medical Director; Joel<br />
Dovenbarger, RN, Vice President Medical<br />
Services; Daniel Nord, Director<br />
Medical Services; Medics: Celia Evesque,<br />
Dan Kinkade; Jane Foley, Administrative<br />
Secretary; Julie Ellis, Research<br />
Secretary; Finance: Chris Bennett,<br />
M.B.A., Vice President Finance and<br />
CFO; Beth Hawkins, CPA, Controller;<br />
Pam Everline, Allan Krehbiel, Lucy<br />
Williams; IDAN: Chris Wachholz, RN,<br />
M.B.A., Vice President IDAN; Elizabeth<br />
Carrasquillo, Latin America Coordinator;<br />
Martha Davis; Research: Richard D.<br />
Vann, Ph.D., Vice President Research;<br />
Petar Denoble, M.D., D.Sc., Senior<br />
Research Director; Donna Uguccioni,<br />
Research Physiologist; Randy Sitzes,<br />
Research Manager; Lisa Li, Computer<br />
Programmer; Jamahl Greene, Secretary;<br />
Training: Bill Clendenen, M.B.A., Vice<br />
President Training; Denise Haskins,<br />
Secretary; Eric Douglas, Mark Butler,<br />
Staff Specialists; Marketing: Barry<br />
Shuster, M.B.A., Vice President Market-<br />
CLINICAL ACTIVITIES<br />
PHOTO BY STEVE BARNETT<br />
DAN research participants undergo a<br />
series of tests to determine their overall<br />
fitness to dive, including this neurological<br />
examination.<br />
ing; Jim Gaston, Marketing Services<br />
Manager; Steve Barnett, Sales and<br />
Promotions Manager; Colin Taylor,<br />
Field and Services Representative; Rick<br />
La Reno, Shelby Cutts, Dave Lawler,<br />
Manager Industry Membership Program;<br />
Laura Johnson, Eileen Weckerle;<br />
Information Technology: Donna Heath,<br />
Vice President Information Technology;<br />
Panchabi Viethiyanathan, Bryon<br />
Buesser, Peter Winkler, Kim Walker,<br />
Bud Elvin; Sponsorship: Cindi Courter,<br />
M.B.A., Sponsor/Development Chief;<br />
Michele Harrison, Deb Taft; Renee<br />
Westerfield, Communications Director;<br />
Rick Melvin, Steve Mehan, Dan Leigh,<br />
Wesley Hyatt.<br />
DAN provides research funding<br />
(total $400,000) for a number of investigations<br />
being pursued by Anesthesiology<br />
faculty. These include Flying after<br />
Diving, Project Dive Exploration and<br />
Plasma Glucose Monitoring during Recreational<br />
Scuba Diving, Doppler Data<br />
Collection during Open Water Diving<br />
and Development of a Rebreathing<br />
Circuit for Emergency Oxygen Delivery.<br />
CLINICAL ACTIVITIES 59
CLINICAL ACTIVITIES<br />
ORTHOPAEDICS,<br />
PLASTICS AND<br />
REGIONAL<br />
<strong>ANESTHESIOLOGY</strong><br />
Francine J. D’Ercole, M.D.<br />
Division Chief, Orthopaedics,<br />
Plastics and Regional<br />
Anesthesiology<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Members:<br />
Helene D. Benveniste, M.D., Ph.D.<br />
Alexis C. Carmer, M.D.<br />
Jennifer T. Fortney, M.D.<br />
H. David Hardman, M.D., M.B.A.<br />
Andrew J. Hartle, M.B., Ch.B., FRCA<br />
David B. MacLeod, M.B., B.S., FRCA<br />
Gavin Martin, M.B., Ch.B., FRCA<br />
Stephen J. Parrillo, M.D.<br />
CRNA Clinical Leads<br />
Patricia M. Allushuski, CRNA, MSN<br />
Pegge L. Hall, CRNA, MSN<br />
CRNA Members<br />
Maurice L. Begin, CRNA<br />
Leslie A. Cline, CRNA, MSN<br />
Ann M. Connell, CRNA<br />
E. Susan Crumpler, CRNA<br />
Terry W. English, CRNA, MS<br />
David H. Gleason, CRNA, BHS<br />
Mack E. Haddock, CRNA<br />
Shelley T. Hilliard, BSN, CRNA<br />
Mary Ann L. Romero, CRNA<br />
Craig E. Shanewise, CRNA, MNA<br />
Henry J. Walker, CRNA, MS, M.B.A.<br />
60 CLINICAL ACTIVITIES<br />
Research Nurse<br />
Karen W. Ramsey, RN, M.B.A.<br />
Support Staff<br />
Pam Upadhaya<br />
Intra-Op Autotransfusion<br />
Coordinator<br />
Francis Osgood, BS, RCP<br />
The Division of Orthopedics, Plastics<br />
and Regional Anesthesiology was<br />
formed in July, 1998. The Division was<br />
created to serve the large inpatient<br />
population requiring total joint replacement,<br />
spine surgery, advanced plastic<br />
surgery and associated orthopedic trauma<br />
surgery. Additionally, the Division<br />
promotes a consult service for special<br />
needs patients requiring regional anesthesiology<br />
techniques. Some surgical<br />
patients may require regional anesthesia<br />
for the management of acute and<br />
chronic pain control. Other patients<br />
managed with regional anesthesia techniques,<br />
especially those with co-existing<br />
disease, may accelerate the patient's<br />
return-to-function with a subsequent<br />
earlier hospital discharge. Recently, the<br />
literature provides evidence regional<br />
anesthesia reduces postoperative mortality<br />
and other serious complications<br />
(1).<br />
Clinical Service<br />
The Regional Anesthesiologist is an<br />
anesthesiologist and consultant trained<br />
in the delivery of state-of-the-art regional<br />
anesthesiology techniques who has<br />
made a long-term commitment to continue<br />
learning and teaching to excel the<br />
specialty. The role as a “Regionalist” is<br />
the design of a patient-focused anesthetic<br />
plan and post-operative management<br />
plan implementing regional anesthesia<br />
techniques which promote a faster<br />
recovery and improve outcomes. This<br />
anesthesiology division is responsible<br />
for quality patient care in cohesive<br />
working relationship with Surgery Division<br />
Chiefs Drs. James Urbanik and<br />
Scott Levin. Additionally, pediatric<br />
orthopedic and general surgical<br />
patients requiring advanced regional<br />
techniques are managed.<br />
Education<br />
The greatest asset fortifying the division<br />
is the consistent effort made in teaching.<br />
The investment made in nurturing<br />
regional anesthesia skills during residency<br />
training and encouraging a lifetime<br />
commitment to learning even after<br />
residency remains the essence for a<br />
well-trained manpower force. The faculty<br />
who teach regional techniques<br />
at Duke remain on a motivated career<br />
path to enhance skills, including effective<br />
ways to teach these skills. Dr. David<br />
MacLeod has developed the Human<br />
Fresh Tissue Lab which allows gross<br />
anatomic instruction to enhance the<br />
understanding of anatomic relationships<br />
pertinent to peripheral nerve<br />
blockade and neuraxial blockade (see<br />
Figure 1). Additionally, Drs. Benveniste<br />
and MacLeod have utilized the (MRI)<br />
imaging lab to answer specific questions<br />
which arise during the clinical<br />
application of regional anesthesiology<br />
techniques. Training residents, fellows<br />
or cross-training faculty continues to be<br />
enforced in the preoperative regional<br />
block area which promotes an effective<br />
learning curve for regional anesthesia<br />
techniques when compared to other<br />
teaching modalities at other programs<br />
(2,3). The Duke regional anesthesiology<br />
handbook for senior residents and the<br />
abridged version for CA-1’s residents<br />
was developed and co-edited by Dr.<br />
Alexis Carmer. A resident student lecture<br />
series and the medical student lecture<br />
series is supported by the division.<br />
Additionally, guest speakers are invited<br />
to divisional meetings. This year, Dr.<br />
James Crews presented the results of<br />
his clinical trials on the new local anesthetic,<br />
levo-bupivacaine, now on formulary.<br />
Fundamental questions pertaining<br />
to regional anesthesia techniques and<br />
local anesthetics are acknowledged<br />
through the AnesthesiaWeb.com by<br />
Dr. Fran D’Ercole.
Research and<br />
Developmental Goals<br />
The focus of research development and<br />
the selection of clinical trials are based<br />
on practical needs identified in orthopedic<br />
and plastic surgery patient care.<br />
Dr. Alexis Carmer is engaged in a<br />
prospective study evaluating the delirium<br />
rate in the elderly requiring orthopedic<br />
surgery and comparing general<br />
versus regional anesthesia is an IRB<br />
approved study. Additionally, the division<br />
is engaged in outcome studies in<br />
the geriatric patient population requiring<br />
major orthopedic surgery in collaboration<br />
with Madan Kwatra, Ph.D. and<br />
the VAH. Dr. Gavin Martin has been<br />
very involved with phase II and III clinical<br />
trials using slow release epidural<br />
liposomal morphine and slow release<br />
hydromorphone for the last two years.<br />
Other IRB approved funded studies<br />
include Arrow’s esophageal doppler for<br />
fluid management during major spine<br />
surgery. Successfully completed studies<br />
include the multi-center phase III artificial<br />
hemoglobin blood substitute investigation<br />
using allogenic bovine red<br />
blood cell (HBOC-201) in orthopedic<br />
patients requiring transfusion. Technical<br />
support for the HBOC-201 Biopure study<br />
was coordinated by Karen Ramsey, RN,<br />
M.B.A. Additionally, Karen Ramsey has<br />
demonstrated excellent rapport with<br />
industry including the drafting of financial<br />
budgets for clinical trials. Clinical<br />
trials in coordination with Dr. Brian<br />
Ginsberg have involved several multiphase<br />
post-op trials for the total hip and<br />
knee replacement patient population.<br />
A few of these studies included immediate<br />
release oxymorphone, sustained<br />
release hydromorphine, IV acetaminophen<br />
and COX2 medications. Dr.<br />
CLINICAL ACTIVITIES<br />
Duke Anesthesiology residents interating with anatomist in the Human Fresh<br />
Tissue Laboratory. Ths lab was designed by Dr. David MacLeod to enhance<br />
education in regional anesthesiology.<br />
Helene Benveniste, former FAER grant<br />
recipient, orchestrates basic science<br />
research for the division. Dr.<br />
Benveniste’s research focuses on the<br />
development of imaging paradigms to<br />
detect and follow progression of early<br />
pathology in Alzheimer's disease. This<br />
includes creating a high-resolution 3D<br />
digital C57B16/J mouse brain atlas by<br />
magnetic resonance imaging to be used<br />
as a standard reference for all neuroanatomical<br />
phenotyping of transgenic,<br />
targeted induced mutations in<br />
mice.<br />
Philanthropy<br />
Congratulations to Maurice Begin,<br />
CRNA and his successful missionary<br />
effort with ORBIS. This opportunity has<br />
provided Mo the experience of delivering<br />
anesthesia in third world countries<br />
in an aircraft with a state-of-the-art operating<br />
room facility designed specifically<br />
for Eye Surgery.<br />
CLINICAL ACTIVITIES 61
CLINICAL ACTIVITIES<br />
OTOLARYNGOLOGY,<br />
HEAD, NECK/NEURO-<br />
<strong>ANESTHESIOLOGY</strong><br />
Cecil O. Borel, M.D.,<br />
Chief, Division of Otolaryngology,<br />
Head, Neck/Neuroanesthesia<br />
Medical Director, Neurosciences<br />
Intensive Care Unit<br />
Associate Professor of<br />
Anesthesiology<br />
Associate Professor of Surgery<br />
(Neurosurgery)<br />
Members<br />
John C. Keifer, M.D.<br />
Kathryn P. King, M.D., MSN<br />
Ziaur Rahman, M.B., B.S.<br />
Dianne L. Scott, M.D.<br />
Alan B. Shang, M.D.<br />
Bryant W. Stolp, Ph.D., M.D.<br />
Jeffrey M. Taekman, M.D.<br />
David S. Warner, M.D.<br />
Carleen E. Bagnall, CRNA, BSN<br />
Cythia R. Black, CRNA<br />
Russell T. Giesler, CRNA, BSN<br />
Janet L. Margeson, CRNA<br />
Michele D. Moody, CRNA, BSN, RN, MS<br />
John F. Pierce, CRNA<br />
Kena B. Sigman, CRNA, MSN<br />
James M. Temo, CRNA, MSN, MBA<br />
62 CLINICAL ACTIVITIES<br />
The Otolaryngology, Head, Neck/Neuroanesthesia<br />
Division provides anesthetic<br />
care for patients undergoing head and<br />
neck surgery, neurological surgery,<br />
neuroradiological procedures, aesthetic<br />
surgery, and electroconvulsive therapy<br />
(ECT).<br />
Otolaryngology, Head,<br />
Neck/Neuroanesthesia/<br />
Airway<br />
Bryant W. Stolp, Ph.D., M.D.<br />
Section Chief<br />
The Otolaryngology, Head, Neck/<br />
Neuroanesthesia/Airway group provides<br />
anesthetic care for adults undergoing<br />
procedures such as: complex head and<br />
neck surgery, airway laser surgery, and<br />
translabrynthine acoustic surgery. In<br />
addition, this group focuses on developing,<br />
maintaining, and providing equipment<br />
and expertise for managing difficult<br />
airways in the OR and hospital<br />
environment.<br />
Teaching efforts have included individual<br />
instruction in use of fiberoptic<br />
and alternative laryngoscopic techniques.<br />
Each year the group presents a<br />
fiberoptic workshop for both residents<br />
and faculty. This year the workshop<br />
was expanded to include more hands<br />
on workstations for the demonstration<br />
and practice of such emergency airway<br />
management skills as cricothyrotomy,<br />
FastTrach LMA, Upshur scope and jet<br />
ventilation. The usual adult and pediatric<br />
fiberoptic stations were upgraded<br />
with the addition of new mannequins<br />
and videos with good success. Perhaps<br />
the best improvement was the addition<br />
of live pig lab stations used to perfect<br />
fiberoptic intubation techniques under<br />
conditions simulating those in the OR.<br />
Future plans include compilation of an<br />
emergency airway management teaching<br />
guide to be used in conjunction<br />
with the manual for resident rotation<br />
on OHN anesthesia. We are still seeking<br />
out space to relocate the permanent<br />
airway management workstation. This<br />
was an extremely useful site for both<br />
residents and faculty alike to practice<br />
intubation skills using a variety of techniques<br />
immediately prior to induction<br />
in the OR. (While in existence we had<br />
no reports of broken fiberoptic scopes!).<br />
We hope to expand this workstation<br />
to include interactive computer simulations<br />
of airway cases. We are actively<br />
involved in the developing teaching<br />
scenarios for the new human anesthesia<br />
simulator. We will be expanding the<br />
teaching to include faculty, fellows,<br />
nurses, and residents from other services.<br />
A final accomplishment this year<br />
includes the creation of special Anesthesia<br />
emergency airway packs located<br />
on all Code carts in the OR and at all<br />
anesthetizing sites out of the OR. Hopefully,<br />
this will allow our anesthesia providers<br />
immediate access to necessary<br />
equipment before the onset of adverse<br />
outcomes.<br />
Neuroanesthesia<br />
John C. Keifer, M.D.<br />
Section Chief<br />
Group members provide anesthesia<br />
for adults undergoing brain and spinal<br />
cord surgery. Anesthesiologists provide<br />
management for specialized neuroanesthesia<br />
care such as the following:<br />
patients in sitting position, cerebral<br />
John C. Keifer, M.D.
aneurysm clipping, aneurysm clipping<br />
under circulatory arrest, awake craniotomy,<br />
seizure surgery, and infratentorial<br />
surgery.<br />
An increasing number of patients<br />
are undergoing “awake” craniotomy.<br />
This approach to intraoperative functional<br />
monitoring allows more aggressive<br />
neurosurgical resection in functionally<br />
sensitive areas related to speech<br />
or motor capability. A brief period of<br />
general anesthesia with an unprotected<br />
airway is followed by a long period of<br />
functional testing during which the<br />
patient must be capable of full alertness<br />
and cooperation. This awake period<br />
is followed by a final period of general<br />
anesthesia for craniotomy closure.<br />
The group has undertaken a clinical research<br />
project to prospectively evaluate<br />
anesthetic techniques for managing<br />
these patients.<br />
ECT, Radiology, and Off-Site<br />
Anesthesia<br />
Jeffrey M. Taekman, M.D.<br />
Section Chief.<br />
Anesthesia is provided in a variety of<br />
“off-site” locations by members of the<br />
group. Services provided in these areas<br />
are more difficult because of their<br />
remote locations and access to emergency<br />
support. These services are highly<br />
valued by patients and referring<br />
physicians. The anesthesiologist often<br />
performs vital consultative and supportive<br />
measures in addition to routine<br />
anesthetic care in these locations.<br />
With the appointment of Michael<br />
J. Alexander, M.D. to the neurosurgical<br />
and neuroradiological faculty, the use<br />
of coiling and embolization procedures<br />
to coagulate intracerebral aneuysms following<br />
subarachnoid hemmorrhage has<br />
increased dramatically. These procedures<br />
require general anesthesia, hemo-<br />
Dianne l. Scott, M.D.<br />
dynamic monitoring, and the potential<br />
need for acute lowering or raising<br />
blood pressure. Anesthesia support<br />
from within the division has been called<br />
on to develop emergency staffing and<br />
management protocols for this challenging<br />
group of patients.<br />
Aesthetic Anesthesia<br />
Dianne L. Scott, M.D.<br />
Section Chief<br />
The Duke Center for Aesthetic Services<br />
functions as a part of the Otolaryngology,<br />
Head And Neck Division. Dr.<br />
Dianne Scott provides general and<br />
sedation anesthesia for ambulatory<br />
patients undergoing cosmetic surgery.<br />
The full service center opened its doors<br />
in October 1997. Anesthesia service is<br />
currently provided for three days per<br />
week with the target goal of five days<br />
per week. There are two fully equipped<br />
operating rooms and a postanesthesia<br />
care unit on site. The medical specialties<br />
involved include otolaryngology,<br />
plastic surgery, oculoplastic surgery and<br />
dermatology. The surgical procedures<br />
involve rhinoplasties, breast augmentation,<br />
breast reduction, face and neck<br />
lifts, body sculpting, liposuctions, brow<br />
CLINICAL ACTIVITIES<br />
lifts, laser resurfacing and blephroplasties.<br />
The facility provides cosmetic services<br />
for the private, self-pay population.<br />
All surgical and anesthesia service<br />
is provided by attending physicians.<br />
There have been 591 anesthetics provided<br />
since 1997. Resident training<br />
rotations began in 2000. Office based<br />
anesthesia is the current trend in anesthesia<br />
and is certainly an aspect of<br />
training that should be incorporated<br />
into the residency program.<br />
Neurointensive Care<br />
Cecil O. Borel, M.D.<br />
Cecil Borel serves as the Medical<br />
Director of the NICU. One of the goals<br />
of this duty is to provide a seamless<br />
integration between OR anesthetic care<br />
and postoperative care. The Unit serves<br />
as the most advanced treatment neurointensive<br />
care unit in the area for the<br />
care of patients with life-threatening<br />
neurological illness.<br />
The NICU facility has undergone<br />
complete renovation in the last year.<br />
The bed capacity has increased from<br />
10 to 14 over the last year in a state-ofthe-art<br />
facility. Five Critical Care Nurse<br />
Practitioners, 5 faculty intensivists, and<br />
three fellows compose the multidisciplinary<br />
critical care team. Multiple clinical<br />
research projects are underway in a<br />
variety of areas including: the role of<br />
vascular growth factors in cerebral<br />
vasospasm, hypothermia for stroke<br />
patients, radiolabeled antibodies for<br />
brain tumor patients, the effect of magnesium<br />
infusion on cerebral vasospasm,<br />
and sleep-wake cycles in neurologically<br />
critically ill patients.<br />
The goal of the Division over the<br />
next several years will be the development<br />
of collaborative clinical and basic<br />
neuroscience research involving Divisions<br />
of Neurology and Neurosurgery.<br />
CLINICAL ACTIVITIES 63
CLINICAL ACTIVITIES<br />
PAIN MANAGEMENT<br />
Thomas E. Buchheit, M.D.<br />
Co-Chief, Division of Pain<br />
Management<br />
Clinical Associate in the<br />
Department of Anesthesiology<br />
PAIN MANAGEMENT<br />
Anne Marie Fras, M.D.<br />
Co-Chief, Division of Pain<br />
Management<br />
Associate in the Department of<br />
Anesthesiology<br />
64 CLINICAL ACTIVITIES<br />
Members<br />
Billy K. Huh, M.D., Ph.D.<br />
Dianne L. Scott, M.D.<br />
Brain Ginsberg, M.B., Ch.B., Acute Pain<br />
Service<br />
Joel S. Goldberg, M.D., Director Pain<br />
Management, Durham VAMC<br />
David Lindsey, M.D., VAMC<br />
Allison Taylor. P.A.-C<br />
Fellow:<br />
Adil S. Kamal, M.D.<br />
The year 2000 brought many changes to<br />
the Division of Pain Management in the<br />
Department of Anesthesiology. After 28<br />
years of distinguished service at Duke<br />
University Medical Center, Bruno J.<br />
Urban, M.D, Dr.med stepped down<br />
from clinical practice. It was also the<br />
year that the leadership in the division<br />
was passed to co-directors, Anne Marie<br />
Fras, M.D. and Thomas E. Buchheit,<br />
M.D. In November of 2000 the completion<br />
of the Morreene Road Clinic<br />
allowed the move of the Anesthesiology<br />
pain clinic to a newly constructed<br />
multidisciplinary clinic facility.<br />
In 1974, Dr. Bruno J. Urban, along<br />
with Dr. Blaine Nashold of Neurosurgery<br />
and Dr. Bill Wilson of Psychiatry,<br />
founded the Duke Pain Clinic to provide<br />
treatment to patients with chronic<br />
pain using a multidisciplinary approach.<br />
This was one of the first clinics established<br />
in the United States to offer this<br />
approach to the evaluation and treatment<br />
of patients with chronic pain<br />
syndromes. Unfortunately, economic<br />
pressures led to the separation of these<br />
specialists into parallel clinics in 1998.<br />
During the 26 years that Dr. Urban practiced<br />
pain management, he stressed<br />
a comprehensive approach to patient<br />
evaluation and treatment to the residents<br />
and fellows who learned pain<br />
management under his tutelage.<br />
One of these former fellows, Dr.<br />
Fras, succeeded Dr. Urban in a leadership<br />
position within the Division. The<br />
future of the division was assured with<br />
naming of Co-Division Chiefs, Dr. Fras<br />
and Dr. Buchheit. Dr. Fras will supervise<br />
clinical matters and Dr. Buchheit<br />
will supervise resident and fellow education<br />
and research. The year 2000 saw<br />
the Anesthesiology Pain Clinic move<br />
from its home of 26 years in Duke South<br />
to join the multidisciplinary clinic<br />
housed in the Morreene Road Clinic<br />
Building. The participation of the<br />
Anesthesiology Pain Management<br />
Division as part of this multi-specialty<br />
clinic will facilitate the cooperation of<br />
clinicians from the specialties of<br />
Anesthesiology, Psychiatry, Psychology,<br />
Neurology, and Neurosurgery. One of<br />
innovative ideas for the new clinic is a<br />
single point of telephone access for<br />
patients and referring physicians. The<br />
proximity of the clinicians from varying<br />
backgrounds with a common interest in<br />
pain management will encourage collaboration<br />
in clinical care, research,<br />
and teaching.<br />
Anesthesiologists in the pain clinic<br />
evaluate and treat all types of chronic<br />
pain syndromes including neuropathic<br />
pain, musculoskeletal pain, headaches,<br />
cancer pain, as well as sympathetic and<br />
visceral pain syndromes. The comprehensive<br />
evaluation in the clinic includes<br />
a detailed pain history, physical<br />
examination, and laboratory assessments<br />
as indicated. Patients seen in<br />
the multidisciplinary clinic complete a<br />
comprehensive Pain Perception Profile<br />
to evaluate the multiple factors involved<br />
in the generation of chronic<br />
pain syndromes. The emphasis on the<br />
multi-dimensional aspect of pain evaluation<br />
and treatment is in accordance<br />
with the original mission of the pain<br />
clinic. The patients may receive a<br />
variety of interventions in the clinic including<br />
standardization of medications,<br />
diagnostic and therapeutic injections,<br />
including discography, neurostimulatory<br />
and infusion procedures, and<br />
neuro-ablative procedures. The location<br />
of the Anesthesiology pain clinic<br />
within multidisciplinary clinic facilitates<br />
referral for physical therapy interventions<br />
as well as instruction in biofeedback<br />
and relaxation techniques.<br />
The outpatient clinic meets five<br />
days per week at Morreene Road. The<br />
expansion of clinic staff in March of
2000 when Dr. Buchheit began seeing<br />
pain patients has allowed the continued<br />
accommodation of urgent pain evaluations<br />
of cancer patients and patients for<br />
injections. The clinic has continued the<br />
recent trend of increasing patient volumes<br />
for clinic visits and injections<br />
while maintaining the comprehensive,<br />
thorough patient evaluations on which<br />
the attending staff pride themselves<br />
(see pain statistics). Drs. Fras, Huh,<br />
Buchheit, and Scott evaluate patients in<br />
the pain clinic. Allison Taylor. P.A.-C<br />
assists in patient evaluation and continuity<br />
of care.<br />
The inpatient Acute Pain Service<br />
(APS) continues to provide patient care<br />
1999<br />
Nerve Blocks/other procedures<br />
Differential Spinal 2<br />
Epidural 664<br />
Paravertebral/facet 127<br />
Lumbar Sympathetic 40<br />
Stellate 21<br />
Celiac plexus 1<br />
Peripheral nerve 44<br />
Brachial Plexus 2<br />
Trigger injection 131<br />
IV lidocaine, bretyliium 30<br />
Neurolytic/cryo 5<br />
Interpleural –<br />
SCS 6<br />
Other 9<br />
TOTAL 1082<br />
Patient Visits<br />
New 1024<br />
Return 2762<br />
TOTAL 3786<br />
Anesthesiology<br />
Inpatient Service 14<br />
PAIN CLINIC STATISTICS<br />
on a 24 hours/day, seven days/week<br />
basis. This coverage is provided by Dr.<br />
Ginsberg (two weeks/month), Dr. Huh<br />
(one week/month), and Dr. Fras (one<br />
week/month). The APS establishes<br />
continuous catheters and maintains<br />
those established in the operating room<br />
for post-operative pain control. In addition,<br />
consultations are provided for difficult<br />
post-operative patients without<br />
catheters and for inpatients with chronic<br />
pain syndromes. This year, the complete<br />
statistics of the APS are available<br />
for the first time. During the year 2000,<br />
close to 1500 patients were followed on<br />
the APS; 1165 of the patients had continuous<br />
epidural catheters. Five special-<br />
2000<br />
Nerve Blocks/other procedures<br />
Differential Spinal 1<br />
Epidural 593<br />
Paravertebral/facet 150<br />
Lumbar Sympathetic 26<br />
Stellate 23<br />
Celiac plexus 5<br />
Peripheral nerve 48<br />
Brachial Plexus 2<br />
Trigger injection 192<br />
IV lidocaine, bretyliium 10<br />
Neurolytic/cryo 0<br />
Interpleural 0<br />
SCS 4<br />
Accupuncture 19<br />
Blood patch 5<br />
TOTAL 1081<br />
Patient Visits<br />
New 1021<br />
Return 2875<br />
TOTAL 3896<br />
Anesthesiology<br />
Inpatient Service 6<br />
CLINICAL ACTIVITIES<br />
ly trained nurses assist the attending<br />
physicians in providing patient care on<br />
the APS.<br />
The Durham VA Medical Center<br />
has seen expansion in the pain clinic as<br />
well. Dr. Goldberg continues to provide<br />
the leadership for that clinic. The Anesthesiology<br />
pain management program<br />
of Drs. Buchheit and Goldberg was augmented<br />
by the return of Dr. David<br />
Lindsay to Duke. In addition, the clinic<br />
staff includes one psychiatrist and one<br />
nurse practitioner. The clinical activity<br />
of the VAMC included 2550 patient visits<br />
in 2000. The clinic meets three<br />
days/week with one additional day of<br />
invasive procedures and inpatient consultations<br />
are provided five days/week.<br />
Dr. Goldberg has expanded clinical<br />
teaching by offering a training course<br />
for Fayetteville VAMC physicians. Dr.<br />
Goldberg transferred the mantle of<br />
Director of the Fellowship Program to<br />
Dr. Buchheit. The Pain Fellow splits<br />
time between the VAMC, the Morreene<br />
Road Clinic, and the APS.<br />
In addition to providing excellent<br />
patient care in the inpatient and outpatient<br />
settings, the goal of excellence in<br />
education and research is emphasized<br />
within the division. The CA-1 residents<br />
each spend one month with the pain<br />
service. The residents participate in the<br />
evaluation and treatment of chronic<br />
pain patients in the Duke Pain Clinic<br />
and the VA Pain clinic over three weeks.<br />
In addition they spend one week rounding<br />
with the Acute Pain Service, learning<br />
strategies for post-operative pain<br />
management,<br />
The pain management fellowship<br />
has undergone several changes during<br />
the year 2000. In September, Dr.<br />
Thomas Buchheit assumed direction of<br />
the fellowship. In November, the new<br />
Morreene Road Pain Clinic became the<br />
primary teaching site. At the new pain<br />
management center, the fellow has not<br />
only had the opportunity to learn from<br />
anesthesiology pain management specialists,<br />
but also from pain specialists in<br />
the fields of neurology, psychiatry, psychology,<br />
neurosurgery, and physical<br />
CLINICAL ACTIVITIES 65
CLINICAL ACTIVITIES<br />
therapy. This year’s fellow, Dr. Adil<br />
Kamal, has learned techniques in fluoroscopically<br />
guided injections, neurolytic<br />
procedures, implantation therapies,<br />
diagnostic discography, and radiofrequency<br />
lesioning. Clinical and<br />
teaching activities have also continued<br />
at the VA pain clinic, directed by Dr.<br />
Joel Goldberg.<br />
Additionally, the year 2000 has<br />
been an active time for establishment<br />
and improvement of educational policies<br />
as guided by the ACGME. We are<br />
working toward our ultimate goal of<br />
making the Duke Anesthesiology Pain<br />
Management Fellowship a model program<br />
in the United States.<br />
Outside interest in the pain fellowship<br />
has also increased, and a total<br />
of 35 completed applications were received<br />
for the 2001 position. The position<br />
has been filled, and applications<br />
have already arrived for the academic<br />
year 2002. The division looks forward<br />
66 CLINICAL ACTIVITIES<br />
2000<br />
ACUTE PAIN SERVICE STATISTICS<br />
Axillary 29<br />
Caudal 4<br />
Consults: 148<br />
Epidural: 1165<br />
Femoral 3<br />
Interscalene 3<br />
PCA 67<br />
Sciatic 12<br />
Superclavicular 4<br />
Tibial 9<br />
Unspecified 37<br />
to a growing and increasingly successful<br />
fellowship in the years to come<br />
Research has continued in the<br />
division as Dr. Huh is investigating<br />
yohimibine infusion as a diagnostic test<br />
for the presence of Complex Regional<br />
Pain Syndrome. In addition, he is looking<br />
into the effects of high concentration<br />
local anesthetics in facet joint injections.<br />
Dr. Fras has a protocol for the<br />
examination of various neurotransmitters<br />
in the CSF of patients with chronic<br />
pain syndromes. Dr. Ginsberg continues<br />
his investigation into new agents for the<br />
medication management of acute pain.<br />
Dr. Urban with Dr. Carlos Nebreda<br />
published a textbook on chronic pain<br />
treatments in Spanish.<br />
Bruno J. Urban Honored at Grand Rounds December 6, 2000<br />
Bruno J. Urban, M.D., Dr.med. came to Duke 28 years ago and continuously served<br />
on our clinical faculty until December 31, 2000. That is more than a quarter of a<br />
century of dedication to Duke University and this Department—a loyalty for which<br />
we are most grateful.<br />
Careers often have beginnings and ends that make sense. Bruno and Dr. Blaine<br />
Nashold established the first pain clinic in Duke South in 1974. They were codirectors<br />
of this clinic which has remained in service at Duke South for 26 years.<br />
We have a new pain clinic and it is co-directed by one of Dr. Urban’s protégées,<br />
Dr. Anne Marie Fras. This new Pain Clinic and new co-directors bring a new beginning<br />
as we celebrate both the beginning and the end of Dr. Urban's active faculty<br />
status.<br />
Dr. Urban was granted the title of Professor Emeritus of Anesthesiology and<br />
was also honored by Dr. Ralph Snyderman. We wish to honor Bruno and his wife,<br />
Ingeborg, for the many patients that have benefited from his dedication, for the<br />
countless resident and fellows who have learned the art and science of pain<br />
management from Dr. Urban. We are hopeful that Dr. Urban will join our “front<br />
row Emeriti Professors” when time permits and that he will have a long and healthy<br />
retirement. We will all miss his no-nonsense approach and dedication to excellent<br />
care.
PEDIATRIC<br />
ANESTHESIA AND<br />
CRITICAL CARE<br />
MEDICINE<br />
Frank H. Kern, M.D., FCCM<br />
Chief, Division of Pediatric<br />
Anesthesia<br />
Associate Director, Pediatric<br />
Critical Care Medicine<br />
Professor of Anesthesiology<br />
Professor of Pediatrics<br />
Pediatric Anesthesia<br />
Frank H. Kern, M.D., FCCM<br />
Chief, Division of Pediatric Anesthesia<br />
Associate Director, Pediatric Critical<br />
Care Medicine<br />
Professor of Anesthesiology<br />
Professor of Pediatrics<br />
Allison K. Ross, M.D.<br />
Section Chief, General Pediatric<br />
Anesthesia<br />
Assistant Professor of Anesthesiology<br />
Members:<br />
Robert L. Coleman, M.D.<br />
Guy deLisle Dear, M.B., FRCA<br />
John B. Eck, M.D.<br />
Thomas O. Erb, M.D., F.M.H.<br />
Brian Ginsberg, M.B., B.Ch.<br />
Scott R. Schulman, M.D.<br />
Clinical responsibilities of the faculty<br />
and staff are to provide comprehensive<br />
care for the pediatric patient.<br />
In 2000 we have been involved<br />
in providing comprehensive pediatric<br />
anesthesia services both in the OR and<br />
at multiple remote anesthetizing sites,<br />
including a regular bone marrow clinic,<br />
endoscopy/bronchoscopy suite and<br />
cardiac catheterization suite. Members<br />
of our division have been actively<br />
involved in planning the Duke Children’s<br />
Hospital which broke ground in March<br />
of 1998 and opened in the spring of<br />
2000. Children specific OR’s, intake<br />
and PACU areas for children have<br />
become an important part of pediatric<br />
anesthetic care at Duke. The pediatric<br />
division has continued to grow in the<br />
services which are provided to children<br />
at Duke and in pediatric anesthesia<br />
research.<br />
Research<br />
Our research efforts have been devoted<br />
to physiology, pharmacokinetics/<br />
dynamics and regional anesthesia.<br />
Physiologic research: Includes cerebral<br />
blood flow, cerebral metabolism<br />
and inflammatory effects of cardiopulmonary<br />
bypass, and cardiorespiratory<br />
interactions.<br />
In the recent past, our section has<br />
described the effects of deep hypothermic<br />
circulatory arrest on cerebral blood<br />
flow and metabolism. Publications<br />
have demonstrated marked differences<br />
in brain blood flow and metabolism between<br />
children undergoing continuous<br />
flow deep hypothermic cardiopulmonary<br />
bypass and children undergoing<br />
deep hypothermic circulatory arrest<br />
and the importance of PaO 2 on cerebral<br />
oxygen utilization during profound<br />
hypothermia. We have also observed<br />
that cerebral blood flow falls linearly<br />
with temperature reduction whereas<br />
metabolism falls exponentially using<br />
alpha stat blood gas regulation. We<br />
have defined a metabolic index for predicting<br />
safe circulatory arrest times<br />
CLINICAL ACTIVITIES<br />
based on metabolic reduction due<br />
to hypothermia. Our group has also<br />
described the effects of CO 2 on cerebral<br />
blood flow during deep hypothermia<br />
in children and we have pioneered the<br />
use of jugular venous saturation as a<br />
monitor for effective cooling of the<br />
brain prior to the institution of circulatory<br />
arrest. In addition, we have<br />
defined the detrimental effects of CPB<br />
and circulatory arrest on respiratory<br />
and myocardial function. While inflammatory<br />
modification of CPB remains the<br />
holy grail in congenital heart surgery,<br />
our efforts at modifying the inflammatory<br />
response through circuit miniaturization,<br />
high dose steroids, inhibition of<br />
inflammatory mediator release are<br />
ongoing projects.<br />
Pharmacokinetics: Our group has<br />
been involved in numerous clinical<br />
research projects involving the pharmacokinetic<br />
and pharmacodynamic<br />
aspects of drugs in children. We have<br />
been involved in Phase 2 and Phase 3<br />
studies of investigational agents. Included<br />
in this list of agents are an intravenous<br />
induction agent, muscle relaxants<br />
and ultrashort acting opioids.<br />
Scott R. Schulman, M.D.<br />
CLINICAL ACTIVITIES 67
CLINICAL ACTIVITIES<br />
Regional Anesthesia: Regional anesthesia<br />
has proven to lessen pain, facilitate<br />
early discharge from the PACU and<br />
minimize the deleterious effects of general<br />
anesthesia in high risk patients.<br />
Examples of the latter include, newborns,<br />
ex-premature infants with respiratory<br />
insufficiency and children with<br />
abnormal respiratory function due to<br />
CNS injury, myopathies, neuropathies<br />
and lung disease. Regional anesthesia<br />
continues to be a fertile area of research<br />
for our group and an important<br />
area for the control of pain in children<br />
undergoing surgery and children with<br />
complex medical problems.<br />
The Pediatric Anesthesia group<br />
has taken part in the International<br />
Cochrane Collaboration in evidencebased<br />
medicine. Our section had been<br />
designated as the section to review<br />
meta-analyses of national clinical trials<br />
in children.<br />
Resident education continues to be<br />
an important aspect of teaching in the<br />
department. In addition to hands on<br />
training and didactic lectures, pediatric<br />
anesthesia has a six-month subspecialty<br />
experience for CA-3 residents and a<br />
one year postgraduate fellowship in<br />
Pediatric Anesthesia that includes experience<br />
in pediatric general, cardiac and<br />
critical care medicine. We have also<br />
established an inter-departmental conference<br />
program dedicated to pediatric<br />
anesthesia and perioperative care of<br />
children. Fellow education, research<br />
and participation in national organizations<br />
remain important goals for the<br />
Pediatric Anesthesia group.<br />
68 CLINICAL ACTIVITIES<br />
PEDIATRIC CRITICAL<br />
CARE MEDICINE<br />
John N. Meliones, M.D., FCCM<br />
Chief, Pediatric Critical Care<br />
Medicine<br />
Medical Director, Pediatric<br />
Intensive Care Unit<br />
Professor of Pediatrics<br />
Associate Professor of<br />
Anesthesiology<br />
Members:<br />
Ira M. Cheifetz, M.D.<br />
Eva N. Grayck, M.D.<br />
Frank H. Kern, M.D., FCCM<br />
Scott R. Schulman, M.D.<br />
The Pediatric Intensive Care Unit is a<br />
multi-disciplinary intensive care unit<br />
which includes two pediatric anesthesiologists<br />
and three pediatric trained critical<br />
care physicians who jointly share<br />
responsibility for the care of medical<br />
and surgical postoperative patients in<br />
the PICU and transitional care unit. The<br />
faculty are responsible for all medical<br />
and surgical admissions into Intensive<br />
Care. Medical patients are admitted<br />
directly to the critical care service. All<br />
surgical patients are admitted to the primary<br />
surgical service with a mandatory<br />
consultation from the pediatric critical<br />
care service. An ongoing fellowship<br />
program is maintained at two fellows<br />
per year.<br />
Research<br />
Research in the Pediatric Intensive Care<br />
Unit has been robust. Areas of investigation<br />
include: Partial liquid ventilation<br />
in ARDS, effects of Nitric Oxide and<br />
varying modes of ventilation on right<br />
ventilation function, cerebral blood<br />
flow, metabolism and near infrared<br />
spectroscopic measurements of cerebral<br />
oxygenation in critically ill newborns<br />
undergoing extracorporeal membrane<br />
oxygenation, pharmacokinetic<br />
research on long term infusions of sedatives<br />
such as midazolam and propofol<br />
for continuous sedation of critically ill<br />
children in the pediatric intensive care<br />
unit. Exciting new areas of research<br />
include the use of liquid ventilation during<br />
CPB to decrease systemic and pulmonary<br />
inflammatory responses. This<br />
investigation is occurring in swine and<br />
clinical arms are under investigation.<br />
The effect of nitric oxide as a putative<br />
mediator of lung injury is under investigation<br />
in a rabbit model in our basic<br />
science laboratory.<br />
Teaching<br />
Training of physicians at the resident<br />
and fellowship level is a very important<br />
part of the pediatric division. We currently<br />
train two fellows per year in<br />
critical care medicine. Three medical<br />
residents receive clinical and didactic<br />
teaching in pediatric intensive care per<br />
month, and fellows and residents in<br />
medicine, anesthesia, surgery frequently<br />
rotate through the PICU. The PICU<br />
rotation remains a favorite rotation for<br />
Duke medical students.
VETERANS AFFAIRS<br />
<strong>ANESTHESIOLOGY</strong><br />
SERVICE<br />
Jonathan B. Mark, M.D.<br />
Chief, Anesthesiology Service<br />
Veterans Affairs Medical Center<br />
Associate Professor of<br />
Anesthesiology<br />
Associate Professor in Medicine<br />
Members:<br />
Jonathan B. Mark, M.D., Chief<br />
Thomas E. Buchheit, M.D.<br />
Joel S. Goldberg, M.D.<br />
Lewis R. Hodgins, M.D.<br />
David R. Lindsay, M.D.<br />
Laura E. Niklason, M.D., Ph.D.<br />
Thomas F. Slaughter, M.D.<br />
Gautam M. Sreeram, M.D.<br />
John (Sam) Thio Sum Ping, M.B., Ch.B.,<br />
FRCA<br />
Dana N. Wiener, M.D<br />
Christopher C. Young, M.D., FCCM<br />
Pain Clinic:<br />
Joel S. Goldberg, M.D., Director<br />
Thomas E. Buchheit, M.D.<br />
David R. Lindsay, M.D.<br />
Surgical Intensive Care Unit:<br />
John (Sam) Thio Sum Ping, M.B., Ch.B.,<br />
FRCA, Director<br />
Lewis R. Hodgins, M.D.<br />
Laura E. Niklason, M.D., Ph.D.<br />
Christopher C. Young, M.D., FCCM<br />
CRNA:<br />
Linda W. Skinner, CRNA, Chief CRNA<br />
Pauline F. Brault, CRNA, BSN<br />
Hazel Kerry, CRNA, MSN<br />
Li-Yuan M. Lo, CRNA, BSN<br />
James M. Neblett III, CRNA, MSN<br />
George W. Tennis, CRNA<br />
Robin W. Westbrook, CRNA, BSN<br />
Physician Assistant:<br />
Delmer L. Shelton, PA<br />
Valerie Forbes, PA, BS<br />
David W. Lewis, PA<br />
Research Assistant:<br />
Cynthia H. Cassell, BA, MA<br />
The Durham Veterans Affairs (VA)<br />
Medical Center is conveniently located<br />
across the street from Duke University<br />
Medical Center. Our VA anesthesia faculty<br />
provide comprehensive clinical<br />
anesthesiology services for the veteran<br />
population at this institution, including<br />
patients undergoing cardiac surgery,<br />
orthopedic joint replacement, major<br />
vascular, thoracic, neurosurgical, plastic,<br />
ENT, urologic, and ophthalmologic<br />
operations. Outside the operating<br />
rooms, our staff care for patients undergoing<br />
electroconvulsive therapy and<br />
those requiring painful diagnostic and<br />
therapeutic procedures in the cardiac<br />
catheterization laboratory, gastrointestinal,<br />
and radiology suites. Our service<br />
provides primary coverage for all<br />
patients in surgical intensive care, short<br />
stay unit, acute and chronic pain management<br />
services, diagnostic transesophageal<br />
echocardiography, and<br />
emergency airway management.<br />
The staff bring special expertise<br />
and interests to all of these clinical arenas.<br />
Faculty with subspecialty board<br />
certification work in intensive care and<br />
pain management, and contribute to<br />
accredited Duke departmental fellowship<br />
training programs in both of these<br />
areas. Other faculty members have<br />
advanced training and interests in cardiac<br />
anesthesia, regional anesthesia,<br />
geriatric anesthesia, fiberoptic techniques<br />
for airway management, and<br />
CLINICAL ACTIVITIES<br />
transesophageal echocardiography.<br />
The expansion and renovation of<br />
the VA operating rooms and recovery<br />
room continued during the past 12<br />
months. In addition to a new heart<br />
room and major orthopedic room, both<br />
of which opened in late 1999, two more<br />
large operating rooms and a minor procedure<br />
room are complete and will be<br />
ready for clinical use after January<br />
2001. At the same time, we will move<br />
into a new post anesthesia care unit<br />
(PACU), located adjacent to the new<br />
operating rooms. The new PACU will<br />
have updated monitoring capabilities,<br />
with the bedside displays supported<br />
from ceiling-mounted articulating<br />
booms. Other features include a new<br />
isolation room and extra bed spaces<br />
to accommodate preoperative patients,<br />
thereby allowing the PACU to serve<br />
both a pre- and postoperative function.<br />
The final phase of this extensive operating<br />
room project will begin this winter,<br />
when the entire original operating room<br />
suite will be closed for renovation. At<br />
the conclusion of this final phase, we<br />
will have three more renovated operating<br />
rooms, a new cystoscopy room, a<br />
new anesthesia workroom and anesthesia<br />
lab-office, and centrally located support<br />
and storage space for operating<br />
room and anesthesia functions. This<br />
project, once completed, should help<br />
the VA provide surgical services in a<br />
modern environment well into the next<br />
century.<br />
The VAMC Pain Clinic, directed by<br />
Dr. Joel Goldberg, is a busy multidisciplinary<br />
unit. In addition to sympathetic,<br />
neurolytic, and other major conduction<br />
blocks, diagnostic thermography is used<br />
regularly in the evaluation of clinic patients.<br />
The Pain Clinic serves as a training<br />
site for the departmental Fellowship<br />
in Pain Management. Residents and fellows<br />
in anesthesia and primary care<br />
rotate through the pain clinic as part<br />
of their training. Over the past year,<br />
our pain management physicians have<br />
accepted important new administrative<br />
roles. Dr. Goldberg was asked to participate<br />
on the American Board of Anes-<br />
CLINICAL ACTIVITIES 69
CLINICAL ACTIVITIES<br />
thesiology Pain Management Examination<br />
Committee, and Dr. Tom<br />
Buchheit was appointed as Co-Director<br />
of the Duke Anesthesia Division of Pain<br />
Management and as Pain Management<br />
Fellowship Director. Dr. Buchheit has<br />
also been very active clinically, both at<br />
Duke and at the VA and has expanded<br />
pain services by offering a variety of<br />
invasive techniques for patients who fail<br />
to respond to more conservative treatments.<br />
These procedures include<br />
radiofrequency nerve root ablation and<br />
implantation of spinal cord stimulators.<br />
Pain management services continue to<br />
grow at the VA, in concert with the VA<br />
national initiative to make pain the “5th<br />
vital sign.” During the past 12 months,<br />
the recruitment of two additional outstanding<br />
practitioners has helped our<br />
pain service continue to grow and serve<br />
as the leading VA pain referral center in<br />
the southeastern United States. Dr.<br />
David Lindsay, former chief resident<br />
and fellow in our department, returned<br />
to join the VA faculty December, 2000.<br />
His background in pain management<br />
and his interests in palliative care will<br />
lend additional experience and breadth<br />
to our pain service. We were fortunate<br />
as well in being able to recruit Marty<br />
Larson, Nurse Practitioner, to join the<br />
pain management team. Marty has<br />
already been active seeing patients in<br />
the clinic, assisting Dr. Buchheit in the<br />
operating room, and serving as co-chair<br />
of the hospital-wide pain initiative committee.<br />
In the latter role, she provides<br />
a unique opportunity for our service to<br />
have a close working relationship with<br />
hospital nursing staff, who carry out<br />
front-line management of pain in our<br />
veteran patients.<br />
The Surgical Intensive Care Unit<br />
(SICU) is an important responsibility of<br />
the Anesthesiology Service. Our faculty<br />
provide perioperative care for all surgical<br />
patients at the VAMC. Dr. John Sum<br />
Ping is the Medical Director of the unit,<br />
a new responsibility that he accepted<br />
this past year. Three other faculty share<br />
attending responsibilities: Drs. Lewis<br />
Hodgins, Laura Niklason, and<br />
70 CLINICAL ACTIVITIES<br />
Christopher Young. Residents from the<br />
Duke Departments of Anesthesiology,<br />
Surgery, Family Medicine, and Obstetrics<br />
and Gynecology provide house staff<br />
coverage for this unit. This heterogeneous<br />
group of trainees provides a<br />
unique collaborative learning environment.<br />
As described below, the SICU<br />
also has been an active site for clinical<br />
research this past year, and a number of<br />
abstracts and manuscripts, focused on<br />
ICU sedation and hemodynamic monitoring<br />
have resulted from these efforts.<br />
Of note, Dr. Christopher Young was<br />
honored this year as a Fellow in the<br />
College of Critical Care Medicine and<br />
will be serving on the American Board<br />
of Anesthesiology Critical Care<br />
Examination Committee.<br />
Our 23-Hour Short Stay Unit (SSU)<br />
continues to grow and serve as the hub<br />
of perioperative patient preparation. It<br />
is conveniently located on the 4th floor<br />
adjacent to our operating rooms and<br />
new recovery room. Renovated just a<br />
year ago, the SSU provides additional<br />
space that allows more private examination<br />
rooms and improved patient<br />
waiting areas. Dr. Dana Wiener continues<br />
her effective leadership as the<br />
Medical Director of the SSU, and along<br />
with other staff anesthesiologists, she<br />
provides consultative medical direction<br />
to the three physician assistants who<br />
perform most of the patient evaluations<br />
on this unit. Mr. Bud Shelton, PA-C, has<br />
worked closely since 1995 to plan the<br />
SSU operations, guide its growth, and<br />
assure its success. Two other physician<br />
assistants, Ms. Susie Forbes, PA, and Mr.<br />
David Lewis, PA, complete the team on<br />
this unit. Each month, more than 300<br />
patients receive care in the SSU, resulting<br />
in a marked reduction in average<br />
hospital length of stay for surgical and<br />
medical patients. Care maps for coronary<br />
artery bypass grafting and knee<br />
and hip joint replacement have originated<br />
in this unit and have been models<br />
for care throughout the VAMC. The<br />
unit has expanded to include medical<br />
patients who require a brief hospital<br />
stay for a variety of diagnostic or thera-<br />
peutic procedures. In fact, nearly 25<br />
percent of the patients seen in this unit<br />
are non-surgical patients, truly making<br />
this a multidisciplinary patient care<br />
service.<br />
The Transesophageal Echocardiography<br />
Service acquired new equipment<br />
this year for digital acquisition and storage<br />
of both intraoperative and other<br />
diagnostic echocardiograms. This is a<br />
very unique, state of the art imaging system,<br />
which allows rapid retrieval and<br />
review of any echocardiogram performed<br />
at the VA or at Duke. Its role<br />
in clinical care is already evident, and<br />
it will offer unique opportunities for<br />
clinical research in the future.<br />
The clinical success of the VA<br />
Anesthesia Service would be impossible<br />
without the ongoing contributions of an<br />
outstanding group of certified registered<br />
nurse anesthetists. Ms. Linda Skinner<br />
has provided superb leadership in her<br />
role as acting Chief CRNA and agreed<br />
to serve in this capacity on a more permanent<br />
basis this year. In 2000, we<br />
were fortunate to recruit two capable<br />
anesthetists, James Neblett and Robin<br />
Westbrook, to join our other experienced<br />
CRNAs, Pauline Brault, Hazel<br />
Kerry, Mary Lo, and George Tennis.<br />
Our CRNAs not only provide clinical<br />
care, but they also support the educational<br />
efforts of the faculty and serve<br />
the VA on a variety of committees.<br />
Members of the faculty also are<br />
active in hospital affairs and provide<br />
leadership in a variety of areas outside<br />
the operating rooms. Dr. Joel Goldberg<br />
chairs the Pharmacy and Therapeutics<br />
Committee, Dr. Thomas Slaughter<br />
chairs the Transfusion Committee, and<br />
Dr. Lewis Hodgins co-chairs the Ethics<br />
Committee.<br />
Research and Publication<br />
Year 2000 was a productive one for divisional<br />
research. Dr. Thomas Slaughter<br />
continues to work closely with Dr.<br />
Gautam Sreeram in the area of perioperative<br />
disorders of hemostasis. Both<br />
remain supported by NIH grants and<br />
commercial awards. Dr. Slaughter’s
success as a physician-investigator was<br />
recognized at the end of this year when<br />
he was promoted to Associate Professor<br />
of Anesthesiology. A number of other<br />
clinical investigators have been active<br />
this year. Dr. Sum Ping has been evaluating<br />
the efficacy of dexmedetomidine<br />
as a sedative-antihypertensive for<br />
patients following cardiac surgery, and<br />
he and Dr. Christopher Young are<br />
actively pursuing other clinical trials<br />
using this unique sedative, both in<br />
intensive care patients as well as in the<br />
departmental human pharmacology<br />
laboratory. Technology assessment<br />
remains another focus of the VA group.<br />
Drs. Slaughter and Sreeram continue to<br />
explore improved methods for bedside<br />
evaluation of the coagulation system<br />
and platelet function, and both have<br />
published widely on hemostasis and<br />
transfusion practice. In addition, Drs.<br />
Chris Young and Jonathan Mark have<br />
been evaluating a new method of cardiac<br />
output measurement that does not<br />
require pulmonary artery catheterization<br />
and is based on ion-selective sensor<br />
technology. Our research assistant,<br />
Ms. Cynthia Cassell, has been instrumental<br />
in providing support for all of<br />
these clinical investigations. The VA<br />
faculty continued to contribute to the<br />
medical literature in 2000 by authoring<br />
numerous chapters and reviews in the<br />
fields of cardiovascular physiology, critical<br />
care, cardiovascular monitoring,<br />
and coagulation pathophysiology.<br />
Teaching<br />
Resident, fellow, and medical student<br />
education are top priorities for the<br />
entire faculty at the VA, as evidenced<br />
by the fact that our clinicians are consistently<br />
rated highly as effective teach-<br />
ers in the department. In recognition of<br />
this tradition that emphasizes resident<br />
education, a VA Teaching Award was<br />
established in 1996 by the Duke Department<br />
of Anesthesiology and was awarded<br />
to Dr. Tom Buchheit this past June.<br />
Daily didactic conferences at the<br />
VA supplement bedside SICU and operating<br />
room training. Each morning,<br />
from 7:00 - 7:45 a.m., a general departmental<br />
teaching conference starts the<br />
educational day, followed by didactic<br />
SICU teaching rounds at 10:00 a.m.<br />
Finally, a departmental Friday morning<br />
Echocardiography and Cardiac Physiology<br />
Conference is attended by faculty<br />
and residents at the VA, Duke cardiac<br />
anesthesia fellows, and fellows and residents<br />
from cardiology and cardiac<br />
surgery.<br />
Medical students from Duke and<br />
other institutions rotate through our<br />
operating rooms and SICU at the VA.<br />
All of our faculty are involved in teaching<br />
students at the bedside and in small<br />
group conferences, and several faculty<br />
contribute to the first year medical<br />
school curriculum in pharmacology<br />
and physiology.<br />
Goals for 2001<br />
Operating Room Renovation. A major<br />
renovation of the entire 40-year-old VA<br />
operating rooms is currently in progress.<br />
The final phase of this multi-year project<br />
will begin in 2001. During this year, we<br />
will modify our daily operating room<br />
schedule to attempt to maintain workload<br />
and clinical productivity.<br />
Short Stay Unit. Work to make preoperative<br />
assessment available electronically<br />
through the VA computer system.<br />
Intensive Care and Monitoring<br />
Units. Promote development of multi-<br />
CLINICAL ACTIVITIES<br />
disciplinary care of the critically ill<br />
patient, training housestaff from Anesthesiology,<br />
Surgery, Family Medicine,<br />
and Obstetrics and Gynecology. Work<br />
more closely with the medical intensive<br />
care unit team to develop further collaborative<br />
efforts in intensive care medicine<br />
and training at the VA and at Duke.<br />
Pain Management Services. Support<br />
pain services to meet the growing clinical<br />
demand, including cancer pain<br />
management and palliative care. The<br />
greatest challenge for the upcoming year<br />
will be to arrange expanded clinic<br />
space and hours to accommodate our<br />
growing pain team and patient load.<br />
Fellowship Training. Continue<br />
board-certified training programs in<br />
Pain Management and Critical Care<br />
with our faculty at Duke. Continue<br />
to develop collaborative subspecialty<br />
training for our cardiac anesthesia fellows,<br />
particularly in transesophageal<br />
echocardiography.<br />
Clinical Research. Support Dr.<br />
Slaughter’s research program in perioperative<br />
hemostasis and thrombosis, linking<br />
both clinical and laboratory investigations,<br />
with a long term goal of establishing<br />
a Laboratory for the Investigation<br />
of Perioperative Hemostasis and Thrombosis<br />
at the Durham VAMC. Continue<br />
and expand SICU research in clinical<br />
pharmacology (sedation) and hemodynamic<br />
monitoring. Aid fellows in<br />
clinical research, particularly in the<br />
areas of transesophageal echocardiography,<br />
cardiac physiology, clinical<br />
monitoring, and perioperative coagulation<br />
disorders.<br />
Digital Echocardiography. Work to<br />
expand the application of digital echocardiography<br />
from clinical service to<br />
clinical research.<br />
CLINICAL ACTIVITIES 71
CLINICAL ACTIVITIES<br />
WOMEN’S ANESTHESIA<br />
AND CRITICAL CARE<br />
MEDICINE<br />
Holly A Muir, M.D., FRCP(C)<br />
Chief, Division of Women's<br />
Anesthesia (DWA)<br />
Assistant Professor of Anesthesia<br />
Associate of Obstetrics and<br />
Gynecology<br />
Members<br />
Elizabeth A. Bell, M.D., M.P.H.,<br />
Terrance W. Breen, M.D.<br />
Peter D. Dwane, M.D., C.M., FRCP(C),<br />
Clinical Director<br />
Ellen M. Lockhart, M.D.<br />
Adeyemi J. Olufolabi, M.B., B.S., FRCA<br />
James D. Reynolds, Ph.D.<br />
John R. Schultz, M.D.<br />
CRNA Staff<br />
Carolyn E. Burgess, CRNA, Ph.D.<br />
Julie T. Fritz, CRNA, MSN<br />
Sarah O. Jinwright, CRNA<br />
Tede E. Spahn, CRNA<br />
Yolanda G. Wright, CRNA<br />
72 CLINICAL ACTIVITIES<br />
Clinical Service<br />
The Division of Women's Anesthesia<br />
(DWA) is responsible for obstetric and<br />
gynecologic anesthesia and provides<br />
continuous in-house faculty coverage<br />
of obstetrics. There were over 3,200<br />
deliveries in 2000. Anesthesia was<br />
involved with over 75% of these patients<br />
at some point in their care. The DWA<br />
provides all major modalities of labor<br />
analgesia including neuraxial narcotics,<br />
combined spinal-epidural analgesia<br />
(CSE), and patient-controlled epidural<br />
analgesia (PCEA).<br />
Over the past year, we have settled<br />
in to the newly constructed Duke<br />
Birthing Center. As a result of a significant<br />
change in our physical layout we<br />
needed to update departmental procedures<br />
and policies to meet the clinical<br />
demands of our service. Residents and<br />
faculty have had to endure almost daily<br />
changes in the way we do business.<br />
Efforts to improve our clinical service<br />
have included the introduction of new<br />
PACU and post-op pain orders, a new<br />
anesthesia record, and access to PCEA<br />
for all patients on labor and delivery.<br />
Unfortunately the year 2000 also resulted<br />
in the loss of the computerized record<br />
keeping system in the OR, (Arkive) with<br />
a delay in its replacement, SATURN. On<br />
the obstetric side we welcomed a new<br />
medical director for labor and delivery,<br />
Dr. Philip Heine. We are looking forward<br />
to a renewed collaborative relationship<br />
with our obstetric colleagues.<br />
The gynecology service saw significant<br />
renovation in OR’s 19 and 20 to allow<br />
for the construction of a high radiation<br />
therapy unit. This project, with direction<br />
from Dr. Peter Dwane, proceeded very<br />
smoothly. This unit allows an expansion<br />
of therapeutic modalities for our<br />
gyn-oncology patients, as well as adding<br />
some challenging anesthetic issues.<br />
Education<br />
Resident education is a major mission<br />
of the Division of Women’s Anesthesia.<br />
We have two residents rotating on<br />
obstetrical anesthesia at all times.<br />
Under the guidance of Dr. Holly Muir,<br />
the DWA Residency Director, we have<br />
reexamined and renewed our commitment<br />
to format education in obstetric<br />
anesthesia. In our continuum of<br />
change, the Divisional meeting was<br />
changed to Thursday afternoons at 5:00<br />
p.m. to avoid conflict with the GVLT<br />
and Cardiac meetings. Here faculty<br />
and fellows review important developments<br />
in the field and discuss research<br />
progress. Residents are encouraged<br />
to attend and contribute. With a good<br />
balance of high-risk and normal pregnancies,<br />
we are confident that our residents<br />
get an education in obstetrical<br />
and gynecological anesthesia that is<br />
second to none. In this new academic<br />
year, we have seen an increased interest<br />
in CA-3 and advanced clinical track<br />
rotations on the obstetric service.<br />
We offer 1-2 fellowship positions<br />
per year in obstetrical anesthesia. These<br />
fellows undertake clinical care and<br />
teaching as well as participate in clinical<br />
and laboratory research. This year<br />
saw a change in our Fellowship Director<br />
from Dr. Elizabeth Bell to Dr. Yemi<br />
Olufolabi. Under his leadership the program<br />
has flourished. This years fellows<br />
included Dr. Sheila Gardner, Dr. John<br />
Schultz and Dr. Ashraf Habib. Our fellowship<br />
program has recently introduced<br />
a new option of combining the<br />
OB experience with Cardiac Anesthesia<br />
and Echo Experience in collaboration<br />
with Dr. Mark Stafford-Smith. Interest is<br />
strong and we are seeing many superb<br />
applicants.<br />
Dr. Peter Dwane, in his capacity as<br />
coordinator of the fourth year clinical<br />
elective, facilitates the introduction of<br />
numerous medical students to the field<br />
of anesthesia, including our own service,<br />
women’s and obstetric anesthesia.<br />
Research<br />
Elizabeth A. Bell, M.D., M.P.H. continues<br />
to coordinate the Combined Obstetric<br />
Research Database (CORD). Using data<br />
obtained from the database, Dr. John<br />
Schultz, under the guidance of Drs. Bell
and Muir, produced an abstract for presentation<br />
at SOAP 2000 comparing the<br />
anesthesia manpower required for patients<br />
using patient controlled epidural<br />
pumps versus continuous infusion<br />
pumps. This retrospective look at our<br />
data lends support to a prospective<br />
study comparing PCEA modalities<br />
under the supervision of Dr. Terry<br />
Breen. Dr. Bell presented the results<br />
of a prospective analysis of anesthesia<br />
time requirements for management of<br />
a labor service at the ASA as a follow<br />
up to her retrospective study published<br />
in 1999.<br />
John R. Schultz, M.D. the most<br />
recent addition to the divisional roster,<br />
is continuing a study to evaluates the<br />
addition of IHIL blocks to neuraxial<br />
narcotics after cesarean section can<br />
reduce the dosage of narcotics and<br />
unwanted side effects. This industrious<br />
young man is also directing a study<br />
evaluating a new simpler form of EKG<br />
monitoring, working on collaborative<br />
projects with Dr. T.J. Gan, and exploring<br />
laboratory research with Dr. James<br />
Reynolds.<br />
Adeyemi J. Olufolabi, M.B., B.S.,<br />
FRCA continues to spearhead an investigation<br />
of TEG and bleeding tendencies<br />
Departmental Support Staff<br />
in severe pre-eclampsia. He is also conducting<br />
a study looking at BIS levels and<br />
suggestion under anesthesia. In 2001,<br />
he hopes to conduct a study using near<br />
infrared spectrometry (NIRS) to evaluate<br />
placental blood flow.<br />
Terrance W. Breen, M.D., FRCP(C)<br />
is organizing a multi-center study to<br />
look at ED-95 doses of local anesthetic<br />
for induction of labor analgesia. He<br />
as well, will be starting a collaborative<br />
study with obstetrics to look at PCEA<br />
modalities and obstetric outcomes. He<br />
has recently been named as the QI<br />
Director for our Department and has<br />
taken this job on with vigor.<br />
Ellen M. Lockhart, M.D. continues<br />
to work on her laboratory based investigations<br />
of progesterone and brain protection.<br />
Scott E. Helsly, M.D., Ph.D., one<br />
of our up and coming Residents, under<br />
the tutelage of Dr. Terrance Breen, presented<br />
a retrospective evaluation of the<br />
risk of total spinal when spinal anesthesia<br />
is administered after failed epidural,<br />
both at the departmental research day<br />
and at the ASA this year.<br />
James D. Reynolds, Ph.D. moved<br />
to the position of the Director of the<br />
Obstetric Anesthesia Research Labora-<br />
CLINICAL ACTIVITIES<br />
tory and has developed collaborative<br />
relationships in his laboratory research<br />
with the Department of Surgery.<br />
Personnel<br />
In the year 2000, the Division saw major<br />
changes in personnel and administrative<br />
structure. Early in the year we were<br />
saddened by the departure but delighted<br />
by the promotion for Mary Carnell to<br />
the office of Grants and Contracts. This<br />
was followed by a move by Dr. John<br />
Booth to the Cardiac Division. John<br />
will be missed on the clinical service,<br />
however, he will continue to explore<br />
his research interests on the genetics<br />
of preterm labor. This year we also saw<br />
changes in our CRNA membership with<br />
the departure of Robert Foy and Mary<br />
Murphy, both to positions at the Ambulatory<br />
Surgery Center. They are both<br />
missed by their colleagues. In July we<br />
saw the departure of our leader, Dr.<br />
Donald Penning to an exiting administrative<br />
position in Toronto, Canada.<br />
He was replaced by Dr. Holly Muir, who<br />
will move the interests of the Division<br />
in new directions.<br />
Barbara Blank Patsy Clifton Vicki Jackson<br />
CLINICAL ACTIVITIES 73
BIOSTATISTICS AND<br />
CLINICAL OUTCOME<br />
William D. White, M.P.H.<br />
Chief, Division of Biostatistics<br />
and Clinical Outcomes<br />
MEMBERS:<br />
Habib El-Moalem, Ph.D.<br />
Barbara Phillips-Bute, Ph.D.<br />
Regina deLacy, B.A.<br />
BIOSTATISTICS AND CLINICAL OUTCOMES<br />
One of the primary commitments and<br />
achievements of the Department of<br />
Anesthesia is research, evidenced by<br />
increasing numbers of publications,<br />
funded research studies, and most<br />
important, improvements in patient<br />
care. Since its organization in 1997, the<br />
Division of Biostatistics and Clinical<br />
Outcomes has been committed to<br />
providing the necessary statistical<br />
resources and support to promote and<br />
enhance these efforts. Working in productive<br />
collaboration with clinicians<br />
and other research faculty and staff,<br />
division members provide statistical<br />
leadership and guidance in the areas of<br />
study design, information management,<br />
and analysis and interpretation of data.<br />
Our mission within the Department is<br />
two-fold: to encourage and promote<br />
research of the highest quality, and to<br />
teach sound principles and interpretation<br />
of statistical research techniques<br />
and results.<br />
Research<br />
74 BIOSTATISTICS AND CLINICAL OUTCOMES..<br />
Two purposes shape the Division's work<br />
with respect to research. First, we support<br />
investigators in the department by<br />
collaborating on both clinical and laboratory<br />
studies. This involves help with<br />
preparing grant proposals, defining<br />
hypotheses, designing studies and calculating<br />
sample sizes, collecting and<br />
managing data, analyzing the data, and<br />
interpreting and reporting results. In<br />
this role we are involved with investigators<br />
at all levels and virtually all divisions<br />
in the department.<br />
Examples of recent projects include<br />
interventions to reduce cognitive<br />
deficits following CABG; effectiveness<br />
of continuous interscalene brachial<br />
plexus block for ambulatory surgery; a<br />
grant to support identification of genes<br />
associated with postoperative delirium<br />
using DNA microarrays; effectiveness<br />
of analgesia after cesarean delivery;<br />
a genetic association with 4 cytokine<br />
inflammatory markers; and correlation<br />
of BIS index with sedation in the ICU.<br />
In the past year the division’s three biostatisticians<br />
provided sample size estimates<br />
for over 150 studies and worked<br />
with over 650 sets of data. Two large<br />
research databases we administer contain<br />
data on nearly 10,000 admissions<br />
for 19 study protocols.<br />
The second area of our research<br />
is within biostatistics. To stay at the<br />
leading edge of our field requires<br />
methodological research and development,<br />
both theoretical and applied.<br />
Areas of current research include factor<br />
analysis of cognitive outcomes data,<br />
statistical methods for genetic and<br />
microarray data, methods for analysis<br />
of continuous-monitor output, variance<br />
components, validation methods, and<br />
incorporation of surrogate variables<br />
in clinical trials.<br />
Teaching<br />
It is the nature of our work and part of<br />
our mission to promote a sound understanding<br />
of statistical principles and to<br />
help clients interpret and evaluate their<br />
own results and those of others. To this<br />
end, members of the division are actively<br />
involved in educational activities<br />
within the department. A vital and rewarding<br />
part of every analysis is the oneon-one<br />
interaction with clients exploring<br />
questions and explaining methods,<br />
results, and appropriate interpretation.<br />
Fellows are mentored in the statistical<br />
part of their projects by statisticians.<br />
The group participates in weekly conferences<br />
and seminars with faculty,<br />
fellows, and medical students. Additionally,<br />
Dr. Habib El-Moalem teaches<br />
in the curriculum of the Department<br />
of Bioinformatics and Biostatistics.<br />
Regina DeLacey, B.S., Habib El-Moalem, Ph.D., Barbara<br />
Phillips-Bute, Ph.D, William Whitey, M.S.
DIVERS ALERT<br />
NETWORK<br />
Peter B. Bennett, Ph.D., D.Sc.<br />
Founder, President and CEO,<br />
Divers Alert Network<br />
Senior Director, Hyperbaric<br />
Center<br />
Professor of Anesthesiology<br />
Vice Presidents<br />
Christopher C. Bennett, M.B.A.<br />
Vice President of Finance and CFO<br />
William H. Clendenen, M.B.A.<br />
Vice President of Training<br />
Joel A. Dovenbarger, RN<br />
Vice President of Medical Services<br />
Cindi C. Easterling, M.Ed.<br />
Vice President of Continuing Medical<br />
Education<br />
Donna Heath, B.S., M.S.<br />
Vice President of Information<br />
Technology<br />
Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP<br />
Vice President and Medical Director<br />
Daniel L. Orr, B.S., M.S.<br />
Executive Vice President and COO<br />
Webb L. Roberts, M.B.A.<br />
Vice President of Operations<br />
Barry K. Shuster, M.B.A.<br />
Vice President of Marketing<br />
Richard D. Vann, Ph.D.<br />
Vice President of Research<br />
Christopher J. Wachholz, M.B.A.<br />
Vice President of International DAN<br />
DIVERS ALERT NETWORK<br />
Directors<br />
Cindi M. Courter, B.F.A., M.A.<br />
Chief Development Officer<br />
Guy deLisle Dear, M.B., FRCA<br />
Assistant Medical Director<br />
Petar J. Denoble, M.D., D.Sc.<br />
Senior Research Director<br />
Deborah A. Williams<br />
Membership Director<br />
Bryant W. Stolp, M.D., Ph.D.<br />
Assistant Medical Director<br />
Edward D. Thalmann, M.D.<br />
Assistant Medical Director<br />
Renee D. Westerfield, B.A.<br />
Communications Director<br />
The Divers Alert Network (DAN) is<br />
an international 501(c)3 non profit<br />
diving safety association affiliated with<br />
the Department of Anesthesiology<br />
and Duke Medical Center. Dr. Peter<br />
Bennett, President and CEO, initiated<br />
DAN in 1980 as a 24-hour emergency<br />
hotline for recreational diving accidents<br />
in the United States and the Caribbean<br />
with grants from NOAA and NIOSH. In<br />
1983 as grants decreased, membership<br />
support was instituted. Today DAN is<br />
supported by 200,000 members and<br />
is growing steadily with a present support<br />
staff of 70 and a budget of over<br />
$13 million. The hotline in 2000, as of<br />
September, received 2,312 emergency<br />
calls, 9,551 information calls and 2,382<br />
e-mails.<br />
DAN exists to provide expert medical<br />
information and advice for the benefit<br />
of the diving public. Its historical<br />
and primary function is to provide<br />
emergency medical information and<br />
assistance for underwater diving accidents,<br />
prevent accidents and promote<br />
diving safety. DAN promotes and supports<br />
underwater diving research and<br />
education particularly as it relates to the<br />
improvement of diving safety, medical<br />
treatment and first aid. DAN strives to<br />
provide the most accurate, up to date<br />
and unbiased information on issues of<br />
common concern to the diving public,<br />
primarily, but not exclusively, for diving<br />
safety.<br />
DAN publishes a bimonthly magazine,<br />
Alert Diver, which updates<br />
research and specialized information to<br />
improve diver safety. From January<br />
2001 it will be published monthly.<br />
Other publications include the DAN<br />
Sponsorship News, membership services<br />
brochures, a DAN Pocket Guide<br />
to First Aid for Scuba Diving and a new<br />
Annual Report.<br />
In 1991, DAN initiated its Oxygen<br />
Program with specialized courses and<br />
developed its own emergency oxygen<br />
equipment vital for delivering oxygen to<br />
a diving accident victim. As of October<br />
1, 2000 over 9,443 qualified Oxygen<br />
Instructors can be found in 88 countries<br />
with 85,623 oxygen providers trained.<br />
DAN Research is supported at a<br />
level of $500,000 with projects carried<br />
out at the Hyperbaric Center. Projects<br />
in analysis or reporting include studies<br />
of: (a) the effects of time to flying after<br />
diving on the risk of decompression<br />
illness; (b) the probability of Dopplerdetected<br />
venous gas bubbles during<br />
real dives to assess the effects of age,<br />
gender, and maximum dive depths; and<br />
(c) the risks of diving with diabetes by<br />
insulin-dependent diabetics. Active<br />
data collection is in progress for: (1)<br />
evaluating ascent rates after diving<br />
at the hyperbaric chamber of Duke<br />
Medical Center; and (2) Project Dive<br />
Exploration (PDE), a long range epidemiology<br />
study with the goal of collecting<br />
computer recorded dive profiles<br />
and injury information from open water<br />
divers. A Dive Computer Identification<br />
Program has been established to single<br />
out dive computer manufacturers<br />
whose instruments are compatible with<br />
PDE. Project Dive Exploration is particularly<br />
interested in attracting older<br />
divers for a study of the Aging Diver.<br />
Volunteer divers can be trained as Field<br />
Research Coordinators (FRC) to collect<br />
data for PDE. In 2000, a summer internship<br />
program began during which four<br />
students were trained as FRCs and provided<br />
experience in diving research.<br />
The internship is presently being<br />
DIVERS ALERT NETWORK..75
DIVERS ALERT NETWORK<br />
extended to Cozumel, Mexico. Over<br />
20,000 dive profiles have been collected<br />
in Project Dive Exploration to date.<br />
Membership dollars also supported<br />
a DAN Recompression Chamber<br />
Assistance Program which provided<br />
education and technical support to<br />
recompression chambers in the Caribbean.<br />
Safety seminars and clinics were<br />
held at all major dive shows in North<br />
America and two very successful CME<br />
courses for physicians on diving medicine<br />
were held in the Caribbean.<br />
DAN has grown internationally<br />
since 1991 and active programs are<br />
available through DAN Europe, DAN<br />
Japan, DAN SE Asia/Pacific and DAN<br />
Southern Africa with a further 60,000<br />
members.<br />
DAN has an active industry<br />
Sponsor Program through resorts and<br />
stores (861), corporations (130), clubs<br />
(130), Friends of DAN (474), and Dive<br />
Instructors (4,056).<br />
In July 1997 DAN moved into its<br />
own 27,000 sq. ft. offices and headquarters<br />
at Colony Road in Durham, North<br />
Carolina. The Peter B. Bennett Center<br />
was named by the DAN Board in honor<br />
of the founder of DAN.<br />
76 DIVERS ALERT NETWORK<br />
When a dive injury is suspected, especially decompression sickness, a physician<br />
can administer a series of tests to check for neurological deficits by observing<br />
strength and reflexes.<br />
Finally, DAN initiated a for profit<br />
subsidiary, DAN Services, Inc., in 1998.<br />
It is wholly owned by DAN and its<br />
mission is:<br />
1. Support DAN in its ability to<br />
improve recreational diving safety and<br />
water related activities.<br />
2 Provide DAN and its members<br />
with services and business opportunities<br />
best provided by a tax-paying,<br />
for-profit corporation.<br />
PHOTO BY STEVE BARNETT<br />
3. Investigate and develop new<br />
services and business opportunities<br />
to benefit DAN and its members.<br />
One of its projects is to develop<br />
the REM O 2—an oxygen rebreather to<br />
enable the DAN standard oxygen emergency<br />
delivery equipment to be expanded<br />
from 30 minutes to up to six<br />
hours from the same oxygen cylinder.<br />
A second is to develop the DAN oxygen<br />
program for aquatics, i.e. use for swimming<br />
pools, emergencies, ocean lifeguards,<br />
etc.
Appointments,<br />
Promotions and Tenure<br />
David S. Warner, M.D.<br />
Chairperson<br />
Members<br />
Peter B. Bennett, Ph.D., D.Sc.<br />
Brian Ginsberg, M.B., Ch.B.<br />
Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP<br />
Mark F. Newman, M.D.<br />
J.G. Reves, M.D. (ex officio)<br />
Debra A. Schwinn, M.D.<br />
Bruno J. Urban, M.D., Dr.med.<br />
Frank H. Kern, M.D., FCCM<br />
Computer<br />
Guy deLisle Dear, M.B., FRCA<br />
Chairperson<br />
Members<br />
Richard J. Adrian<br />
Edward F. Cousineau, M.A., M.B.A.<br />
Larry A. Dowell, A.A.S.<br />
Andrew F. Meyer, M.D., M.B.A.<br />
Debra A. Schwinn, M.D.<br />
Kisan P. Uphadaya, A.A.S.<br />
Christopher A. Wester<br />
William D. White, M.P.H.<br />
Education Executive<br />
Jonathan B. Mark, M.D.<br />
Chairperson<br />
Members<br />
Patsy E. Clifton<br />
Anthony J. Colantonio, M.D.<br />
Guy deLisle Dear, M.B., FRCA<br />
Daniel D. DeMeyts, M.D.<br />
Peter D. Dwane, M.D., C.M., FRCP(C)<br />
John B. Eck, M.D.<br />
Katherine P. Grichnik, M.D.<br />
John C. Keifer, M.D.<br />
Kathryn P. King, M.D., M.S.N.<br />
Kurt J. Knauth, M.D.<br />
Catherine K. Lineberger, M.D.<br />
James R. McCurdy, II, M.D.<br />
Holly A. Muir, M.D., FRCP(C)<br />
Patti L. Myers<br />
<strong>DEPARTMENT</strong>AL COMMITTEES<br />
Cathleen L. Peterson-Layne, M.D., Ph.D.<br />
Kerri M. Robertson, M.D., FRCP(C)<br />
David B. Schinderle, M.D.<br />
Bryant W. Stolp, M.D., Ph.D.<br />
Jeffrey M. Taekman, M.D.<br />
David S. Warner, M.D.<br />
Emergency Airway Service<br />
Bryant W. Stolp, M.D., Ph.D.<br />
Chairperson<br />
Members<br />
Kathryn P. King, M.D., M.S.N.<br />
Nancy W. Knudsen, M.D.<br />
Eugene W. Moretti, M.D.<br />
John (Sam) Thio Sum Ping, M.B.,<br />
Ch.B., FRCA<br />
Christopher C. Young, M.D.<br />
Equipment, Supplies and<br />
Products Committee<br />
David A. Lubarsky, M.D., M.B.A.<br />
Chairperson<br />
Guy deLisle Dear, M.B., FRCA<br />
Acting Chairperson<br />
Members<br />
Steven E. Guerrant, Clinical Engineering<br />
Brooke L. Berson, Procurement Services<br />
Cynthia H. Robertson, Corporate<br />
Assistance Associate, Perioperative<br />
Services<br />
Frank H. Kern, M.D., FCCM<br />
Hilary P. Grocott, M.D., FRCP(C)<br />
Janet E. Goral, BSN, CRNA<br />
Holly A. Muir, M.D., FRCP(C)<br />
Jacques Somma, M.D., FRCP(C)<br />
Bryant W. Stolp, M.D., Ph.D.<br />
Stanley W. Weitzner, M.D.<br />
Eleanor W. Carter, CRNA<br />
Larry A. Dowell, A.A.S.<br />
Jeffrey M. Taekman, M.D.<br />
Peter D. Dwane, M.D., C.M., FRCP(C)<br />
Finance Committee<br />
David A. Lubarsky, M.D., M.B.A.<br />
Chairperson<br />
Members<br />
Cecil O. Borel, M.D.<br />
Edward F. Cousineau, M.A., M.B.A.<br />
Guy deLisle Dear, M.B., FRCA<br />
Francine J. D’Ercole, M.D.<br />
Anne Marie Fras, M.D.<br />
Charlene D. Hundley, B.B.A.<br />
Joseph P. Mathew, M.D.<br />
Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP<br />
Holly A. Muir, M.D., FRCP(C)<br />
Kerri M. Robertson, M.D., FRCP(C)<br />
Natalie J. Schneider, B.B.A.<br />
Susan M. Steele, M.D.<br />
Steven M. Williams, B.B.A.<br />
Christopher C. Young, M.D., FCCM<br />
Operations and Safety F.G.<br />
Hall Hyperbaric Center<br />
Richard D. Vann, Ph.D.<br />
Chairperson<br />
Members<br />
Michael J. Natoli, B.S., M.S.<br />
Pelzer Owen Doar, B.S.<br />
Thomas L. Edwards<br />
John H. Rice, R.N.<br />
Albert E. Boso, B.S., P.T.<br />
Quality Improvement<br />
Terrance W. Breen, M.D., FRCPC<br />
Chairperson<br />
Members<br />
Patricia M. Allushuski, CRNA, M.S.N.<br />
Eleanor W. Carter, CRNA<br />
Tong Joo Gan, M.B., B.S., FRCA<br />
Brian Ginsberg, M.B., Ch.B.<br />
Catherine K. Lineberger, M.D.<br />
Karen C. Nielsen, M.D.<br />
David B. MacLeod, M.B., B.S., FRCA<br />
Joseph P. Mathew, M.D.<br />
Adeyemi J. Olufolabi, M.B., B.S., FRCA<br />
James M. Temo, CRNA, M.S.N., M.B.A.<br />
Iain C. Sanderson, M.B., Ch.B., FRCA<br />
<strong>DEPARTMENT</strong>AL COMMITTEES 77
<strong>DEPARTMENT</strong>AL COMMITTEES<br />
David B. Schinderle, M.D.<br />
Diane L. Scott, M.D.<br />
Susan M. Steele, M.D.<br />
Patricia S. Tucker, R.N.C., B.S.N.,<br />
QI Coordinator<br />
Research Committee<br />
David S. Warner, M.D.<br />
Chairperson<br />
Members<br />
General<br />
Helene D. Benveniste, M.D., Ph.D.<br />
Patricia A. Cruse, A.A.S.<br />
Tong J. Gan, M.B., B.S., FRCA<br />
Stephen M. Klein, M.D.<br />
Madan M. Kwatra, Ph.D.<br />
Richard E. Moon, M.D., C.M., M.Sc.<br />
FRCP(C), FACP, FCCP<br />
Laura E. Niklason, M.D., Ph.D.<br />
Donald H. Penning, M.Sc., M.D.<br />
Karen W. Ramsey, R.N., M.B.A.<br />
Scott R. Schulman, M.D.<br />
Thomas F. Slaughter, M.D.<br />
Mark Stafford Smith, M.D., C.M., FRCP,<br />
DABA<br />
William D. White, M.P.H.<br />
Executive<br />
Patricia A. Cruse, A.A.S.<br />
Tong J. Gan, M.B., B.S., FRCA<br />
Kathryn P. King, M.D., M.S.N.<br />
Mark F. Newman, M.D.<br />
William D. White, M.P.H.<br />
Resident Advisory<br />
Committee<br />
Catherine K. Lineberger, M.D.<br />
Chairperson<br />
Members<br />
Terrance W. Breen, M.D., FRCP(C)<br />
Alexis C. Carmer, M.D.<br />
Peter D. Dwane, M.D., C.M., FRCP(C)<br />
John B. Eck, M.D.<br />
Jennifer T. Fortney, M.D.<br />
Tong Joo Gan, M.B., B.S., FRCA<br />
Katherine P. Grichnik, M.D., M.S.<br />
John C. Keifer, M.D.<br />
Kathryn P. King, M.D., M.S.N.<br />
78 <strong>DEPARTMENT</strong>AL COMMITTEES<br />
Ellen M. Lockhart, M.D.<br />
David A. Lubarsky, M.D., M.B.A.<br />
Jonathan B. Mark, M.D.<br />
Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP<br />
Eugene W. Moretti, M.D.<br />
Kerri M. Robertson, M.D., FRCP(C)<br />
Bryant W. Stolp, M.D., Ph.D.<br />
Jeffrey M. Taekman, M.D.<br />
Dana N. Wiener, M.D.<br />
Resident Evaluation<br />
Committee<br />
Catherine K. Lineberger, M.D.<br />
Chairperson<br />
Members<br />
Alexis C. Carmer, M.D.<br />
Fiona M. Clements, M.D.<br />
Francine J. D’Ercole, M.D.<br />
Guy deLisle Dear, M.B., FRCA<br />
Peter D. Dwane, M.D., C.M., FRCP(C)<br />
John B. Eck, M.D.<br />
Katherine P. Grichnik, M.D., M.S.<br />
Lewis R. Hodgins, M.D.<br />
John C. Kiefer, M.D.<br />
Kathryn P. King, M.D., M.S.N.<br />
Stephen M. Klein, M.D.<br />
Nancy W. Knudsen, M.D.<br />
David R. Lindsay, M.D.<br />
Eugene W. Moretti, M.D.<br />
Holly A. Muir, M.D., FRCP(C)<br />
Dianne L. Scott, M.D.<br />
Mark Stafford Smith, M.D., C.M., FRCP,<br />
DABA<br />
John T. Sum-Ping, M.B., Ch.B., FRCA<br />
Resident Selection<br />
Committee<br />
Catherine K. Lineberger,M.D.<br />
Chairperson<br />
Members<br />
John V. Booth, M.B., Ch.B., FRCA<br />
Cecil O. Borel, M.D.<br />
Terrance W. Breen, M.D., FRCPC<br />
Thomas E. Buchheit, M.D.<br />
Alexis C. Carmer, M.D.<br />
Guy deLisle Dear, M.B., FRCA<br />
Francine J. D’Ercole, M.D.<br />
John B. Eck, M.D.<br />
Jennifer T. Fortney, M.D.<br />
Anne Marie Fras, M.D.<br />
Tong Joo Gan, M.B., B.S., FRCA<br />
Katherine P. Grichnik, M.D., M.S.<br />
Brian Grinsberg, M.B., Ch.B.<br />
Hilary P. Grocott, M.D., FRCP(C)<br />
Steven E. Hill, M.D.<br />
John C. Keifer, M.D.<br />
Frank H. Kern, M.D., FCCM<br />
Nancy W. Knudsen, M.D.<br />
David R. Lindsay, M.D.<br />
Ellen M. Lockhart, M.D.<br />
David A. Lubarsky, M.D., M.B.A.<br />
David B. MacLeod, M.B., B.S., FRCA<br />
Jonathan B. Mark, M.D.<br />
Gavin Martin, M.B., Ch.B., FRCA<br />
Richard E. Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP<br />
Eugene W. Moretti, M.D.<br />
Holly A. Muir, M.D., FRCP(C)<br />
Mark F. Newman, M.D.<br />
Laura E. Niklason, M.D., Ph.D.<br />
Adeyemi J. Olufolabi, M.B., B.S., FRCA<br />
J. G. Reves, M.D.<br />
Allison K. Ross, M.D.<br />
Iain C. Sanderson, M.B., Ch.B., FRCA<br />
Thomas F. Slaughter, M.D.<br />
Mark Stafford-Smith, M.D., C.M., FRCP,<br />
DABA<br />
Bryant W. Stolp, M.D., Ph.D.<br />
Jeffrey M. Taekman, M.D.<br />
David S. Warner, M.D.<br />
Dana N. Wiener, M.D.<br />
Christopher C. Young, M.D., FCCM
DIVISION CHIEFS AND COMMITTEE CHAIRPERSONS<br />
Departmental Executive Committee<br />
J.G. Reves, M.D., Chairperson<br />
Members<br />
Cecil O. Borel, M.D.<br />
Terrance W. Breen, M.D.<br />
Thomas E. Buchheit, M.D.<br />
Edward F. Cousineau, M.A., M.B.A.<br />
Francine J. D’Ercole, M.D.<br />
John B. Eck, M.D.<br />
Anne Marie Fras, M.D.<br />
Russell T. Giesler, CRNA<br />
Frank H. Kern, M.D., FCCM<br />
Catherine K. Lineberger, M.D.<br />
David A. Lubarsky, M.D., M.B.A.<br />
Jonathan B. Mark, M.D.<br />
Richard E. Moon, M.D. C.M., M.Sc., FRCP(C), FACP, FCCP<br />
Holly A. Muir, M.D., FRCP(C)<br />
Mark F. Newman, M.D.<br />
J. G. Reves, M.D.<br />
Kerri M. Robertson, M.D., FRCP(C)<br />
Alison K. Ross, M.D.<br />
Debra A. Schwinn, M.D<br />
Susan M. Steele, M.D.<br />
David S. Warner, M.D.<br />
William D. White, M.P.H.<br />
Christopher C. Young, M.D.<br />
DIVISION CHIEFS AND COMMITTEE CHAIRPERSONS 79
80<br />
Thirteenth Annual ASA Duke Anesthesiology Alumni Reception<br />
SAN FRANCISCO, CALIFORNIA • OCTOBER 15, 2000
EDUCATION<br />
Catherine K. Lineberger, M.D.<br />
Residency Program Director<br />
Associate Professor of<br />
Anesthesiology<br />
It is a pleasure to once again summarize<br />
the many contributions our faculty<br />
and residents and fellows contribute in<br />
the arena of education. One of the<br />
three major charges of any academic<br />
Department, our educational mission<br />
has thrived in 2000.<br />
Graduate Medical Education<br />
Internship<br />
In the year 2000 match we matched our<br />
third group of interns. The internship<br />
was established in the 1998-1999 academic<br />
year to meet the needs of applicants<br />
to our program that wished to<br />
pursue the entire postgraduate education<br />
curriculum in one location. Each<br />
year we have enrolled eight interns,<br />
and the program continues under the<br />
capable leadership of the Assistant<br />
Program Director, John B. Eck, M.D.<br />
The internship is a rotating internship<br />
designed to meet the educational<br />
needs of future anesthesiologists. It is a<br />
unique program at Duke, and unlike<br />
many transitional internships, is limited<br />
to interns who plan anesthesia careers<br />
at Duke. The internship emphasizes<br />
general medicine, surgery and pedi-<br />
82 EDUCATION..<br />
EDUCATION<br />
atrics, with a particular emphasis on<br />
critical care medicine. Interns rotate<br />
through nine mandatory rotations and<br />
have elective opportunities as well.<br />
Notable events regarding the<br />
internship include the addition of an<br />
anesthesiology rotation as a required<br />
rotation. The interns, in conjunction<br />
with Dr. Eck, decide what aspects of<br />
our Department they would like to feature,<br />
and the rotation is constructed<br />
accordingly. Some of the interns have<br />
opted to spend valuable time on the<br />
acute pain service, or have gained<br />
experience with starting IVs, basic intubation<br />
and airway skills, etc. The<br />
hyperbaric medicine elective continues<br />
to be popular, and gives the interns an<br />
exposure to one of the unique aspects<br />
of the Department.<br />
The faculty have now had the<br />
opportunity to work with two classes<br />
of graduates from our internship. These<br />
interns have had the benefit of knowledge<br />
of the institution and colleagues<br />
from other departments, and have the<br />
appropriate medical knowledge for the<br />
specialty of anesthesiology. In addition,<br />
our interns' performance on the medicine,<br />
surgery, emergency medicine and<br />
pediatric services has been evaluated<br />
quite favorably. This was evidenced in<br />
2000 when the Department of Medicine<br />
looked to our Department for intern<br />
support of its plan to add a team on the<br />
General Medicine Service at Durham<br />
Regional Hospital.<br />
Residency<br />
In May of 2000 the anesthesiology<br />
residency, critical care fellowship and<br />
pain fellowship underwent their respective<br />
reviews by the Anesthesiology<br />
Residency Review Committee of the<br />
Accreditation Council for Graduate<br />
Medical Education. The quality of all<br />
three programs was affirmed by the<br />
ACGME's decision to accord continued<br />
full accreditation status to the three programs.<br />
Preparation for these reviews is<br />
a time-consuming process and the contributions<br />
of Christopher C. Young,<br />
M.D., FCCM, Joel S. Goldberg, M.D.,<br />
John B. Eck, M.D., Catherine K.<br />
Lineberger, M.D., Ms. Patsy Clifton,<br />
Ms. Laraine Tuck, and Mr. Edward<br />
Cousineau were critically important to<br />
the successful outcome. The reviewer<br />
met with many of the interns, residents<br />
and faculty from the Department and<br />
their time and effort is also appreciated.<br />
The American Board of Anesthesiology<br />
released figures from 1995-1999<br />
and demonstrated that the Duke Anesthesiology<br />
residency graduates have a<br />
collective board certification rate of<br />
97% in that time interval, compared<br />
with 81% nationally. This includes the<br />
period of time when interest in anesthesiology<br />
as a career dropped precipitously.<br />
These data support the outstanding<br />
efforts of our faculty and residents in<br />
the development of one of the country's<br />
best residency programs.<br />
For the 2000 Match we received<br />
980 applications, and interviewed<br />
88 medical students. We ranked 75 students<br />
and once again, filled all of our<br />
requested positions in the match. The<br />
overall quality of the applicant pool<br />
increased this year, as did the size of<br />
the pool. Our graduating class of residents<br />
pursued fellowships in cardiac<br />
anesthesia, pain management, and private<br />
practice opportunities in locations<br />
across the country.<br />
2000 Graduate Residents<br />
Randy P. Brewer, M.D.<br />
Pain Fellowship, Mayo Jacksonville,<br />
FL<br />
Andrea L. Crawford, M.D.<br />
Private Practice, Los Angeles, CA<br />
B. Will Curtis, M.D.<br />
Private Practice, Austin TX<br />
Adil J. Kamal, M.D.<br />
Pain Fellowship, Duke<br />
Christopher M. Kerr, M.D.<br />
Private Practice, Salinas, KS<br />
Robert R. Panten, Jr., M.D.<br />
Cardiac Fellowship, Duke<br />
Garrett W. Scales, M.D.<br />
Private Practice, Austin TX<br />
Bo Wu, M.D.<br />
Cardiac Fellowship, Duke
Several advances in the residency<br />
curriculum and management deserve<br />
mention.<br />
Jeffrey M. Taekman, M.D. developed<br />
a new, web-based resident evaluation<br />
system for the Department. Holly<br />
A. Muir, M.D., FRCP(C) and Catherine<br />
K. Lineberger, M.D. assisted him with<br />
the development of the new evaluation<br />
criteria. This system is accessible via<br />
any internet service and is intended<br />
to facilitate the evaluation process and<br />
provide more feedback to the residents.<br />
Dr. Taekman is quite interested in incorporating<br />
computer-based and webbased<br />
items into educational curricula,<br />
and organized sessions for the residents<br />
to learn about internet-based resources<br />
for reviewing the literature.<br />
Two years ago, the chief residents<br />
developed an Advanced Resident Lecture<br />
Series. This is a series of biweekly<br />
lectures, with faculty and topics selected<br />
by the chief residents. Drs. Bo Wu and<br />
Garrett Scales continued to organize the<br />
series through the 1999-2000 academic<br />
year, and David B. Schinderle, M.D. and<br />
James R. McCurdy, II, M.D. are handling<br />
the duties in the 2000-2001 year. These<br />
lectures are intended to supplement the<br />
residency curriculum lectures, which<br />
are held on Wednesday mornings.<br />
Duke is fortunate to have a human<br />
fresh tissue laboratory under the supervision<br />
of Scott L. Levin, M.D., Chief of<br />
the Division of Plastic Surgery. This<br />
year, David B. MacLeod, M.B., B.S.,<br />
FRCA organized the first of several<br />
planned anatomy dissections for the<br />
residents. The first session concentrated<br />
on brachial plexus anatomy. Each resident<br />
attended one of two sessions<br />
which featured a review lecture and<br />
an opportunity to review the brachial<br />
plexus anatomy using demonstrations<br />
with a dissected cadaver. The Department<br />
is supporting Dr. MacLeod’s plans<br />
for additional sessions focusing on<br />
other aspects of anatomy that are relevant<br />
to anesthesia practice and regional<br />
anesthesia in particular.<br />
The Department explored the new<br />
expanding technology of human simulation<br />
this year. As plans for the purchase<br />
of a simulator at Duke developed,<br />
the Department of Anesthesiology<br />
decided to provide each senior resident<br />
with the opportunity to spend a day in a<br />
simulator session. The first group of residents<br />
spent a day in December at the<br />
simulation laboratory at Wake Forest<br />
University (WFU) with Dr. Michael<br />
Olympio. The residents found this valuable,<br />
and the Department plans to send<br />
the remainder of the senior class to<br />
WFU later this year. We anticipate the<br />
arrival of a simulator, which will be<br />
used by the schools of medicine and<br />
nursing in addition to our Department.<br />
Fellowships<br />
As mentioned above, our ACGMEaccredited<br />
fellowships in critical care<br />
medicine and pain management received<br />
full continued accreditation in<br />
2000. More detailed descriptions of<br />
these and other fellowships (cardiothoracic<br />
anesthesia, obstetric anesthesia,<br />
regional anesthesia, hyperbaric medicine,<br />
human pharmacology, and neuroanesthesia)<br />
can be found in the appropriate<br />
clinical sections of this report.<br />
All of the Duke fellowships provide<br />
excellent opportunities for the development<br />
of outstanding academic careers<br />
and enhancement of clinical skills.<br />
Fellows in all of the fellowships have<br />
a long history of productivity regarding<br />
publications, meaningful research and<br />
acquiring funding. Of particular note<br />
this year, one of our cardiac fellows,<br />
G. Burkhard Mackensen, M.D. won first<br />
prize in the national ASA Resident<br />
Research Essay contest for his abstract<br />
and paper entitled, “Neuroprotection<br />
from Delayed Post-Ischemic Administration<br />
of a Metalloporphyrin Catalytic<br />
Antioxidant in the Rat.” This work was<br />
accomplished with David S. Warner,<br />
M.D. and has been a springboard for<br />
Dr. Mackensen's career, which now<br />
includes several additional papers and<br />
grants.<br />
EDUCATION<br />
Undergraduate Medical<br />
Education<br />
Medical Student Education<br />
The Department of Anesthesiology is<br />
fortunate to have established significant<br />
amounts of participation in all four<br />
years of the medical school curriculum.<br />
Many of our faculty influence the makeup<br />
of the medical school classes by<br />
serving on the Medical School Admissions<br />
Committee. These include<br />
Kathryn E. King, M.D., John B. Eck,<br />
M.D., Christopher C. Young, M.D.,<br />
FCCM, Bryant W., Stolp, M.D., Ph.D.,<br />
Laura E. Niklason, M.D., Ph.D., Richard<br />
E. Moon, M.D., C.M., M.Sc., FRCP(C),<br />
FACP, FCCP, Adeyemi John Olufolabi,<br />
M.B., B.S., DCH, FRCA, John C. Keifer,<br />
M.D., Mark Stafford Smith, M.D., C.M.,<br />
FRCP, DABA, and J.G. Reves, M.D. In<br />
addition, Drs. King and Young are<br />
members of the Executive Admissions<br />
Committee for the medical school.<br />
First Year Curriculum<br />
Several departmental faculty continue<br />
to serve as mentors in the PRACTICE<br />
(Progressive Responsibilities and<br />
Competencies Through an Integrated<br />
Clinical and Curricular Experience)<br />
course, including Edmond C. Bloch,<br />
M.B., Ch.B., Merel H. Harmel, M.D. and<br />
Kathryn E. King, M.D. This longitudinal<br />
course represents a significant commitment<br />
of faculty time for the course,<br />
which runs for a two-year cycle. The<br />
course consists of small group discussions<br />
and sessions on interviewing,<br />
physical diagnosis, ethics and other topics<br />
and prepares students to assume the<br />
professional responsibilities of a physician.<br />
It is as rewarding for the faculty<br />
as it is valuable for the students.<br />
Dr. Bret Stolp continues to be the<br />
course director for the first year physiology<br />
course. In addition, Drs. Richard<br />
Moon, Jonathan Mark, and Chris Young<br />
also participate as faculty in the course.<br />
Dr. Lewis Hodgins continues to participate<br />
as a lecturer in the first year pharmacology<br />
course.<br />
EDUCATION 83
EDUCATION<br />
Second Year Curriculum<br />
Many of the Department of Anesthesiology<br />
faculty participate in the second<br />
year of the medical school curriculum,<br />
either as clinical supervisors or participating<br />
in the lecture series associated<br />
with the core clinical courses. Elizabeth<br />
A. Bell, M.D. lectures in the obstetrics<br />
and gynecology core course. Dr.<br />
Kathryn King continues to organize<br />
the anesthesiology component of the<br />
surgery core course. Many departmental<br />
faculty, including Drs. King, Gavin<br />
Martin, David MacLeod, Peter Dwane,<br />
Elizabeth Bell, Brian Ginsberg, Lewis<br />
Hodgins, Catherine Lineberger, Jerry<br />
Reves, Iain Sanderson, and Mark<br />
Stafford-Smith give lectures to the students<br />
in the introductory portion of the<br />
course. Nearly every department member,<br />
including faculty, residents and<br />
nurse anesthetists, helps provide meaningful<br />
clinical exposure to the specialty<br />
during the three daylong introductory<br />
series to the surgery core course.<br />
Third Year Curriculum<br />
The Department has sponsored one of<br />
the third year study tracks, Anesthesia,<br />
Surgery and Environmental Physiology,<br />
for six years. Dr. Kathryn King is the<br />
Administrative Director for the study<br />
track, and the steering committee<br />
includes Drs. Richard Moon, David<br />
Warner, James Reynolds, Bret Stolp and<br />
Steve Vaslef. Currently nine students<br />
are studying in the track, doing scientific<br />
projects under the supervision and<br />
mentorship of one of the faculty in the<br />
study track. These faculty include Drs.<br />
David Warner, Laura Niklason, and<br />
Richard Moon from the Department<br />
of Anesthesiology, and Drs. Steve<br />
Eubanks, Jeff Lawson, and Steve Vaslef<br />
in the Department of Surgery.<br />
Most of the students in the track<br />
produce at least one research paper,<br />
and some win awards, such as Brian<br />
Kaminski, who won the top prize out<br />
of 180 papers presented at the Southeastern<br />
Trauma Conference Fall 2000<br />
meeting. Mr. Kaminski’s work was in<br />
Dr. Steve Vaslef's laboratory.<br />
84 EDUCATION..<br />
Fourth Year Curriculum<br />
The Department offers a research elective,<br />
a critical care elective and a clinical<br />
elective in the fourth year. While the<br />
faculty involved in the research elective<br />
can vary from year to year, many<br />
department members have participated<br />
in the lecture series for the clinical elective<br />
for several years. These faculty<br />
include the course director, Dr. Peter<br />
Dwane, as well as Drs. Bret Stolp, Iain<br />
Sanderson, Jonathan Mark, Dana<br />
Wiener, Lewis Hodgins, Kathy Grichnik,<br />
Brian Ginsberg, Jerry Reves, John Eck,<br />
Allison Ross, and Guy Dear. This year<br />
Drs. Merel Harmel and Eugene Moretti<br />
have started to lecture in the course.<br />
Dr. Chris Young continues to serve as<br />
the course director for the critical care<br />
elective.<br />
The contributions of many faculty<br />
and resident clinical mentors to the<br />
fourth year medical students cannot be<br />
overstated. Similarly, the Departmental<br />
Teaching Scholars provide organization<br />
of the clinical preceptors and organize<br />
the students’ clinical case conferences<br />
each year. Last year Drs. Will Curtis<br />
and Chris Kerr filled this role admirably,<br />
and Drs. Jon-Paul Harmer and Peter<br />
DeBalli are our current Teaching<br />
Scholars.<br />
Lastly, during the year 2000, a<br />
medical school curriculum review was<br />
accomplished by the Task Force on<br />
Curriculum Structure and Organization,<br />
which was led by Anesthesiology Chair,<br />
J.G. Reves, M.D. and Dale Purves, M.D.,<br />
Chair of the Neurobiology Department.<br />
It is expected that the task force recommendations<br />
will be developed further<br />
in 2001 and implemented in 2002.<br />
Events<br />
The Eighth Departmental Academic<br />
Evening was held on May 2, 2000 at the<br />
Durham Hilton Hotel. Several residents<br />
and fellows submitted abstracts for the<br />
event, which is described in greater<br />
detail in another section of this report.<br />
Alina M. Grigore, M.D. won the Dick<br />
Smith Award, and Timothy O. Stanley,<br />
M.D., Maribel G. Gamoso, M.D., and<br />
Karen C. Neilsen, M.D. were runners-up<br />
for the award. Dr. Adil Kamal won first<br />
prize in the new case report category,<br />
and Dr. Peter DeBalli was the runner<br />
up. The evening was well-attended and<br />
is an opportunity for the Department to<br />
showcase the research and other academic<br />
efforts of its non-faculty members.<br />
Resident and Fellow Participants,<br />
2000 Academic Evening<br />
Randy P. Brewer, M.D.<br />
Peter DeBalli, III, M.D.<br />
George N. Djaiani, M.D., FRCA<br />
Maribel G. Gamoso, M.D.<br />
Sheila F. Gardner, M.D.<br />
Charles H. Gleaton, M.D.<br />
Alina M. Grigore, M.D.<br />
Scott E. Helsley, M.D., Ph.D.<br />
David M. Hendricks, M.D.<br />
Adil S. Kamal, M.D.<br />
Marcella J. Lanzinger, M.D.<br />
G. Burkhard Mackensen, M.D.<br />
Karen C. Neilsen, M.D.<br />
Robert R. Panten, Jr., M.D.<br />
John R. Schultz, M.D.<br />
Timothy O. Stanley, M.D.<br />
Lian Kah Ti, M.B., B.S.<br />
The Department of Anesthesiology<br />
at the University of North Carolina at<br />
Chapel Hill sponsored the 2000 Gulf<br />
Atlantic Residents’ Research Conference<br />
(GAARC). Several residents and fellows<br />
from our Department presented abstracts,<br />
and Dr. Robert Panten was the<br />
recipient of the third place award for<br />
case reports. Dr. Peter DeBalli won the<br />
third place award in the literature review<br />
category. Drs. John Eck, John Keifer,<br />
and Jerry Reves attended the meeting<br />
and served as faculty moderators.<br />
Resident and Fellow Participants,<br />
2000 GAARC<br />
Peter DeBalli, III, M.D.<br />
James R. McCurdy, M.D.<br />
G. Burkhard Mackensen, M.D.<br />
John Moloney, M.D.<br />
Robert R. Panten, Jr., M.D.<br />
David B. Schinderle, M.D.<br />
Timothy O. Stanley, M.D.<br />
Lian Kah Ti, M.B., B.S.<br />
Chiedozie Udeh, M.B., B.S.
The Annual Resident Graduation<br />
and Awards Banquet was held on June<br />
17, 2000 at the Hope Valley Country<br />
Club. Over 150 Department members<br />
and families attended the event, our<br />
opportunity to celebrate the accomplishments<br />
of the graduating resident<br />
class. Many awards were given to faculty<br />
and residents. Dr. Reves presented<br />
the Robert N. Sladen Teacher of the<br />
Year award to John C. Keifer, M.D. and<br />
Dr. Lineberger presented the VA<br />
Teaching award to Thomas E. Buchheit,<br />
M.D. Several medical student teaching<br />
awards were presented by Dr. Kathryn<br />
King, including awards to Kurt J.<br />
Knauth, M.D. and Julie Z. Woosley,<br />
M.D. as Resident Teachers of the Year,<br />
and B. Will Curtis, M.D. for the Outstanding<br />
Resident Contribution to Medical<br />
Student Education. Carleen E.<br />
Bagnall, CRNA was the recipient of the<br />
Medical Student CRNA Recognition<br />
award, and Bryant Stolp, M.D., Ph.D.<br />
received the Medical Student Faculty<br />
Recognition Award.<br />
Dr. John Eck presented certificates<br />
to each of the interns as they completed<br />
the internship year, and our Departmental<br />
fellows were acknowledged<br />
by their program directors.<br />
Christopher M. Kerr, M.D. received<br />
the award for Outstanding Graduate<br />
Resident in Anesthesiology. Drs. Garrett<br />
Scales and Bo Wu were recognized for<br />
their contributions as Chief Residents,<br />
and Drs. Will Curtis and Christopher<br />
Kerr were acknowledged for their work<br />
as Teaching Scholars. Drs. Will Curtis,<br />
Adil Kamal, and Garrett Scales were<br />
recognized with certificates acknowledging<br />
completion of ten liver transplants.<br />
Andrew J. Hartle, M.B., Ch.B.,<br />
FRCA presented Dr. Laura Kihlstrom<br />
with the Golden Tuohy Award, resulting<br />
from a particularly difficult call night on<br />
the obstetric service.<br />
In October Dr. Peter DeBalli represented<br />
the Department as our resident<br />
representative for the ASA resident<br />
section meeting in San Francisco, CA.<br />
Similarly, Dr. Cathleen Peterson-Layne<br />
was sponsored as our FAER scholar<br />
at the same meeting.<br />
The sixth annual Alumni Evening<br />
was held on November 3 at the Siena<br />
Hotel in Chapel Hill, and was organized<br />
by Katherine P. Grichnik, M.D., MS and<br />
Peter D. Dwane, M.D., C.M., FRCP(C).<br />
Residents and their guests were treated<br />
to a nice dinner and then were addressed<br />
by Drs. Charlene Elliott, Scott<br />
Howell, Steve Rogers and Joshua<br />
Schwartz who provided them with<br />
advice and insight into various practice<br />
situations. It is always nice to hear from<br />
our alumni and see their post-Duke<br />
accomplishments.<br />
Summary<br />
Duke Anesthesiology is fortunate to<br />
have the resources of talented faculty,<br />
residents and fellows, in addition to a<br />
rich clinical environment in which to<br />
work. We look forward to another year<br />
of learning and professional growth.<br />
EDUCATION<br />
EDUCATION 85
EDUCATION<br />
Lectures, Conferences and Didactics<br />
Date Title Speaker Position<br />
<strong>ANESTHESIOLOGY</strong> AND ENVIRONMENTAL PHYSIOLOGY<br />
May 1 Academic Evening David Warner, M.D. Faculty<br />
Kathryn King, M.D., MSN Faculty<br />
September 11 Coagulation Jeff Lawson, M.D., Ph.D. Duke Staff<br />
Vascular Biology Jeff Lawson, M.D., Ph.D. Duke Staff<br />
Blood Substitutes Steve Vaslef, M.D., Ph.D. Faculty<br />
Tissue Engineering Laura Niklason, M.D., Ph.D. Faculty<br />
12 Fetal Brain Injury James Reynolds, Ph.D. Faculty<br />
The Grant Process Madan Kwatra, Ph.D. Faculty<br />
IRB/Human Studies T.J. Gan, M.B., B.S., FRCA Faculty<br />
Ethics of Animal Research Lee Tyrey, Ph.D. Duke Staff<br />
12 What Does a Journal Editor Look For? J. G. Reves, M.D. Faculty<br />
David Warner, M.D. Faculty<br />
13 CRP 240: Statistics Bill Wilkinson, Ph.D. Duke Staff<br />
14 Ischemic Brain Injury David Warner, M.D. Faculty<br />
Hilary Grocott, M.D., FRCP(C) Faculty<br />
Brain Imaging Helene Benveniste, M.D., Ph.D. Faculty<br />
14 Hyperbaric Medicine Richard Moon, M.D., C.M., M.Sc., Faculty<br />
FRCP(C), FACP, FCCP<br />
Bryant Stolp, M.D., Ph.D. Faculty<br />
Richard Vann, Ph.D. Faculty<br />
15 Molecular Pharmacology Madan Kwatra, Ph.D. Faculty<br />
Gregory Michelotti, Ph.D. Faculty<br />
October 3 Minimally Invasive Surgery Steve Eubanks, M.D. Duke Staff<br />
CARDIAC LECTURES<br />
January 4 Cognition and Cardiac Anesthesia Mark Newman, M.D. Faculty<br />
11 Rationale of CPB Temperatures Hilary Grocott, M.D., FRCP(C) Faculty<br />
25 Thoracic Anesthesia Katherine Grichnik, M.D., MS Faculty<br />
February 1 Paravertebral Block Steven Hill, M.D. Faculty<br />
8 Post CPB Vasodilatation, Impressions of Vasopressin Andrew Hilton, M.B., B.S., FANZCA Faculty<br />
15 Research Update Joseph Mathew, M.D. Faculty<br />
22 Neurocognition Update Mark Newman, M.D. Faculty<br />
29 Right Ventricular Function Jonathan Mark, M.D. Faculty<br />
March 7 Sympathectomy for the Treatment of Refractory Sunil Panchal, M.D. Guest<br />
Angina<br />
14 Perioperative Renal Function Mark Stafford Smith, M.D., C.M., Faculty<br />
FRCP, DABA<br />
21 Common Postoperative Problems in the Cardiac ICU Andrew Hilton, M.B., B.S., FANZCA Faculty<br />
28 Air Emboli and Hyperbaric Medicine Bryant Stolp, M.D., Ph.D. Faculty<br />
86 EDUCATION..
Lectures, Conferences and Didactics<br />
EDUCATION<br />
Date Title Speaker Position<br />
April 4 The Digital Echo Lab John Toptine, RRT Duke Staff<br />
11 Cognition and Paravertebral Block in Thoracic Patients Katherine Grichnik, M.D., MS Faculty<br />
18 Postoperative Pain Management in Thoracic Patients Brian Ginsberg, M.B., Ch.B. Faculty<br />
25 Research Update Madan Kwatra, Ph.D. Faculty<br />
May 2 SCA Poster Presentations The Cardiac Fellows Resident Faculty<br />
16 Pulmonary Hypertension in Pediatric Cardiac Surgery Frank Kern, M.D., FCCM Faculty<br />
30 Lung Cancer and Thoracic Surgery Thomas D'Amico, M.D. Duke Staff<br />
June 6 Adult Congential Heart Surgery Hilary Grocott, M.D., FRCP(C) Faculty<br />
13 Does Anything Reduce Cardiac Morbidity? Lee Fleisher, M.D. Guest<br />
20 Nitric Oxide in Cardiac Surgery Stan Shernan, M.D. Guest<br />
27 Evaluation of a Novel Neuroprotectant G. Burkhard Mackensen, M.D. Faculty<br />
July 11 “CT State of the Union Address” Mark Newman,M.D. Faculty<br />
18 Novel Antiplatelet Therapy Gautham Sreeram, M.D. Faculty<br />
25 Palm Pilot Use Joseph Mathew, M.D. Faculty<br />
August 1 Divisional Research Interests The Cardiac Faculty Faculty<br />
8 Divisional Research Interests The Cardiac Faculty Faculty<br />
15 Intraoperative Thoracic Surgery Emergencies Katherine Grichnik, M.D., MS Faculty<br />
September 5 Patterns of Postoperative Renal Dysfunction Mark Stafford Smith, M.D., C.M., Faculty<br />
FRCP, DABA<br />
19 Are All Beta-Blockers the Same? John Booth, M.B., Ch.B., FRCA Faculty<br />
26 Research Update Laura Niklason, M.D., Ph.D. Faculty<br />
October 3 Echo Case Reviews Daniel Bainbridge, M.D. Faculty<br />
10 History of Cardiac Anesthesia J.G. Reves, M.D. Faculty<br />
24 Synthetic Oxygen Carriers Steven Hill, M.D. Faculty<br />
November 14 Diastolic Dysfunction and Echocardiography Joseph Mathew, M.D. Faculty<br />
21 TEE Considerations for the Ross Procedure Daniel Thys, M.D. Guest<br />
December 5 Anesthesia and Space Physiology Richard Moon, M.D., C.M., M.Sc., Faculty<br />
FRCP(C), FACP, FCCP<br />
12 Left Ventricular Assist Devices Carmello Milano, M.D. Duke Staff<br />
19 TEE Considerations Roman Kluger, M.D. Guest<br />
CRITICAL CARE CONFERENCES<br />
January 27 Ethical Issues in the ICU Lewis Hodgins, M.D. Faculty<br />
February 10 Medical Management of Subarchnoid Hemorrhage Cecil Borel, M.D. Faculty<br />
24 Ethical Issues in ICU Lewis Hodgins, M.D. Faculty<br />
March 23 Hypobaric Physiology Richard Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP Faculty<br />
EDUCATION 87
EDUCATION<br />
Lectures, Conferences and Didactics<br />
Date Title Speaker Position<br />
April 6 Clinical Effects of Altitude David Murdoch, M.D. Duke Staff<br />
20 Methemoglodinemia-Case Report and Review John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
of Literature<br />
May 18 Current Status of Blood Substitutes Steven Vaslef, M.D., Ph.D. Faculty<br />
August 10 Complications of Invasive Hemodynamic Monitoring David Schinderle, M.D. Resident<br />
24 Tissue Engineering and You Laura Niklason, M.D., Ph.D. Faculty<br />
September 7 ICU Sedation Kurt Knauth, M.D. Resident<br />
21 Candidemia Gary Cox, M.D. Duke Staff<br />
GERONTOLOGICAL RESEARCH IN ANESTHESIA AND SURGERY PROGRAM (GRASP)<br />
January 10 Strategy to Analyze the Effect of Aging on Jacques Somma, M.D., FRCP(C) Faculty<br />
Pharmacokinetics and Dynamics<br />
February 7 Spinal Opioids in the Elderly Thomas Buchheit, M.D. Faculty<br />
April 10 Physical Fitness and Postoperative Complications Miriam Morey, Ph.D. Duke Staff<br />
A Review of the Currently Used Instruments to Detect Madan Kwatra, Ph.D. Faculty<br />
Postoperative Delerium<br />
May 22 Impact of Anesthesia; Problems in Analysis of Gerda Fillenbaum, Ph.D. Duke Staff<br />
Secondary Data from a Representative Older<br />
Community Sample<br />
June 12 Delirium Jack Twersky, M.D. Duke Staff<br />
August 7 Predicting Adverse Postoperative Outcomes in Richard Moon, M.D., C.M., M.Sc., Faculty<br />
Patients Aged 80 Years or Older FRCP(C), FACP, FCCP<br />
September 11 Delirium in Orthopedic Patients William Richardson, M.D. Duke Staff<br />
November 6 Mental Status Screening Katherine Welsh-Bohmer, Ph.D. Duke Staff<br />
GRAND ROUNDS<br />
January 5 The Relationship of Addiction to the Treatment Charles O’Brien, M.D., Ph.D. Guest<br />
of Chronic Pain<br />
12 Should We Use Local Anesthetic in Thoracic Epidural Oscar DeLeon Casasola, M.D. Guest<br />
Anesthesia and Analgesia?<br />
19 Preemptive Analgesia: Fact or Fiction Tarsha Garvin, M.D. Resident<br />
February 2 Sex, Lies and Anesthesia Peter DeBalli, III, M.D. Resident<br />
9 Success With Heart Failure: Recent Advances Michael Cuffe, M.D. Duke Staff<br />
88 EDUCATION..
Lectures, Conferences and Didactics<br />
EDUCATION<br />
Date Title Speaker Position<br />
February 16 Preemptive Analgesia: Fact or Fiction? Tarsha Garvin, M.D. Resident<br />
23 Pre and Postoperative Management of the Geriatric David Lipschitz, M.D., Ph.D. Guest<br />
Patient<br />
March 1 Unrelated Umbilical Cord Blood Transplant Joanne Kurtzberg, M.D. Duke Staff<br />
8 Clinical Case Conference John Eck, M.D. Faculty<br />
15 Waiting to Inhale: Post Anesthetic Apnea . . . Jay McCurdy, M.D. Resident<br />
22 Genetic Approach to Understanding and Treating Jeffrey Leiden, M.D., Ph.D. Guest<br />
Cardiovascular Disease<br />
29 Anesthesia Related Cardiac Arrest in Children-Lessons Jeffrey Morray, M.D. Guest<br />
Learned From the Closed Claims Project and the<br />
POCA Registry<br />
April 5 New Concepts in Neuroanesthesia William Kofke, M.D, FCCM Guest<br />
12 Awake Craniotomy: Seizure vs. Tumor Surgery John Keifer, M.D. Faculty<br />
19 Seizures and Anesthesia Julie Woosley, M.D. Resident<br />
26 State-Dependent Respiratory Control; Clinical<br />
Relevance and Basic Mechanisms Ralph Lydic, Ph.D. Guest<br />
May 3 Sedating the ICU Patient- Challenges, Old and New Kurt Knauth, M.D. Resident<br />
10 Case Presentation--Methemoglobinemia and its John Sum-Ping, M.B., Ch.B., FRCA Faculty<br />
Clinical Implication<br />
17 Ethics Lewis Hodgins, M.D. Faculty<br />
24 On Traumatologic Resuscitation in the Twentieth Peter Safar, M.D., Dr.h.c., FCCM, FCCP Guest<br />
Century<br />
31 Management of the Septic Patient Christopher Young, M.D., FCCCM Faculty<br />
June 7 Perioperative Organ Protection Eugene Moretti, M.D. Faculty<br />
14 Cost Containment and Perioperative Care; Fact Lee Fleischer, M.D. Guest<br />
or Fiction<br />
21 Morbidity and Mortality Rounds: Management Kerri Robertson, M.D., FRCP(C) Faculty<br />
Strategies for Intraoperative Pulmonary Embolism Peter DeBalli, III, M.D. Resident<br />
28 Post Dural Puncture Headache Holly Williams-Davis, M.D. Resident<br />
July 5 Professionalism Catherine Lineberger, M.D. Faculty<br />
12 Office-Based Anesthesia--Adventures in Anesthesia Jason Burke, M.D. Resident<br />
19 Chemical Dependence Catherine Lineberger, M.D. Faculty<br />
26 Hyperbaric Oxygen in the 21st Century Richard Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP Faculty<br />
August 2 Complementary and Alternative Medicine Martin Sullivan, M.D. Duke Staff<br />
9 Current State of Transfusion Services at Duke Steven J. Bredehoeft, M.D. Duke Staff<br />
16 Preoperative Screening at Duke - Recurrent State Ron Olson, M.D., CCEP Faculty<br />
of an Ever-Changing Census<br />
23 State of the Department J. G Reves, M.D. Faculty<br />
30 State of Saturn Iain Sanderson, M.B., Ch.B., FRCA Faculty<br />
September 6 Dialysis Patients and Surgery: What Anesthesiologists Steve Schwab, M.D. Duke Staff<br />
Need to Know But Are Too Busy to Ask.<br />
13 Origins and Interpreting Hemodynamics Joannes Karis, M.D. Faculty<br />
20 Magnesium: Elixir Vitae? Marcella Lanzinger, M.D. Resident<br />
27 Ventilator Induced Lung Injury Neil Macintyre, M.D. Duke Staff<br />
EDUCATION 89
EDUCATION<br />
Lectures, Conferences and Didactics<br />
Date Title Speaker Position<br />
October 4 Unintentional Total Spinals After Failed Labor Scott Helsley, M.D., Ph.D. Resident<br />
Epidurals in Parturients<br />
11 HIPAA Concepts, Background, Impact for Physician David Kirby Duke Staff<br />
Researchers<br />
25 Computers and Medical Practice James Morris, Jr., M.D. Duke Staff<br />
November 1 Insights Into Pharmacologic Neuroprotection for Hilary Grocott, M.D., FRCP(C) Faculty<br />
Cardiac Surgery<br />
8 JCHO Required Safety Update Training Course Debra Hunt, Ph.D. Duke Staff<br />
15 Thoracic Epidural Anesthesia and Cardiac Ischemia Matthew Taylor, M.D. Resident<br />
22 Perioperative Echocardiography: A Challenge for Daniel Thys, M.D. Guest<br />
Anesthesiology<br />
29 How Research in Cardiac Anesthesia has Changed Fiona Clements, M.D. Faculty<br />
our Clinical Practice<br />
December 6 Christmas Quiz Elizabeth Bell, M.D. Faculty<br />
13 Hypertrophic Cardiomyopathy and Pregnancy Bill Norcross, M.D. Resident<br />
20 Quality Improvement Terrance Breen, M.D., FRCPC Faculty<br />
HYPERBARIC LECTURES<br />
March 16 DAN: Beginnings - Today - Tomorrow Peter Bennett, Ph.D., D.Sc. Faculty<br />
April 12 The Australian Experience on CO Poisoning Ian Miller, M.B. Guest<br />
20 Marine Biotoxins David Hendricks, M.D. Duke Staff<br />
July 20 Pulmonary Alveolar Proteinosis Claude Piantadosi, M.D. Faculty<br />
August 31 Biochemical Markers of Tissue Damage in Response Kathy Coulombe Duke Staff<br />
to Bubbles and Other Injuries<br />
September 6 Physical, Physical Chemical, and Biophysical Richard Vann, Ph.D. Faculty<br />
Concepts/Bubbles and Decompression Physiology<br />
8 Decompression History, Haldane, and Bubbles/ Richard Vann, Ph.D. Faculty<br />
Decompression Safety and Operational Methods<br />
14 DCI: Pathophysiology Richard Vann, Ph.D. Faculty<br />
Richard Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP Faculty<br />
15 Decompression Illness: Therapy Richard Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP Faculty<br />
19 Decompression Illness: Clinical Presentation and Wayne Massey, M.D. Duke Staff<br />
Diagnosis<br />
20 Exercise and Cardiorespiratory Physiology: Normal Bryant Stolp, M.D., Ph.D. Faculty<br />
Function and Measurements<br />
21 Decompression Illness: Epidemiology Guy deLisle Dear, M.B., FRCA Faculty<br />
Bubble Trouble: Surface Tension, Surfactants, and David Needham, Ph.D. Duke Staff<br />
Gas Nuclei Sung Hee Lee, Ph.D. Duke Staff<br />
Dennis Kim, Ph.D. Duke Staff<br />
27 Exercise and Cardiorespiratory Physiology: Richard Vann, Ph.D. Faculty<br />
Effects of Breathing Apparatus<br />
29 Sinus and Pulmonary Barotrauma Cameron Gillespie, M.D. Guest<br />
90 EDUCATION..
Lectures, Conferences and Didactics<br />
October 2 Barotrauma and Dysbaric Diseases of the Hearing Cameron Gillespie, M.D. Guest<br />
and Vestibular System<br />
4 High Altitude Expeditions on Mt. Everest Eric Simonson Guest<br />
5 Inert Gas Narcosis Peter Bennett, Ph.D., D.Sc. Faculty<br />
6 Direct Effects of Pressure: High Pressure Nervous<br />
Syndrome Peter Bennett, Ph.D., D.Sc. Faculty<br />
9 Drowning Guy deLisle Dear, M.B, FRCA Faculty<br />
12 Altitude Illness: Pathophysiology, Prevention, Richard Moon, M.D., C.M., M.Sc., Faculty<br />
Treatment of AMS, HAPE, HACE FRCP(C), FACP, FCCP<br />
18 Altitude, Aviation, and Space Physiology Neal Pollock, Ph.D. Faculty<br />
19 Exercise and Cardiorespiratory Physiology: Gravity Richard Moon, M.D., C.M., M.Sc., Faculty<br />
FRCP(C), FACP, FCCP<br />
20 Altitude Decompression Richard Vann, Ph.D. Faculty<br />
23 Biochemistry and Physiology of Inhaled O2 and CO2 Claude Piantadosi, M.D. Faculty<br />
27 CNS Oxygen Toxicity (Hyperoxia and Post Hypoxia) Claude Piantadosi, M.D. Faculty<br />
30 Hyperbaric Oxygen Therapy: Poisoning Claude Piantadosi, M.D. Faculty<br />
November 1 Thermal Physiology: Protection from Extremes Edward Thalmann, M.D. Faculty<br />
of Heat and Cold<br />
6 Hyperbaric Oxygen Therapy: Wound Healing Bryant Stolp, M.D., Ph.D. Faculty<br />
8 Hyperbaric Oxygen Therapy: Infection Richard Moon, M.D., C.M., M.Sc., Faculty<br />
FRCP(C), FACP, FCCP<br />
10 Investigational and Other HBO Indications Guy deLisle Dear, M.B., FRCA Faculty<br />
13 Commercial Diving Operations Gary Beyerstein Guest<br />
15 Effects of Immersion on Vision, Hearing, Movement, Loring Crepeau, Ph.D<br />
and Locomotion .<br />
16 Breath Hold Diving Richard Vann, Ph.D. Faculty<br />
17 Human Engineering in Life Support Equipment<br />
Design Lew Nuckols, Ph.D. Guest<br />
20 Vibration, Radiation, and Underwater Sound and Ed Cudahy, Ph.D. Guest<br />
Explosion Hazards<br />
21 Making Diving Safer Richard Vann, Ph.D. Faculty<br />
27 Fitness to Dive: Physical Standards and Return to Richard Moon, M.D., C.M., M.Sc., Faculty<br />
Diving FRCP(C), FACP, FCCP<br />
29 Shellfish and Seafood Poisoning David Hendricks, M.D. Duke Staff<br />
PAIN CONFERENCES<br />
EDUCATION<br />
Date Title Speaker Position<br />
January 5 Pain Pathway Billy Huh, M.D., Ph.D. Faculty<br />
Addiction and Pain Management Charles O'brien, M.D., Ph.D. Guest<br />
12 Should We Use Local Anesthetics in Thoracic Oscar DeLeon Casasola, M.D. Guest<br />
Epidurals?<br />
February 2 Three-In-One Fascia Iliaca Block Bruno Urban, M.D., Dr.med. Faculty<br />
Treatment of Vertebral Compression Bruno Urban, M.D., Dr.med. Faculty<br />
Fractures with Calcitonin And Risedronate<br />
Guidelines for Narcotic Maintenance Therapy for Bruno Urban, M.D., Dr.med. Faculty<br />
Non-Cancer Patients<br />
3 Critical Appraisal of Electromedicine: Cranial Bruno Urban, M.D., Dr.med. Faculty<br />
Electrostimulation and TENS<br />
EDUCATION 91
EDUCATION<br />
Lectures, Conferences and Didactics<br />
Date Title Speaker Position<br />
March 29 Case Report: Calcitonin/ Elavil for Metastatic Bruno Urban, M.D., Dr.med. Faculty<br />
Breast Cancer Pain<br />
Interthecal Steroids For Post-Herpetic Neuralgia Bruno Urban, M.D., Dr.med. Faculty<br />
April 26 Review of Interventional Techniques of Chronic Bruno Urban, M.D., Dr.med. Faculty<br />
Spine Pain Management<br />
June 7 Treatment of Spinal Pain by Lumbar RF Procedures Bruno Urban, M.D., Dr.med. Faculty<br />
July 31 CRPS, New Nomenclature and Treatments Thomas Buchheit, M.D. Faculty<br />
August 7 A Guestial Low Back Pain Thomas Buchheit, M.D. Faculty<br />
15 Functional Anatomy of the Spine Joel Goldberg, M.D. Faculty<br />
28 Neural Blockade for Pain Management Thomas Buchheit, M.D. Faculty<br />
September 12 Mechanisms of Pain Transmission I Thomas Buchheit, M.D. Faculty<br />
19 Pain Management Case Studies Joel Goldberg, M.D. Faculty<br />
28 Spinal Infusion for Cancer Pain Thomas Buchheit, M.D. Faculty<br />
October 2 Invasive Therapies for CRPS Thomas Buchheit, M.D. Faculty<br />
November 21 Spinal Opioids Thomas Buchheit, M.D. Faculty<br />
RESEARCH CONFERENCES<br />
March 6 Platelet Function Testing in Cardiac Surgery Gautam Sreeram, M.D. Faculty<br />
April 3 The Association of Rewarming Rate and<br />
Neurocognitive Dysfunction After Cardiac Surgery Alina Grigore, M.D. Faculty<br />
3 Effects of Allopregnanolone on Induced Cellular Ellen Lockhart, M.D. Faculty<br />
Injury in Human NT2 Cells<br />
June 5 Neuroprotection from Delayed Post-Schemic<br />
Adminsistration of a Metalloporphyrin Catalytic<br />
Anti-Oxidant in the Rat G. Burkhard Mackensen, M.D. Faculty<br />
July 24 Desensitization of the Substance P Receptor:<br />
a Mechanistic Approach Mark Richardson, Ph.D. Duke Staff<br />
August 14 Progress in Engineered Arteries Tracy DuLaney, Ph.D. Duke Staff<br />
September 25 Continuous Catheter Anesthesia in the Outpatient Steve Klein, M.D. Faculty<br />
Environment<br />
October 30 Bispectral Index for Electroconvulsive Therapy John Keifer, M.D. Faculty<br />
November 27 Pulmonary Physiology in Environmental Extremes Richard Moon, M.D., C.M., M.Sc., Faculty<br />
FRCP(C), FACP, FCCP<br />
92 EDUCATION..
Lectures, Conferences and Didactics<br />
December 11 Use and Validation of Near Infrared Spectroscopy James Reynolds, Ph.D. Faculty<br />
to Measure Fetal Cerebral Oxygenation In Utero:<br />
Studies Using Nearterm Fetal Sheep<br />
RESIDENT LECTURES<br />
EDUCATION<br />
Date Title Speaker Position<br />
January 12 Chronic Pelvic/Abdominal Pain in Women Carlos Nebreda, M.D. Faculty<br />
19 Complex Regional Pain Syndrome Thomas Buchheit, M.D. Faculty<br />
26 Myofascial Pain Syndrome Dianne Scott, M.D. Faculty<br />
February 2 Cognitive Dysfunction in the Post-Operative Period Kathy Grichnik, M.D., MS Faculty<br />
9 Air, Air, Everywhere Edith Marom, M.D. Duke Staff<br />
16 Geriatric Clinical Pharmacology Madan Kwatra, Ph.D. Faculty<br />
23 Ophthalmic Anesthesia Charles Garcia-Rodriguez, M.B., B.S. Faculty<br />
March 1 Pediatric Head Trauma Allison Ross, M.D. Faculty<br />
8 Pediatric Syndromes and Their Implications Guy deLisle Dear, M.B., FRCA Faculty<br />
15 Pediatric Ventilators: Modes, Methods... Frank Kern, M.D., FCCM Faculty<br />
22 Anesthesia for Airway Surgery in Children John Eck, M.D., F.M.H. Faculty<br />
29 Sedation of Off-Site Pediatric Anesthesia Robert Coleman, M.D. Faculty<br />
April 5 Airway Management for the Neurosurgical Patient Randall Brewer, M.D. Resident<br />
12 Positioning the Neurosurgical Patient John Keifer, M.D. Faculty<br />
19 Neural Monitoring Jeffrey Taekman, M.D. Faculty<br />
26 Management of Head Trauma David Warner, M.D. Faculty<br />
May 3 Acid Base Balance Andrew Hilton, M.B., B.S, FANZCA Faculty<br />
10 What Nutrition and When Should it be Given? John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
17 Mechanical Ventilation Laura Niklason, M.D., Ph.D. Faculty<br />
24 Blood Transfusion Thomas Slaughter, M.D. Faculty<br />
31 Antibiotic Choices for Hospital Infection Deborah Friedman, M.D. Duke Staff<br />
June 7 Pheochromocytoma Eugene Moretti, M.D. Faculty<br />
14 Airway Management and Cervical Spine Injury Randall Brewer, M.D. Resident<br />
21 Pharmacokinetics and Dynamics for Dummies Jacques Somma, M.D., FRCP(C) Faculty<br />
28 Liver Boarded Kerri Robertson, M.D., FRCP(C) Faculty<br />
July 5 Nuts and Bolts Catherine Lineberger, M.D. Faculty<br />
12 Clinical Case Conference Catherine Lineberger, M.D. Faculty<br />
19 Substance Abuse Video Catherine Lineberger, M.D. Faculty<br />
26 Internet-Based Learning Jeffrey Taekman, M.D. Faculty<br />
September 6 ABG Interpretation: The Respiratory Gases Richard Moon, M.D., C.M., M.Sc., Faculty<br />
FRCP(C), FACP, FCCP<br />
13 ABG Interpretation: Acid-Base Pathology Richard Moon, M.D., C.M., M.Sc., Faculty<br />
FRCP(C), FACP, FCCP<br />
20 Understanding and Interpreting Hemodynamics Laura Niklason, M.D., Ph.D Faculty<br />
27 Infusing Narcotics: the Context-Sensitive Half-Time Jacques Somma Faculty<br />
to the Rescue, M.D., FRCP(C)<br />
EDUCATION 93
EDUCATION<br />
Lectures, Conferences and Didactics<br />
Date Title Speaker Position<br />
October 4 Introduction to Informatics Jeffrey Taekman, M.D. Faculty<br />
11 Assessing the Quality of Online Medical Information Jeffrey Taekman, M.D. Faculty<br />
25 Information Systems and Their Application in Clinical Iain Sanderson, M.B.,Ch.B., FRCA Faculty<br />
Medicine<br />
November 1 Most Missed 2000 Cardiac Key Words Steven Hill, M.D. Faculty<br />
8 Most Missed 2000 Thoracic Key Words Katherine Grichnik, M.D., MS Faculty<br />
15 Regional Anesthesia for Thoracic Surgery Mark Stafford Smith, M.D., CM, Faculty<br />
FRCP, DABA<br />
22 Post Anesthesia ICU Problems John Booth, M.B., Ch.B., FRCA Faculty<br />
29 Controversies PA Catheter Use David Lubarsky, M.D., M.B.A. Faculty<br />
December 6 Fetal Monitoring Ellen Lockhart, M.D. Faculty<br />
13 OB Emergencies Asraf Habib, M.B., B.Ch., M.Sc., FRCA Faculty<br />
20 Complications of OB Anesthesia Adeyemi Olufolabi, M.B., B.S., FRCA Faculty<br />
VETERANS AFFAIRS MEDICAL CENTER LECTURES<br />
January 3 Thoracic Aneurysm Anesthesia/Management Gautam Sreeram, M.D. Faculty<br />
4 Pulse oximetry Christopher Young, M.D., FCCM Faculty<br />
6 Aging—Keywords Dana Wiener, M.D. Faculty<br />
7 Case Studies John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
10 High Altitude Medicine Charles Garcia-Rodriguez, M.B., B.S. Faculty<br />
11 Acute Pain Thomas Buchheit, M.D. Faculty<br />
13 Preop Evaluation of Bleeding Risk Thomas Slaughter, M.D. Faculty<br />
14 Preop Evaluation Dana Wiener, M.D. Faculty<br />
18 LVH - Strain or Ischemia Mathew Taylor, M.D. Resident<br />
20 Gas Exchange Lewis Hodgins, M.D. Faculty<br />
21 Morbidity and Mortality Conference—CVP Jonathan Mark, M.D. Faculty<br />
Placement Method<br />
24 Acute Poisoning Charles Garcia-Rodriguez, M.B., B.S. Faculty<br />
31 Cardiac Pacemakers Keith Hanson, M.D. Resident<br />
August 2 Preoperative Assessment of Endocrine Disease Catherine Lineberger, M.D. Faculty<br />
9 Preoperative Testing--How Much, How Little? Ronald Olson, M.D., CCFP Faculty<br />
16 Neuromuscular Disorders Cecil Borel, M.D. Faculty<br />
23 Evaluating the Clotting Cascade for Anesthesiologists John Schultz, M.D. Faculty<br />
30 Risk Assessment Iain Sanderson, M.B.,Ch.B., FRCA Faculty<br />
February 1 Morbidity and Mortality - Septic Shock Christopher Young, M.D., FCCM Faculty<br />
3 Morbidity and Mortality Conference - Total Spinal Lewis Hodgins, M.D. Faculty<br />
3 Physiology in the Elderly Dana Wiener, M.D. Faculty<br />
4 Opioid Analgesia Thomas Buchheit, M.D. Faculty<br />
7 Carotid Endarterectomy Garrett Scales, M.D. Resident<br />
8 Autononic Pain Joel Goldberg, M.D Faculty<br />
11 Bleeding and CPB Thomas Slaughter, M.D. Faculty<br />
94 EDUCATION..
Lectures, Conferences and Didactics<br />
EDUCATION<br />
Date Title Speaker Position<br />
February 14 Anticoagulants, New Antiplatelet Agents and Gautam Sreeram, M.D. Faculty<br />
Regional Anesthesia<br />
15 Poisoning Charles Garcia-Rodriguez, M.B., B.S. Faculty<br />
17 Adult Resipratory Disease Syndrome William Norcross, M.D. Resident<br />
18 Sevoforane in Heart Surgery Lewis Hodgins, M.D. Faculty<br />
24 Adult Resipratory Disease Syndrome Timothy Hayward, M.D. Resident<br />
25 Morbidity and Mortality Conference - AVP Use Andrew Hilton, M.B., B.S., FANZCA Faculty<br />
28 Protection from Respiratory Contamination— Rebecca Bateman, Industrial Hygienist Guest<br />
PAPR Respirator<br />
March 2 Case Conference Dana Wiener, M.D. Faculty<br />
6 Morbidity and Mortality Conference John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
7 Thermoregulation; Temperature and Heat Charles Garcia-Rodriguez, M.B., B.S. Faculty<br />
9 HTT Gautam Sreeram, M.D. Faculty<br />
10 Esophagogastrectomy Lewis Hodgins, M.D. Faculty<br />
13 Airway Garrett Scales, M.D. Resident<br />
16 Peripheral Nerve Blocks Joel Goldberg, M.D. Faculty<br />
17 Pharmacology to Reduce Blood Lose Thomas Slaughter, M.D. Faculty<br />
21 Adult Respiratory Disease Syndrome Chad Grotecut, M.D. Resident<br />
23 Malignant Hyperthermia Elayne Schweikert, CRNA Duke Staff<br />
24 Peripheral Nerve Catheters Stuart Grant, M.B., Ch.B. Faculty<br />
27 Ewings Sarcoma Mark Albritton, M.D. Resident<br />
28 IARS Abstracts Marcella Lanzinger, M.D. Resident<br />
30 Perioperative Neural Injuries Thomas Buchheit, M.D. Faculty<br />
31 Chartery Morbidity and Mortality Jonathan Mark, M.D. Faculty<br />
April 3 Perioperative Risk Assessment / Abdominal Aortic Christopher Young, M.D., FCCCM Faculty<br />
Aneurysm<br />
4 Bi Spectral Index Scott Helsley, M.D. Resident<br />
6 Herbs and Anesthesia Dana Wiener, M.D. Faculty<br />
7 Infection Control Mary Moorefield, RN Guest<br />
10 Oxygen Physiology Lewis Hodgins, M.D. Faculty<br />
11 Pain Clinic Complications Joel Goldberg, M.D. Faculty<br />
13 Tricuspid Regulation John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
14 Case Presentation—AAA with Pacemaker Gautam Sreeram, M.D. Faculty<br />
17 Cardiac Pressures Jonathan Mark, M.D. Faculty<br />
18 Medical Error Charles Garcia-Rodriguez, M.B., B.S. Faculty<br />
20 Muscle Relaxants David Schinderle, M.D. Resident<br />
21 IR Ventilation Andrew Hilton, M.B., B.S., FANZCA Faculty<br />
24 Case Presentation - Coagulation Disorder Laura Kihlstrom, M.D. Resident<br />
25 Remifonlonyl William Norcross, M.D. Resident<br />
28 Morbidity and Mortality Jonathan Mark, M.D. Faculty<br />
May 1 Management of Hyperdynamic States Lewis Hodgins, M.D. Faculty<br />
2 Upper Extremity Nerve Blocks Thomas Buchheit, M.D. Faculty<br />
4 Popular Use of Herbs Dana Wiener, M.D. Faculty<br />
5 Morbidity and Mortality John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
9 Intra Uterine Growth Retardation Krystle Pham, M.D. Resident<br />
11 Transducers Peter Baek, M.D. Resident<br />
EDUCATION 95
EDUCATION<br />
Lectures, Conferences and Didactics<br />
Date Title Speaker Position<br />
May 12 Porphyria Gautam Sreeram, M.D. Faculty<br />
15 Aortic Aneurysms Thomas Slaughter, M.D. Faculty<br />
15 AAA Thomas Slaughter, M.D. Faculty<br />
16 Ventilation Andrew Hilton, M.B., B.S., FANZCA Faculty<br />
18 Gem Premier Jim Ellefson Guest<br />
19 Morbidity and Mortality Christopher Young, M.D., FCCM Faculty<br />
22 Regional Anesthesia and the Neurologic Exam Thomas Buchheit, M.D. Faculty<br />
23 Blood Transfusion Laura Khilstrom, M.D. Resident<br />
25 Post op Pain Management in the Opicod Tolerant Thomas Buchheit, M.D. Faculty<br />
Patient<br />
26 Respiratory—Circulatory Interactions Jonathan Mark, M.D. Faculty<br />
30 Innnervation of Larynx John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
June 2 Keyword Review Dana Wiener, M.D. Faculty<br />
5 Case Study Christopher Kerr, M.D. Resident<br />
6 Case Study John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
8 Case Study Graham Lashley, M.D. Resident<br />
9 Anesthesia for Repair of Thoracic Aneurysm Thomas Slaughter, M.D. Faculty<br />
12 Oxygenaration During Mechanical Ventilation Andrew Hilton, M.B., B.S., FANZCA Faculty<br />
13 Evaluation of Abdominal Pain in ICU Fernando Delvecchio, M.D. Resident<br />
15 Pain Medications Joel Goldberg, M.D. Faculty<br />
16 Clinical Studies Jonathan Mark, M.D. Faculty<br />
John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
19 Pulse Oximetry Christopher Young, M.D.. FCCM Faculty<br />
20 Hemolytic and Researchers Daphne Jones, M.D. Resident<br />
22 Carotid Disease Paul Chai, M.D. Resident<br />
29 Muscle Relaxants Cathleen Peterson-Layne, M.D., Ph.D. Resident<br />
30 Morbidity and Mortality Jonathan Mark, M.D. Faculty<br />
July 6 Anatomy Key Words Dana Wiener, M.D. Faculty<br />
7 Pharmacologic Approaches to Hemostasis Thomas Slaughter, M.D. Faculty<br />
10 Micrologic Evaluation of High Extremity Thomas Buchheit, M.D. Faculty<br />
11 Inhaled Agents Lewis Hodgins, M.D. Faculty<br />
13 Amniotic Fluid Embolism Leigh Elmore, M.D. Resident<br />
17 LMA Tarsha Garvin, M.D. Resident<br />
18 Poppy Joel Goldberg, M.D. Faculty<br />
20 Optimal Preload Jonathan Mark, M.D. Faculty<br />
21 Awareness during Anesthesia Jonathan Mark, M.D. Faculty<br />
24 Anesthesia Machine Laura Kihlstrom, M.D. Resident<br />
25 High Altitude Oxygenation Lewis Hodgins, M.D. Faculty<br />
26 Fire Safety Clorine Chasteen Guest<br />
27 Ethics Lewis Hodgins, M.D. Faculty<br />
28 Obstructive Sleep Apnea and Awake Case Presentation Christopher Young, M.D., FCCM Faculty<br />
31 Neuropathic Pain Thomas Buchheit, M.D. Faculty<br />
96 EDUCATION..
Lectures, Conferences and Didactics<br />
EDUCATION<br />
Date Title Speaker Position<br />
August 1 Heparin Induced Thrombocytopenia Ryan Simovitch, M.D. Resident<br />
3 Stress Ulceration with Acquired Pneumonia Allen Cheng, M.D. Fellow<br />
4 Morbidity and Mortality Lewis Hodgins, M.D. Faculty<br />
8 VA Trivia Kurt Knauth, M.D. Resident<br />
10 ECG Monitoring Jonathan Mark, M.D. Faculty<br />
11 Neuromuscular Blockade - Prolonged Gautam Sreeram, M.D. Faculty<br />
14 Transfusion Thomas Slaughter, M.D. Faculty<br />
15 Low Back Pain Joel Goldberg, M.D. Faculty<br />
17 I-Stat Ed Cole, Specialist Guest<br />
18 Morbidity and Mortality Dana Wiener, M.D. Faculty<br />
21 Diabetes Mellites - Perioperative Management Cathleen Peterson-Layne, M.D., Ph.D. Resident<br />
22 Anesthetic Considerations in Renal Disease Eric Miller, M.D. Resident<br />
25 Morbidity and Mortality - TURP Syndrome Christopher Young, M.D., FCCM Faculty<br />
28 Aspiration Pnermonitis Patricia Macha, M.D. Resident<br />
29 Case Report Jeffrey Yergler, M.D. Resident<br />
31 Complications following Vascular Surgery Shanka Biswas, M.D. Resident<br />
September 1 Morbidity and Mortality - Hyperthyroidism John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
5 Renal Physiology Lewis Hodgins, M.D. Faculty<br />
7 Epidural Anesthesia in Labor Cescili Drake, M.D. Resident<br />
8 Preop Coagulation Testing Thomas Slaughter, M.D. Faculty<br />
11 Neuroanatomy of Pain Thomas Buchheit, M.D. Faculty<br />
12 Case Discussion John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
14 Latex Dana Wiener, M.D. Faculty<br />
15 Anesthesiologist Role Antibiotic Administrate to Ellen Flanagan, M.D. Resident<br />
Prevent Postop Infection<br />
18 Desflurane Barbara McDermott, CRNA Duke Staff<br />
19 Cases in Pain Management Joel Goldberg, M.D. Faculty<br />
21 Cholinesterase's Deficiency Keith Hanson, M.D. Resident<br />
22 Controversial Issues in ICU Laura Niklason, M.D., Ph.D. Faculty<br />
25 LMA William Corkey, M.D. Resident<br />
26 Hypoalbuminemia Abigail Melnick, M.D. Resident<br />
28 Sepsis from Invasive Lines Allen Cheng, M.D. Resident<br />
October 9 Oxygen Delivery Lewis Hodgins, M.D. Faculty<br />
5 High Altitude Physiology Dana Wiener, M.D. Faculty<br />
6 Leave Forms Jonathan Mark, M.D. Faculty<br />
10 Local Anesthetic John Mitchell, M.D. Resident<br />
12 Coexisting Disease Gautam Sreeram, M.D. Faculty<br />
13 Research Variables Thomas Slaughter, M.D. Faculty<br />
17 Hemodynamic Monitoring in Preclampsia Connette McMahon, M.D. Resident<br />
20 BP Lewis Hodgins, M.D. Faculty<br />
26 Surgical Management of Pancreatitis Michael Davidson, M.D. Resident<br />
27 Morbidity and Mortality Joel Goldberg, M.D. Faculty<br />
30 Liuev Reaction—Post op Consideration Lewis Hodgins, M.D. Faculty<br />
31 Kidney Lewis Hodgins, M.D. Faculty<br />
EDUCATION 97
EDUCATION<br />
Lectures, Conferences and Didactics<br />
Date Title Speaker Position<br />
November 2 Pharmaco Kinetics Ronald Logan Duke Staff<br />
3 ECG's John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
6 Depression and Anesthesia Holly Davis, M.D. Resident<br />
7 Cardiac Tamporade Gautam Sreeram, M.D. Faculty<br />
9 Peripheral Nerve Injuries - Preop Dana Wiener, M.D. Faculty<br />
13 Pacemakers Jonathan Mark, M.D. Faculty<br />
14 Airway Management in Patients with Goiter (Thyroid) John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
16 Case Presentation “Problems with BP” Adam Schow, M.D. Resident<br />
17 Automatic Defibrillator Within the OR Virginia Kent, RN Guest<br />
20 Waste Anesthetic Gases Will Corkey, M.D. Resident<br />
21 Spinal Opiods Thomas Buchheit, M.D. Faculty<br />
28 Nerve Physiology and Anatomy Joel Goldberg, M.D. Faculty<br />
December 1 Inhalation Anesthetics Lewis Hodgins, M.D. Faculty<br />
4 Cancer Pain Paula Lee, M.D. Resident<br />
5 Heparin Administration Gautam Sreeram, M.D. Resident<br />
7 Cardiac Output Laura Niklason, M.D., Ph.D. Faculty<br />
8 Dexmedetomidine Christopher Young, M.D., FCCM Faculty<br />
11 Anesthesia Gas Machine, Gas Supplies, Scavengers John Sum Ping, M.B., Ch.B., FRCA Faculty<br />
12 Hypertrophic Cardiomyopathy William Norcross,M.D. Resident<br />
14 Pulse Oximetry David Lindsay, M.D. Faculty<br />
15 Hip Replacement in the Elderly Dana Wiener, M.D. Faculty<br />
19 Pacemakers Daniel DeMeyts, M.D. Resident<br />
21 Review of Hemostasis, Coagulation and Associated Paul Shook, M.D. Resident<br />
Blood Products<br />
22 Physiology of the Elderly Daphne Jones, M.D. Resident<br />
WOMEN'S ANESTHESIA<br />
January 11 ....and by a sleep to say we end the heartache John Booth, M.B., Ch.B., FRCA Faculty<br />
heartache and the thousand natural shocks<br />
the flesh is heir to; tis a consummation devoutly<br />
to be wished<br />
February 1 Morbidity and Mortality Conference Adeyemi Olufolabi, M.B., B.S., FRCA Faculty<br />
15 Business Donald Penning, M.Sc., M.D. Faculty<br />
22 The Use of Caffeine for PDPH Peter Dwane, M.D., C.M., FRCP(C) Faculty<br />
29 Was Gertie Marx off the Marx? Hypotension After John Schultz, M.D. Faculty<br />
Spinal.<br />
March 7 How Much Labor in a Labor Epidural? Elizabeth Bell, M.D., M.P.H. Faculty<br />
21 Risk Management in OB Anesthesia Barbara Hendrix Duke Staff<br />
28 How Anesthesiologists Practice Obstetric Anesthesia Terrance Breen, M.D., FRCPC Faculty<br />
98 EDUCATION..
Lectures, Conferences and Didactics<br />
EDUCATION<br />
Date Title Speaker Position<br />
April 4 Spinal Anesthesia for Labor Epidural Ellen Lockhart, M.D. Faculty<br />
11 Fellows Conference Ellen Lockhart, M.D. Faculty<br />
Sheila Gardner, M.D. Faculty<br />
18 Perioperative Use of Local Anesthetics Jim Crews, M.D. Guest<br />
25 Morbidity and Mortality Conference Adeyemi Olufolabi, M.B., B.S., FRCA Faculty<br />
May 9 Morbidity and Mortality Conference Adeyemi Olufolabi, M.B., B.S., FRCA Faculty<br />
16 Business Meeting J.G. Reves, M.D. Faculty<br />
23 Prelude to SOAP Ellen Lockhart, M.D. Faculty<br />
June 13 How Does Blood Clot? John Schultz, M.D. Faculty<br />
20 Business Meeting Holly Muir, M.D., FRCP(C) Faculty<br />
17 QI Issues Terrance Breen, M.D., FRCP Faculty<br />
July 4 Business Meeting Holly Muir, M.D., FRCP(C) Faculty<br />
11 Business Meeting Holly Muir, M.D., FRCP(C) Faculty<br />
August 3 Business Meeting Holly Muir, M.D., FRCP(C) Faculty<br />
17 Business Meeting Holly Muir, M.D., FRCP(C) Faculty<br />
24 Business Meeting Holly Muir, M.D., FRCP(C) Faculty<br />
31 Research Meeting James Reynolds, Ph.D. Faculty<br />
September 7 Business Meeting Holly Muir, M.D., FRCP(C) Faculty<br />
21 Difficult Airway Management “New Toys” and Ideas Bryant Stolp, M.D., Ph.D. Faculty<br />
for Helping to Set Up Our New ORs<br />
28 Journal Club Terrance Breen, M.D., FRCPC Faculty<br />
October 5 Psychosocial Aspects of Acute Pain David Sheffield, Ph.D. Guest<br />
19 Business Meeting Holly Muir, M.D., FRCP(C) Faculty<br />
26 CORD Elizabeth Bell, M.D., M.P.H. Faculty<br />
November 2 Hematology Thomas Ortel, M.D., Ph.D. Guest<br />
9 Research Meeting James Reynolds, Ph.D. Faculty<br />
16 Business Meeting Holly Muir, M.D., FRCP(C) Faculty<br />
30 Journal Club Adeyemi Olufolabi, M.B., B.S., FRCA Faculty<br />
December 7 Divisional Policy and Procedure Meeting Peter Dwane, M.D., C.M., FRCP(C) Faculty<br />
14 Business Meeting Holly Muir, M.D., FRCP(C) Faculty<br />
EDUCATION 99
EDUCATION<br />
David S. Warner, M.D.<br />
Program Co-Chair and Moderator<br />
Kathryn E. King, M.D., MSN<br />
Program Co-Chair<br />
100 EDUCATION<br />
Eighth Academic Evening<br />
The Annual Academic Evening was<br />
established in 1993 as a forum for the<br />
display and celebration of ongoing<br />
research and academic activity by<br />
fellows, residents, graduate students,<br />
medical students, undergraduates, and<br />
nurse anesthetists working in the research<br />
groups within the Department<br />
of Anesthesiology. Submitted abstracts<br />
are initially scored by a committee of<br />
faculty members. A subset of abstracts<br />
is thereby selected for poster presentation<br />
to the Guest Judge at the Academic<br />
Evening. All individuals who submit<br />
abstracts are invited to present their<br />
work at the poster-discussion session.<br />
Each poster presenter provides a brief<br />
tour of the poster and participates in<br />
a discussion session led by a senior<br />
faculty member and attendees of the<br />
Academic Evening.<br />
Presentations are followed by a<br />
lecture, dinner, discussion and awards<br />
by the Guest Judge. Previous Judges<br />
have included Roger L. Royster, M.D.,<br />
Donald S. Prough, M.D., Thomas F.<br />
Hornbein, M.D., John Kampine, M.D.,<br />
Ph.D., James C. Eisenach, M.D., Richard<br />
J. Traystman, Ph.D., and Steven Shafer,<br />
M.D. The Academic Evening is<br />
approved for 3.0 hours in Physician’s<br />
Recognition Award Category I of the<br />
American Medical Association.<br />
In 2000, we were honored to have<br />
as Guest Judge, Margaret Sedensky,<br />
M.D., Ph.D., Professor, Department of<br />
Anesthesiology, Assistant Professor,<br />
Department of Genetics, Case Western<br />
Reserve University School of Medicine.<br />
Dr. Sedensky presented a superb and<br />
entertaining lecture entitled: “Trends in<br />
anesthesia research: To infinity and<br />
beyond.”<br />
Interest in this event is reflected<br />
by the fact that we received 43 abstracts<br />
and hosted over 100 attendees. This<br />
year's event was generously supported<br />
by Abbott Laboratories, Aspect Medical,<br />
AstraZeneca LP, Roche Pharmaceuti-<br />
cals, Organon, Inc., Purdue Pharma<br />
L.P., and Glaxo Wellcome, Inc.<br />
A gala dinner was then held. Dr.<br />
Sedensky presented awards in the following<br />
categories (embellished with<br />
her own gift of T-shirts from the Rock<br />
and Roll Hall of Fame):<br />
Post Doctoral Laboratory<br />
1st Place: G. Burkhard Mackensen, M.D.<br />
Finalists: Jose Pineda, M.D., Santi<br />
Punnahitananda, Ellen Lockhart, M.D.<br />
Dick Smith Award - Post Doctoral<br />
Clinical<br />
1st Place: Alina Grigore, M.D.<br />
Finalists: Timothy Stanley, M.D., Maribel<br />
Gamoso, M.D., Karen Nielsen, M.D.<br />
Pre-Doctoral Non Medical Student<br />
1st Place: Janet Hall, CRNA<br />
Finalist: Amy Kondyra<br />
Case Report<br />
1st Place: Adil Kamal, M.D.<br />
Finalist: Peter DeBalli III, M.D.<br />
Medical Student<br />
1st Place: Carolyn Clayton<br />
Finalist: Kelly Schofield<br />
The Dick Smith Award honors<br />
L. Richard Smith, Ph.D., who passed<br />
away in 1996. Dr. Smith not only provided<br />
many years of superb statistical<br />
support to our Department, but also<br />
epitomized qualities of intellect, selfeffacement,<br />
wisdom, good humor and<br />
immense personal courage. He serves<br />
as a role model for us all.<br />
The Department is indebted to Mrs.<br />
Elizabeth Barbee, Mrs. Beverly Hester,<br />
Ms. Jessica Harris and Ms. Kimberly<br />
Westbrooks who performed the organizational<br />
duties resulting in the great<br />
success of the event.<br />
The 2001 Annual Academic<br />
Evening is scheduled to be held May 1,<br />
2001, and Guest Judge will be Alex<br />
Evers, M.D. from Washington University.
2000 BUSINESS <strong>OF</strong>FICE <strong>ANNUAL</strong> <strong>REPORT</strong><br />
Edward F. Cousineau, M.A.,<br />
M.B.A.<br />
Business Manager<br />
Private Diagnostic Clinic<br />
At mid year 2000 the clinical case-loads<br />
for Anesthesiology began to fall off by<br />
about 10% as surgical volumes shifted<br />
away from Duke Hospital. By late in<br />
the year these volumes were again<br />
climbing a bit. The phenomenon<br />
resulted in the closure of several operating<br />
rooms at various times. By year’s<br />
end the Hospital was preparing to reopen<br />
these rooms to accommodate its<br />
still shifting volumes and to provide surgical<br />
specialties with needed time.<br />
The PDC’s implementation of a<br />
new cost allocation mechanism hit the<br />
department rather hard. Under these<br />
norms, the department was allocated a<br />
share in the PDC administrative costs of<br />
other clinical departments. This meant<br />
that these extra costs not usually borne<br />
by other anesthesiology groups and<br />
academic anesthesiology departments<br />
would be added on to our fair share of<br />
the operating and administrative burden.<br />
The establishment of a joint billing and<br />
collections service to be known, as the<br />
Professional Revenue Management<br />
Organization—the PRMO—in mid 2001<br />
would further complicate the cost allocation<br />
process. There is some specula-<br />
tion that the Duke Health System will<br />
insist on true activity-based cost accounting<br />
for the PRMO. This would<br />
bolster the department’s contention<br />
over the last three years that PDC costs<br />
should be properly managed in a manner<br />
consistent with industry-wide practices.<br />
Only one other PDC department<br />
has consistently sided with this point<br />
of view.<br />
The PDC continued to provide<br />
improved financial information during<br />
calendar year 2000. A major initiative<br />
sought to accelerate collections for<br />
both Duke Hospital and the PDC. This<br />
resulted in the formation of a “Cash<br />
Acceleration Team” for Anesthesiology<br />
in July of 2000. Best estimates suggest<br />
that the department collected perhaps<br />
$800,000 in old accounts. Moreover,<br />
clearing the backlog enables better<br />
collection efforts to now be directed<br />
toward newer denials.<br />
Departmental<br />
Office space continued to be in<br />
extremely short supply throughout the<br />
department during the year. In-house<br />
chiefs were appointed for the Divisions<br />
of Women’s Anesthesia and Critical<br />
Care Medicine; Pain Management; and<br />
General, Vascular, Transplant Anesthesia<br />
and Critical Care Medicine.<br />
The new interdisciplinary pain<br />
clinic facility at Morreene Road was<br />
opened in late October. The facility<br />
makes patient access for chronic pain<br />
treatment much easier. Two dedicated<br />
block rooms designed for C-arm fluroscopy<br />
have been placed in use. Patient<br />
and procedural volumes are beginning<br />
to grow. However, the PDC has had<br />
some operational issues that must be<br />
addressed before the clinic will generate<br />
a positive revenue stream.<br />
The department's national ranking<br />
in NIH research awards has constantly<br />
remained in the top four over the past<br />
three years. During the 2000 NIH reporting<br />
period, the department's total NIH<br />
awards surpassed the amount reported<br />
by the number one institution in the<br />
previous 1999 reporting period. For<br />
calendar 2000 the department’s total<br />
external funding for research was over<br />
$6.1 million.<br />
Two key members of the business<br />
office staff received promotions outside<br />
of the department in autumn 2000.<br />
Steve Williams, former administrative<br />
manager, was made director of PDC<br />
Reimbursement. Mary W. Smith, former<br />
HR manager, was recruited back into<br />
the University Human Resources activity<br />
and was given a senior post within the<br />
university’s wage and salary function.<br />
Ms. Natalie Schneider and Mrs. Charlene<br />
Hundley assumed their respective positions<br />
at year’s end. Ms. Gloria Howard<br />
took over the role of staff specialist<br />
within the business manager’s office.<br />
Hospital<br />
The department now functions as a<br />
personnel records custodian for hospital<br />
employees in most instances. An<br />
increased role in management of the<br />
CRNA staff has fallen back into the<br />
department after resting exclusively<br />
with the hospital's peri-operative management<br />
team. The divisional chiefs<br />
have a much expanded role.<br />
The department continued to provide<br />
services for the selection and evaluation<br />
of anesthesia capital equipment<br />
to the hospital. Calendar 2000 saw the<br />
implementation of the new automated<br />
anesthesia record keepers, Saturn, from<br />
North American Drager. The review<br />
and purchase of other needed clinical<br />
equipment has slowed somewhat as<br />
Duke Hospital re-organizes its capital<br />
equipment request processes.<br />
The Departments of Anesthesiology,<br />
Surgery and Obstetric and Gynecology<br />
each began paying a share of the costs<br />
of the Physicians Assistants and Nurse<br />
Practitioners assigned to the pre-operative<br />
screening unit. These mid-level<br />
practitioners have added funding from<br />
Duke Hospital. Placing these positions<br />
within the PDC structure helps assure<br />
proper reporting relationships for compliance<br />
purposes.<br />
2000 BUSINESS <strong>OF</strong>FICE <strong>ANNUAL</strong> <strong>REPORT</strong> 101
102 SUPPORT STAFF..<br />
Anesthesia Clinical Research Staff<br />
First row left to right:<br />
Yung-Wei Hsu, M.D.<br />
Michele Ladd<br />
Suzanne Aycock, R.N.<br />
Scott McEwen<br />
Second row left to right:<br />
Lee McClurkin, R.N.<br />
Aaron Harrison<br />
Karen Ramsey, R.N.<br />
Not Pictured:<br />
Debbie Jones, R.N.<br />
Jolin Reeves<br />
SUPPORT STAFF<br />
Administrative Staff<br />
First Row left to right<br />
Natalie Schneider, B.B.A.<br />
Rosemary Cumbie, A.A.<br />
Patricia Cruse, A.A.S.<br />
Second Row left to right<br />
Edward Cousineau, M.A., M.B.A.<br />
Larry Dowell, A.A.S.<br />
Charlene Hundley, B.B.A.<br />
Not Pictured:<br />
Steve Williams, B.B.A.<br />
Mary Smith, B.S., M.Ed.<br />
Anesthesia Support<br />
Left to right<br />
Lessie Owens, MLPN<br />
Delmar Shelton, PA-C<br />
Allison Taylor, B.S., PA-C
Anesthesia Technician Staff<br />
Sitting left to right<br />
Anesha Smith<br />
Amanda Cheek<br />
Heidi Brothers<br />
Standing left to right<br />
Daniel Huffman<br />
Jessie Swain<br />
Roger Hall<br />
Helen Trotter<br />
Todd Rogers<br />
Not Pictured<br />
Mattie Bradley<br />
Katie Cook<br />
Les Manning<br />
Sanders Massey III<br />
Horacio Salgado<br />
Ricky Sallars<br />
Korkeshia Taylor<br />
Dwayne Thompson<br />
SUPPORT STAFF<br />
Cardiothoracic Anesthesia Clinical Research<br />
Seated left to right<br />
Erin Ward, B.S.<br />
Terri Moore, B.A.<br />
Amanda Cheek, B.A.<br />
Second Row left to right:<br />
Melanie Tirronen, B.S.<br />
Malissa Harris, R.N., B.S.N.<br />
Beverly Perry<br />
Third Row left to right<br />
Erich Lauff, B.A.<br />
Chonna Campbell, B.S.<br />
Tori Latiker, B.S.<br />
Vincent Gaver, B.A.<br />
Jerry Kirchner, B.S., CCRA<br />
Mary Helen Currier, B.A.<br />
Not pictured<br />
Franz Derilus, B.S.<br />
Jason Hawkins, R.N., B.S.N.<br />
Tanya Kagarise, B.S.<br />
Aimee Butler, M.S.<br />
Keinya Lee, B.S<br />
SUPPORT STAFF 103
SUPPORT STAFF<br />
Divers Alert Network<br />
First Row left to right<br />
Denise Haskins<br />
Betty Orr<br />
Hattie Hargraves<br />
Jeannie Floyd<br />
Sherry Strickland<br />
Eileen Weckerle<br />
Jane Foley<br />
Rick Melvin<br />
Cindi Easterling, M.Ed.<br />
Chris Wachholz, M.B.A.<br />
Lisa Li<br />
104 SUPPORT STAFF..<br />
Second Row left to right<br />
Faye Bowen<br />
Panchabi Vaithiyanathan<br />
Donna Heath, B.S., M.S.<br />
Dave Lawler<br />
Kim Walker<br />
Beth Hawkins<br />
Laura Johnson<br />
Julie Ellis<br />
Donna Uguccioni<br />
Colin Taylor<br />
Scott Norris<br />
Bill Clendenen, M.B.A.<br />
James Fisher<br />
Duke North Support Staff<br />
Left to right<br />
Regina Williams<br />
Cheryle Davis<br />
LaTanya Rhames<br />
Kimberly Westbrooks<br />
Barbara Blank<br />
Pamela Upadhaya<br />
Annette Eddins<br />
Marilyn Helms<br />
Angela Rogers<br />
Thomas Pafford<br />
Not pictured<br />
Brenda Mickley<br />
Laraine Tuck<br />
Sara Yetsko<br />
Josie Tackett<br />
Sharon Skeeter<br />
Emily Coburn<br />
Tonya Meadows<br />
Patsy Crutchfield<br />
Shelia Johnson<br />
Allen Gattis<br />
Valorie Smith<br />
Third Row left to right<br />
Bill Terry<br />
Larry Crabtree<br />
Tommy Fowler<br />
Shirley Fowler<br />
Bud Elvin<br />
Barry Shuster, M.B.A.<br />
Nathalie Judkins<br />
Webb Roberts, M.B.A.<br />
Celia Evesque<br />
Peter Bennett, Ph.D., D.Sc.<br />
Dan Kinkade<br />
Deb Taft<br />
Shelly Hicks<br />
Chris Shoemaker<br />
Bryon Buesser<br />
Dan Leigh<br />
Fourth Row left to right<br />
Randy Sitzes<br />
Dan Orr, B.S., M.S.<br />
Mark Butler<br />
Nathan Duryea<br />
David Martinez<br />
Chris Bennett, M.B.A.<br />
Deborah Williams<br />
Steve Mehan<br />
Rick La Reno<br />
Brian Levering<br />
Ron Eldridge<br />
Petar Denoble, M.D., D.Sc.<br />
Eric Douglas<br />
Steve Barnett<br />
Jamahl Green<br />
Jim Gaston<br />
Wesley Hyatt<br />
Ralph Ariail<br />
James Hallmon<br />
Deborah Belk<br />
Melina Shabani<br />
Michelle Harward
Hyperbaric Center<br />
Left to right<br />
Eric Schinazi<br />
Richard Moon, M.D., C.M., M.Sc.,<br />
FRCP(C), FACP, FCCP<br />
Albert "Sonny" Boso<br />
Carmen Hurst<br />
Michael Natoli<br />
Eugene Hobbs<br />
Neal Pollock, Ph.D.<br />
Benjamin Comfort<br />
Ivan Demchenko, D.Sc.<br />
Deborah Brann<br />
Klaus Torp, M.D.<br />
Paul Thomas Edwards<br />
John Freiberger, M.D.<br />
Bryant Stolp, M.D., Ph.D.<br />
Duke South Support Staff<br />
Seated left to right<br />
Maria Johnson<br />
Kathryn White<br />
Lonie Purefoy<br />
Gloria Howard<br />
Standing left to right<br />
Alan Dunn<br />
Larry O’Neal<br />
Not Pictured<br />
Donna Harris<br />
Ocie Ingram<br />
Eris Joffe<br />
Marcie Robinson<br />
Claude Piantadosi, M.D.<br />
Barry Castle<br />
Richard Vann, Ph.D.<br />
Eric Alford<br />
Guy deLisle Dear, M.B., FRCA<br />
Not Pictured<br />
Peter Bennett, Ph.D., D.Sc.<br />
Martha Sue Carraway, M.D.<br />
Owen Doar<br />
Kevin Kraft, RN<br />
John Rice, RN<br />
Roberta Rose, RN<br />
Herbert Saltzman, M.D.<br />
Sherry Strickland<br />
Edward Thalmann, M.D.<br />
Aaron Walker<br />
SUPPORT STAFF<br />
SUPPORT STAFF 105
SUPPORT STAFF<br />
106 SUPPORT STAFF..<br />
Information Systems<br />
Standing left to right.<br />
Iain Sanderson, M.B<br />
William Gilbert, B.S., C.N.E.<br />
Christopher Wester<br />
Kisan Upadhaya, A.A.S.<br />
Richard Adrain, B.S.<br />
Regina Williams<br />
Larry Dowell, A.A.S.<br />
Not Pictured<br />
Stephen White<br />
Human Neurophysiology<br />
and Pharmacology Laboratory<br />
Standing left to right<br />
David Wright, M.B., Ch.B.<br />
Kerri Robertson, M.D., FRCP(C)<br />
Jacques Somma, M.D., FRCP(C)<br />
Yung-Wei Hsu, M.D.<br />
John Keifer, M.D.<br />
Eugene Moretti, M.D.<br />
Sitting left to right<br />
Aaron Harrison, B.S.<br />
Karen Ramsey, R.N., B.S.N., M.B.A., M.H.A.<br />
David MacLeod, M.B., B.S., FRCA<br />
The Medical Assembler Seniors<br />
Left to right<br />
Ky Taing<br />
Linda Harris, Supervisor<br />
Mattie Bradley<br />
Barry Nichols<br />
Yuhsuan Chen<br />
Not Pictured<br />
Sanders Massey III
Molecular Pharmacology Laboratory<br />
Front row left to right<br />
Terese Camp<br />
Michael Smith, M.S.<br />
Debra Schwinn, M.D.<br />
Back Row left to right<br />
Daniel Morris, Ph.D.<br />
Elizabeth Barbee<br />
Jessica Morris<br />
Gregory Michelotti, Ph.D.<br />
Not Pictured<br />
Beilei Lei, M.D., Ph.D.<br />
Simon Millar, M.B., Ch.B., FRCA<br />
SUPPORT STAFF<br />
Multidisciplinary Neuroprotection Laboratory<br />
Front row left to right<br />
Ann Brinkhous<br />
Beverly Hester<br />
Jim Onigkeit<br />
Ellen Bennett, Ph.D.<br />
Jose Pineda, M.D.<br />
Mitsuo Aono, M.D.<br />
Second row left to right<br />
Gary Massey<br />
Betty Smith<br />
Yukie Sato, M.D.<br />
Jesica Pandika<br />
Carla Calvi<br />
Hilary Grocott, M.D., FRCP(C)<br />
Augusto Parra, M.D.<br />
Matthew McGirt<br />
Third row left to right<br />
William Matthew, Ph.D.<br />
Daniel Laskowitz, M.D.<br />
David Warner, M.D.<br />
Robert Pearlstein, Ph.D.<br />
Huaxin Sheng, M.D.<br />
Kyosang Kim, M.D.<br />
Ronald Goldberg, M.D.<br />
SUPPORT STAFF 107
SUPPORT STAFF<br />
108 SUPPORT STAFF..<br />
Preoperative Screening Unit (2D)<br />
Front Row left to right<br />
Patricia Fenlon, RN, M.S.N.<br />
Lelia Gentry, PA-C<br />
Mary Crawford, RN<br />
Brenda Doris<br />
Anthony Basil, RN<br />
Mark Johnson, PA-C<br />
Second Row left to right<br />
Ella Smith<br />
John Stover, F.N.P.<br />
Lou Breedlove<br />
Wanda G. Johnson, RN, MA<br />
Third Row left to right<br />
Dynetta Tatum<br />
Yolanda Mack<br />
Sheila Lambert-Adams<br />
Amy Batchelder, PA-C<br />
Anita Stallings, NCA II<br />
Fourth Row left to right<br />
Ronald Olson, M.D.<br />
Joyce Ruffin<br />
Iain Sanderson, M.B. Ch.B., FRCA<br />
Not Pictured<br />
Denise Bass<br />
William Buckmaster, RN<br />
Tammy Coble, RN<br />
Jennifer Gunn, F.N.P.<br />
Mary Hawthorne, A.N.P.<br />
Deborah Hobbs, N.C.A. II<br />
Rhonda McNeil<br />
Jeffrey McNeil, F.N.P.<br />
Elizabeth Owen, A.N.P.<br />
Shelfna Pettiway<br />
Patricia Quinlan, F.N.P.<br />
Shelia Ruffin<br />
Stanton Simmerson, RN<br />
Allison Smith, PA-C<br />
Suzanne Spence, F.N.P.<br />
Theresa Vinson<br />
Bobbit Wilkins, PA-C<br />
Pain Clinic<br />
Left to right<br />
Deanna Carson<br />
Connie Winstead
Signal Transduction Laboratory<br />
Front Row Left to Right<br />
Jason Kilts, Ph.D.<br />
Tammy Evans, A.B.<br />
Banalata Sen, Ph.D.<br />
Scott Hagen, M.D.<br />
Back Row Left to Right<br />
Keisuke Yamaguchi, M.D.<br />
Madan Kwatra, Ph.D.<br />
Yuri Klyachkin, B.A.<br />
VA Support Staff<br />
Patti Yetsko<br />
Women’s Anesthesia<br />
Back Row left to right<br />
Peter Dwane, M.D., C.M., FRCP(C)<br />
Terrance Breen, M.D., FRCP(C)<br />
Ashraf Habib, M.B., Ch.B., FRCA<br />
James Reynolds, Ph.D.<br />
John Schultz, M.D.<br />
Front row left to right<br />
Lou Ellen Andrews<br />
Holly Muir, M.D., FRCP(C), Chief<br />
Tede Spahn, CRNA<br />
Not Pictured<br />
Emily Coburn<br />
SUPPORT STAFF<br />
SUPPORT STAFF 109
Institutional Review Board<br />
APPROVED HUMAN PROTOCOLS<br />
Bell, Elizabeth A., M.D., M.P.H.<br />
How much labor is in a labor epidural? Impact of<br />
changes in technique on costs associated with maintaining<br />
an obstetric anesthesia service.<br />
CORD: Comprehensive obstetric neonatal research database.<br />
Bennett, Peter B., Ph.D., D.Sc.<br />
Effect of daily exposure to compressed air on immune<br />
system.<br />
Booth, John V., M.B., Ch.B., FRCA<br />
Genetic basis of preterm delivery.<br />
Adrenergic receptor mutations associated with hypertension<br />
in women.<br />
Borel, Cecil O., M.D.<br />
The presence of vascular growth factors in CSF following<br />
subarachnoid hemorrhage.<br />
Effect of vascular growth factors on cerebral blood<br />
vessels.<br />
Breen, Terrance W., M.D., FRCPC<br />
The effective dose of epidural bupivacaine, ropivacaine<br />
and levobupivacaine for pain relief in nulliparous labor.<br />
The effective dose of epidural bupivacaine, ropivacaine<br />
and levobupivacaine for pain relief in multiparous labor.<br />
The effective dose of epidural bupivacaine, ropivacaine<br />
and levobupivacaine, plus fentanyl, for pain relief in nulliparous<br />
labor.<br />
Retrospective analysis of high spinal anesthesia in<br />
patients undergoing cesarean section.<br />
Brewer, Randall P., M.D.<br />
Comparison of serum and cerebrospinal fluid magnesium<br />
levels after an intravenous bolus dose of magnesium sulfate<br />
in patients with intracranial hypertension.<br />
Carmer, Alexis C., M.D.<br />
Lumbar plexus continuous catheters vs. patient controlled<br />
analgesia.<br />
D’Ercole, Francine J., M.D.<br />
A multi-center clinical outcome and cost-finding study<br />
of the use of the HemoSonic 100 cardiac output monitor<br />
compared to routine care in spinal surgery patients<br />
110 CLINICAL RESEARCH<br />
CLINICAL RESEARCH<br />
A multicenter, randomized, single-blind, red blood cellcontrolled,<br />
parallel-group study to evaluate the effect<br />
on allogeneic red blood cell use and the safety of room<br />
temperature stable hemoglobin-based oxygen carrier-201<br />
(HBOC-201) when administered therapeutically and perioperatively<br />
in orthopedic surgery patients who have not<br />
received erythropoietin no undergone preoperative<br />
autologous blood donation.<br />
Eck, John B., M.D.<br />
The efficacy of sciatic nerve blockade vs. caudal epidural<br />
blockade for pain control following club foot repair in<br />
children.<br />
Erb, Thomas O., M.D., F.M.H.<br />
Propofol or isoflurane anesthesia for pediatric radio frequency<br />
catheter ablation: A feasibility and cost analysis.<br />
Fras, Anne Marie, M.D.<br />
Determination of CSF neurotransmitters during treatment<br />
for chronic pain.<br />
Gan, T.J., M.B., B.S., FRCA<br />
A comparison of cardiac output and stroke volume using<br />
esophageal Doppler, non-invasive cardiac output monitor<br />
and PA catheter.<br />
The clinical use of Hextend ® compared to 5% albumin<br />
in patients undergoing radical retropubic prostatectomy<br />
or partial or total nephrectomy.<br />
A comparative study between serum potassium levels<br />
determined by point of care testing (POCT) vs. clinical<br />
chemistry laboratory (CCL).<br />
An open evaluation of the safety and clinical utility of<br />
E-TRANS ® for the management of post-op pain following<br />
short -stay surgical procedures.<br />
An open label, randomized comparative study to compare<br />
the effects of intubating doses of rapacuronium,<br />
rocuronium, cisatracurium or succinlycholine on the<br />
clinical durations of maintenance doses of cisatracurium<br />
or rocuronium under isoflurane anesthesia.<br />
An open evaluation of safety and clinical utility of<br />
E-TRANS ® for management of post-operative pain in<br />
elderly patients.<br />
A research study to place a value on postoperative<br />
muscle pain.<br />
A research study to determine a monetary value on the<br />
avoidance of intraoperative awareness.<br />
Methohexital and propofol as sedative agents during<br />
monitored anesthetic care (MAC).
The determination of the MAC reduction of sevoflurane<br />
with acupuncture analgesia.<br />
Evaluate the safety and efficacy of poly SFH-P injection<br />
in the total elimination of allogenic red cell transfusion<br />
RTBSE-8-07.<br />
Comparison of acupuncture vs. ondansetron for the<br />
prevention of post operative nausea and vomiting.<br />
Efficacy of BIS monitor-eirected verbal therapeutic<br />
suggestion during general anesthesia for abdominal<br />
hysterectomy.<br />
Determination of the onset and timing of tolerance of<br />
opioids following opioid antagonists.<br />
Comparison of recovery and postoperative neuropsychological<br />
function after remifentanil or fentanyl<br />
based anesthetic during carotid endarterectomy.<br />
A randomized, double-blind comparison of the efficacy<br />
of patient-controlled antiemesis with propofol vs.<br />
ondansetron in the treatment of PONV.<br />
PentaLyte ®, dose escalation safety study.<br />
Research study to improve recovery outcomes in elderly<br />
ambulatory patients.<br />
Ginsberg, Brian, M.B., Ch.B.<br />
A multi-center, multi-national, open-label extension study<br />
of oral naloxone for the treatment of opioid-induced<br />
constipation in patients with chronic, non-malignant<br />
or malignant pain.<br />
Multi-center, randomized, double-blind, placebo-group,<br />
dose ranging comparison of the analgesic efficacy and<br />
safety of Numorphan ® IR (oxymorphone HCL immediate<br />
release), Percolone ® and placebo in patients with postsurgical<br />
pain following orthopedic total hip and knee<br />
replacement.<br />
A randomized, open-label, single-dose, pilot study to evaluate<br />
the safety & efficacy of Dilaudid CR (TM) in patients<br />
with acute, moderate to severe postoperative pain.<br />
Double blind, placebo controlled single dose evaluation<br />
of the safety & efficacy of hydromorphone hydrochloride<br />
controlled release 24 mg capsules in acute post-operative<br />
pain.<br />
Comparison of the analgesic efficacy of Ultracet versus<br />
Tylenol with codeine no. 3 vs. placebo for the treatment<br />
of post-surgical pain.<br />
Safety & efficacy of electrotransport (E-TRANS ®) fentanyl<br />
for the treatment of post-operative pain.<br />
CLINICAL RESEARCH<br />
Safety & efficacy of electrotransport (E-TRANS ®) fentanyl<br />
compared to IV PCA morphine for the treatment of postoperative<br />
pain.<br />
Greengrass, Roy A., M.D., FRCP(C)<br />
Post open herniorrhaphy pain comparison of local<br />
anesthetic vs. saline wound perfusion on analgesic<br />
requirements.<br />
A comparison of dolasetron with dolasetron plus dexamethasone<br />
in the prevention of PONV in laparoscopic<br />
cholecystectomy patients.<br />
Efficacy of subclavian perivascular brachial plexus blockade<br />
using Doppler ultrasound and nerve stimulator for<br />
upper extremity surgery.<br />
Habib, Ashraf S., M.B., B.Ch., M.Sc., FRCA<br />
Ethnicity and analgesic requirements following cesarean<br />
section.<br />
Does magnesium sulfate reduce analgesic requirements<br />
following cesarean section.<br />
Hill, Steven E., M.D.<br />
Clinical trial to evaluate the efficacy and safety of<br />
Hemolink in patients undergoing primary CABG surgery.<br />
Paravetebral nerve blockade for perioperative analgesia<br />
during thoracoscopic surgery.<br />
Huh, Billy K., M.D., Ph.D.<br />
Lumbar facet block with high concentration mixture<br />
of tetracaine and bupivacaine.<br />
Yohimbine infusion as test for sympathetically maintained<br />
pain.<br />
King, Kathryn E., M.D., MSN<br />
Teaching intubation using cadaver vs. mannequin<br />
models.<br />
Klein, Stephen M., M.D.<br />
Post-operative pain relief after rotator cuff repair: a randomized<br />
study comparing continuous interscalene<br />
brachial plexus blockade vs. intra-articular infusion.<br />
Paravertebral lumbar somatic nerve blocks vs. local infiltration:<br />
postoperative analgesia for outpatient inguinal<br />
herniorrhaphy.<br />
Efficacy of interscalene nerve block vs. intra-articular<br />
infusion for shoulder arthroscopy.<br />
CLINICAL RESEARCH 111
CLINICAL RESEARCH<br />
Kwatra, Madan M., Ph.D.<br />
Effect of cardiopulmonary bypass (CPB) on signaling<br />
through G protein-coupled receptors in peripheral blood<br />
mononuclear cells (PBMCs). A pilot study.<br />
Effect of age on g-protein coupled receptor system in<br />
human peripheral blood mononuclear cells.<br />
MacLeod, David B., M.B., B.S., FRCA<br />
Paravertebral nerve blockade vs. local infiltration for<br />
iliac crest bone graft.<br />
Martin, Gavin, M.B., Ch.B., FRCA<br />
A phase 3, randomized, double-blind, placebo controlled,<br />
parallel group, dose-ranging study to evaluate the safety<br />
& efficacy of a single epidural dose of sustained-release<br />
encapsulated morphine (SKY0401) in the management<br />
of post-operative pain in patients undergoing hip<br />
arthroplasty.<br />
A multi-center clinical outcome and cost-finding study<br />
of the use of the HemoSonic 100 cardiac output monitor<br />
compared to routine care in spinal surgery patients.<br />
Mathew, Joseph P., M.D.<br />
Assessment of myocardial and splanchnic organ perfusion<br />
during coronary artery bypass graft surgery (CABG)<br />
by contrast echocardiography.<br />
Inflammation, coagulation and cognitive decline after<br />
cardiac surgery.<br />
A phase 2 randomized, double-blind, placebo-controlled<br />
study of the effect of h5G1.1-scFv on total mortality and<br />
adverse cardiovascular ischemic outcomes in patients<br />
undergoing cardiopulmonary bypass.<br />
Moon, Richard E., M.D., C.M., M.Sc., FRCP(C),<br />
FACP, FCCP<br />
An evaluation of 3-hydroxy-3-methylglutaryl (HMG)-CoA<br />
reductase inhibitors on hypoxic pulmonary vasoconstriction.<br />
The effects of hyperbaric exercise on pulmonary gas<br />
exchange in older divers.<br />
The relationship of s-nitrosohemoglobin and hypoxicvasoconstriction<br />
over a prolonged altitude exposure.<br />
Effects of abdominal surgery on signaling through G protein-coupled<br />
receptors.<br />
112 CLINICAL RESEARCH<br />
Moretti, Eugene W., M.D.<br />
Effect of surgery on mangesium stores.<br />
The association of apolipoprotein gene polymorphism<br />
with acute renal failure in the critically ill.<br />
An evaluation of the antimicrobial properties of the<br />
Vantex central venous catheter with Oligon material.<br />
Muir, Holly A., M.D., FRCP(C)<br />
A trial to compare the safety & efficacy of labor and<br />
delivery analgesia using ropivacaine alone and in combination<br />
with fentanyl versus bupivacaine in combination<br />
with fentanyl during epidural administration (CARE).<br />
Murdoch, John A.C., M.B., Ch.B., B.Sc.<br />
Recovery from abdominal aortic aneurysm repair:<br />
comparison between transabdominal and endovascular<br />
surgical repair.<br />
Newman, Mark F., M.D.<br />
Neuromonitoring to improve quality and decrease cost<br />
of coronary artery bypass graft surgery.<br />
A prospective trial of a temperature management system<br />
in OPCAB cardiac surgery and the effect of OPCAB on the<br />
systemic inflammatory response. Intraoperative cardiac<br />
function, and postop renal, pulmonary and cognitive<br />
function.<br />
A phase II, multicenter, placebo-controlled, randomized,<br />
double-blind, dosing regimen optimization and dose<br />
escalation study to evaluate safety, toleration and clinical<br />
pharmacology of CP-597,396 administered for vascular<br />
surgery.<br />
The role of genetics on cardiac surgery outcomes.<br />
A prospective trial of a temperature management system<br />
in OPCAB cardiac surgery.<br />
A randomized double blind placebo controlled study of<br />
neuroprotection with lidocaine during cardiac surgery.<br />
Peri-operative genetic outcome (POGO-1) Trial<br />
Effectiveness of 2.7 g PFC/kg of AF0144 to augment intraoperative<br />
autologous donation in CABG with CPB.<br />
The effect of off pump coronary artery bypass (OPCAB)<br />
on cognitive function - one year longitudinal follow-up<br />
Genetic basis of cognitive decline after surgery - five year<br />
longitudinal study.<br />
Randomized trial of a temperature management system<br />
during routine cardiac surgery.
Magnesium neuroprotection in cardiac surgery (MANIC).<br />
Genetic basis of cognitive decline after anesthesia and<br />
surgery.<br />
An open label pharmacokinetic study to evaluate the<br />
pharmacokinetics, pharmacodynamics, toleration and<br />
safety of CP-597, 396 administered for 24 hours in subjects<br />
undergoing coronary artery bypass graft (CABG) surgery.<br />
Nielsen, Karen C., M.D.<br />
A cohort study assessing the effectiveness and costs of<br />
total knee arthroplasty performed under continuous<br />
peripheral nerve blocks in an ambulatory setting.<br />
Postoperative pain relief after open shoulder surgery: A<br />
non-randomized controlled trial comparing continuous<br />
interscalene brachial plexus blockade in the 23 hour<br />
recovery care center vs. home catheter program.<br />
A randomized prospective trial comparing paravetebral<br />
nerve block and general anesthesia for surgical treatment<br />
of breast cancer pilot study.<br />
A randomized controlled trial assessing the effectiveness<br />
of general anesthesia vs. lumbar plexus/sciatic nerve<br />
block vs. lumbar plexus/sciatic nerve block with continuous<br />
home catheter for postoperative pain control after<br />
knee surgeries.<br />
A comparison of low dose lidocaine and ropivacaine<br />
spinal blocks in the ambulatory setting.<br />
Olson, Ronald P., M.D., CCFP<br />
Hyperkalemia in patients completing vascular surgery:<br />
prevalence and morbidity.<br />
Prevalence of abnormal preoperative hemoglobin levels.<br />
Olufolabi, Adeyemi J., M.B., B.S., FRCA<br />
Is there an increase in the incidence cesarean sections in<br />
mothers with positive HIV following evidence of reduced<br />
vertical transmission to the neonate?<br />
A randomized, prospective double-blind comparison of<br />
the efficacy of generic propofol with diprivan.<br />
The use of near infrared spectroscopy to determine<br />
oxygenation in the placental tissue.<br />
Efficacy of BIS monitor-eirected verbal therapeutic<br />
suggestion during general anesthesia for abdominal<br />
hysterectomy.<br />
CLINICAL RESEARCH<br />
Podgoreanu, Mihai V., M.D.<br />
The role of genetic polymorphisms of the beta 2 adrenergic<br />
receptors in cardiac surgery outcome.<br />
Reves, J.G., M.D.<br />
Use of discarded materials.<br />
Hemodilution and brain protection in cardiac surgery.<br />
Aging and post cardiopulmonary bypass afterdrop.<br />
Reynolds, James D., Ph.D.<br />
Enhanced research training for medical students.<br />
Ross, Allison K., M.D.<br />
Ropivacaine for caudal analgesia in children.<br />
Optimal ropivacaine concentration for sciatic nerve block<br />
in children.<br />
Schultz, John R., M.D.<br />
Comparing a modified ECG to the standard three lead<br />
ECG for detecting myocardial ischemia and p wave<br />
height in high risk patients in the non-invasive cardiac<br />
diagnostic laboratory.<br />
Motion induced artifactual ventilatory absence-motion<br />
induced artifact (MIA).<br />
Schwinn, Debra A., M.D.<br />
Adrenergic receptor polymorphisms and hypertension.<br />
Adrenergic receptor mutations associated with<br />
hypertension.<br />
Why do cardiac surgical patients choose to participate<br />
or not participate in medical research studies?<br />
Does cardiopulmonary bypass with cardioplegic arrest<br />
cause adrenergic receptor desensitization in adults with<br />
chronic disease undergoing elective cardiac surgery?<br />
Slaughter, Thomas F., M.D.<br />
Mechanisms of aprotinin-mediated hemostasis.<br />
Somma, Jacques, M.D., FRCP(C)<br />
Research on age, effect and interaction between propofol<br />
and remifentanil.<br />
A double blind randomized study to compare the<br />
analgesia and respiratory effect of dexmedetomidine<br />
and remifentanil.<br />
A randomized, double-blind, parallel-design, placebo<br />
and active controlled multicenter ascending dose ranging<br />
study of the safety and efficacy of single doses of Org<br />
41739 in the treatment of post-operative pain in ASA class<br />
I and II surgical patients.<br />
CLINICAL RESEARCH 113
CLINICAL RESEARCH<br />
Stafford Smith, Mark, M.D., C.M., FRCP, DABA<br />
Mitral valve surgery and acute renal dysfunction:<br />
Heartport vs. median sternotomy.<br />
Markers of renal dysfunction as outcome predictors<br />
in coronary artery bypass surgical patients.<br />
Trial to evaluate the efficacy of fenoldopam mesylate<br />
in preserving renal function and decreasing healthcare<br />
resource utilization of coronary artery bypass grafting<br />
(CABG) patients.<br />
Swaminathan, Madhav, M.D.<br />
The role of genetics on cardiac transplant surgery<br />
outcomes.<br />
The association of renal dysfunction and neurocognitive<br />
deficit after cardiac surgery.<br />
Vann, Richard D., Ph.D.<br />
The effects of ascent rate on DCS and VGE.<br />
Effects of early delivery of oxygen during exercise.<br />
Decompression in space: simulated altitude exposure at<br />
30,000 feet.<br />
Project Dive Exploration.<br />
Surface intervals before flying after diving.<br />
Total Anesthesiology Research Dollars<br />
$6,500,000<br />
$6,000,000<br />
$5,500,000<br />
$5,000,000<br />
$4,500,000<br />
$4,000,000<br />
$3,500,000<br />
$3,000,000<br />
$2,500,000<br />
$2,000,000<br />
$1,500,000<br />
$1,000,000<br />
$500,000<br />
$0<br />
114 CLINICAL RESEARCH<br />
Warner, David S., M.D.<br />
Integrated training in anesthesiology research.<br />
Welsby, Ian M.B., B.S., B.Sc., FRCA<br />
Computerized thromboelastography coagulation analyzer<br />
guided coagulation monitoring and transfusion management<br />
in the cardiac surgical patient.<br />
In vitro measurement of the anti-factor Xa activity of low<br />
molecular weight heparin.<br />
Young, Christopher C., M.D., FCCCM<br />
Long term infusion of rocuronium in adult ICU subjects.<br />
Government Industry Combined<br />
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Active Institutional Animal Care<br />
and Use Protocol<br />
Benveniste, Helene D., M.D., Ph.D.<br />
Prolonged maturation of stroke in rat brain over 24 hours<br />
followed by diffusion weighted imaging.<br />
Neuroimaging of control and APP overexpressing mice.<br />
A digital mouse brain atlas.<br />
Grocott, Hilary P., M.D., FRCP(C)<br />
Cerebral mRNA expression during cardiopulmonary<br />
bypass in the rat.<br />
Evaluation of liposome encapsulated ropivicaine for sciatic<br />
nerve blockade in the rat.<br />
Neuroprotective strategies during cardiopulmonary<br />
bypass in the rat.<br />
The effect of temperature on cognitive impairment and<br />
cerebral inflammation following cardiopulmonary bypass<br />
in the rat.<br />
Kwatra, Madan M., Ph.D.<br />
Effect of age on cardiac g protein-coupled receptors.<br />
Niklason, Laura E. M.D., Ph.D.<br />
Tissue engineered vascular grafts in swine.<br />
LABORATORY RESEARCH<br />
Reynolds, James D., Ph.D.<br />
Magnesium sulfate and preterm fetal brain injury.<br />
Effects of insufflation/laparoscopic procedures on fetal<br />
cerebral oxygenation.<br />
Magnesium sulfate and fetal hypoxic brain injury.<br />
Ethanol (alcohol) and in utero fetal cerebral hypoxia.<br />
Enhanced research training for medical students.<br />
Maternal laparoscopic surgery and postnatal outcome.<br />
Use of nitric oxide to control the hemodynamic effects of<br />
CO 2.<br />
Effects if maternal anesthesia on fetal brain oxygen levels.<br />
Schwinn, Debra A., M.D.<br />
Heterogeneity of adrenergic receptors.<br />
Warner, David S., MD<br />
Characterization of complement-mediated hypoxicischemic<br />
reperfusion injury in the immature rat brain.<br />
Extracellular oxygen radicals and ischemic brain injury.<br />
Role of extracellular superoxide dismutase and ApoE in<br />
outcome from head injury.<br />
Cerebral ischemia: minimizing damage during anesthesia.<br />
Mechanisms of post-subarachnoid hemorrhage delayed<br />
arteriopathy in the mouse.<br />
Effects of RSR13 and mild hypothermia against ischemic<br />
brain injury.<br />
LABORATORY RESEARCH 115
Bell, Elizabeth A., M.D.<br />
Anesthetic Choice for Cesarean Section<br />
in the Setting of the Fetal Distress:<br />
Research Applications for the Comprehensive<br />
Obstetrical-Neonatal Research<br />
Database (CORD)<br />
Sponsor: International Anesthesia<br />
Research Society<br />
Benveniste, Helene D., M.D., Ph.D.<br />
Magnetic Resonance Microscopy and<br />
Alzheimer's Disease: Early Detection<br />
of Alzheimer's Pathology in Transgenic<br />
Mice Overexpressing Beta Amytoid<br />
Protein<br />
Sponsor: Alzheimer's Association<br />
A 3D C57BL6/J Mouse Brain Atlas by<br />
Magnetic Resonance Microscopy<br />
Sponsor: National Institutes of Health<br />
In Vivo Magnetic Resonance Microscopy<br />
and Alzheimer's Disease: Defining and<br />
Staging the Progression of Alzheimer’s<br />
Pathology in Transgenic Mice<br />
Sponsor: American Federation for Aging<br />
Research<br />
Gan, Tong Joo, M.B., B.S., FRCA<br />
Enhancing Recovery Outcomes in<br />
Elderly Ambulatory Patients<br />
Sponsor: International Anesthesia<br />
Research Society<br />
The Clinical Use of Extend Compared<br />
to 5% Albumin in Patients Undergoing<br />
Radical Retroperitoneal Prostatectomies<br />
Sponsor: Abbott Laboratories<br />
Trial to Evaluate the Interaction of<br />
Maintenance Doses of Rocuronium with<br />
an Intubating Dose of Rapacuronium,<br />
Rocuronium, or Succinylcholine<br />
Sponsor: Organon Teknika, Inc.<br />
PentaLyte Dose Escalation Safety Study<br />
Sponsor: Biotime, Inc.<br />
116 RESEARCH GRANTS<br />
RESEARCH GRANTS<br />
An Open Evaluation of the Safety and<br />
Clinical Utility of E-TRANS(fentanyl) for<br />
the Management of Post-Operative Pain<br />
in Elderly Patients.<br />
Sponsor: Alza Corporation and PPD, Inc.<br />
An Open Evaluation of the Safety and<br />
Clinical Utility of E-TRANS(fentanyl)<br />
for Management of Post-Operative Pain<br />
Following Short-Stay Surgical Procedure<br />
Sponsor: Alza Corporation and PPD, Inc.<br />
A Randomized, Double Blind Comparison<br />
of Ondansetron and Placebo in<br />
the Prevention of Postoperative Nausea<br />
and Vomiting After Craniotomy Surgery<br />
Sponsor: Glaxo Wellcome Inc.<br />
Ginsberg, Brian, M.B., Ch.B.<br />
The Safety and Efficacy of Electrotransport<br />
(E-TRANS) Fentanyl for the<br />
Treatment of Post-Operative Pain: A<br />
Double-Blind, Multicenter, Placebo-<br />
Controlled Trial.<br />
Sponsor: Alza Corporation and PPD, Inc.<br />
Study to Access the Analgesic Efficacy<br />
and Safety of Injectable Acetaminophen<br />
for the Treatment of Post-Operative Pain<br />
Following Orthopedic Surgery<br />
Sponsor: Laboratories UPSA<br />
A Double-Blind, Placebo Controlled<br />
Single Dose Evaluation of the Safety<br />
and Efficacy of Hydromorphone Hydrochloride<br />
Controlled-Released 24mg<br />
Capsules in Acute Post-Operative Pain<br />
Sponsor: Purdue Pharma L.P.<br />
Clinical Protocol for a Double-Blind,<br />
Placebo-Controlled Comparison of the<br />
Analgesic Activity of SC-69124A 20 mg<br />
IV, SC-<br />
Sponsor: G. D. Searle and Company,<br />
Inc.<br />
A Multicenter, Multinational, Openlabel,<br />
Extension of Oral Naloxone for<br />
the Treatment of Opoid -Induced<br />
Constipation in Patients with<br />
ChronicNon-Malignant or Malignant<br />
Pain<br />
Sponsor: Roxane Laboratories<br />
Hill, Steven E., M.D.<br />
A Phase III Randomized, Double-Blind,<br />
Controlled Clinical Trial to Evaluate<br />
the Efficacy and Safety of Hemolink in<br />
Patients Undergoing Primary Coronary<br />
Artery Bypass Grafting Surgery<br />
Sponsor: Hemosol (USA), Inc.<br />
Hodgins, Lewis R., M.D.<br />
Sevoflurane vs Fentanyl Plus Midazolam<br />
for the Induction of Anesthesia In<br />
Patients for Coronary Artery Bypass and<br />
Grafting<br />
Sponsor: Abbott Laboratories<br />
Klein, Stephen M., M.D.<br />
A Comparison of Continuous Interscalene<br />
Brachial Plexus Blockade With<br />
Single Injection Technique for Open<br />
Shoulder Repair In Outpatients<br />
Sponsor: I-Flow Corporation<br />
Kwatra, Madan M., Ph.D.<br />
Function Of Human Substance P<br />
Receptor<br />
Sponsor: National Institutes of Health<br />
Aging And G Protein Coupled<br />
Receptors In Human Heart<br />
Sponsor: National Institutes of Health<br />
Lockhart, Ellen M., M.D.<br />
Progesterone as an Endogenous<br />
Neuroprotectant<br />
Sponsor: Foundation For Anesthesia<br />
Education and Research
Mackensen, George B., M.D.<br />
Peri-Ischemic Cerebral Blood Flow in<br />
Near-Complete Forebrain Ischemia in<br />
Rats<br />
Sponsor: Society Of Cardiovascular<br />
Anesthesiologists<br />
Martin, Gavin, M.B., Ch.B., FRCA<br />
A Phase II, Open-Label, Dose Escalation<br />
/ De-Escalation Study of the Sustained<br />
Release Encapsulated Morphine<br />
(C0401) AdministeredEpidurally for<br />
the Treatment of Post-Operative Pain in<br />
Patients Undergoing Hip Arthroplasty<br />
Procedures<br />
Sponsor: Syke Pharma Inc.<br />
A Multicenter, Randomized, Single-<br />
Blind, Red Blood, Cell-Controlled,<br />
Parallel-Group Study to Evaluate the<br />
Effect on Allogenic Red Blood Cell Use<br />
and the Safety of Room Temperature<br />
Stable Hemoglobin-Based Oxygen<br />
Carrier-201 (HBOC-201) When Administered<br />
Therapeutically and Perioperatively<br />
in Orthopedic Surgery Patients<br />
Who Have Not Received Erythropoietin<br />
Nor Undergone Preoperative Autologous<br />
Blood Donation<br />
Sponsor: BioPure Biopharmaceuticals<br />
Mathew, Joseph P., M.D.<br />
Inflammation, Coagulation, and<br />
Cognitive Decline After Cardiac Surgery<br />
Sponsor: American Heart Association<br />
Evaluation of the Safety and Efficacy<br />
of Parecoxib 40mg Q 12H Followed by<br />
Valdecoxib 40 mg<br />
Sponsor: G. D. Searle and Company, Inc.<br />
Moretti, Eugene W., M.D.<br />
An Evaluation of the Antimicrobial<br />
Properties of the Vantex Central Venous<br />
Catheter with Oligon Material<br />
Sponsor: Edwards Life Sciences LLC<br />
Newman, Mark F., M.D.<br />
A Phase III, Single-Blind, Randomized,<br />
Parallel-Group, Multicenter, Controlled<br />
Study of the Effectiveness of 2.7-g<br />
PFC/kg<br />
Sponsor: Alliance Pharmaceutical<br />
Corporation<br />
Genetics, Inflammation and Post-Op<br />
Cognitive Dysfunction<br />
Sponsor: National Institutes of Health<br />
A Phase II, Multi-Center, Placebo-<br />
Controlled, Randomized, Double-Blind<br />
Dosing Regimen Optimization and<br />
Dose-Escalation Study to Evaluate the<br />
Safety, Toleration and Clinical Pharmacology<br />
of CP-597-396 Administered<br />
4 Days to Subjects Undergoing<br />
Vascular Surgery<br />
Sponsor: Pfizer, Inc.<br />
Neuromonitoring to Improve Quality<br />
and Decrease Cost of Coronary Artery<br />
Bypass Graft Surgery<br />
Sponsor: Somanetics Corporation<br />
An Open-Label, Pharmacokinetic Study<br />
to Evaluate the Pharmacokinetics,<br />
Pharmacodynamics, Toleration and<br />
Safety of CP-597,396 Administered 24<br />
Hours in Subjects Undergoing CABG<br />
Sponsor: Pfizer, Inc.<br />
Genetic Basis of Cognitive Decline After<br />
Surgery<br />
Sponsor: National Institutes of Health<br />
A Randomized Controlled Trial of the<br />
Arctic Sun Temperature Management<br />
System in the Efficient Use of Hypothermia<br />
and Avoidance of Hyperthermia<br />
in Patients Undergoing CPB<br />
for Cardiac Surgery<br />
Sponsor: Medivance, Inc.<br />
RESEARCH GRANTS<br />
A Prospective Trial of the Arctic Sun in<br />
Maintaining Normothermia In OPCAB<br />
Cardiac Surgery<br />
Sponsor: Medivance, Inc.<br />
Randomized Double Blind Placebo<br />
Controlled Study of Neuroprotection<br />
with Lidocaine<br />
Sponsor: American Heart Association<br />
Niklason, Laura E., M.D., Ph.D.<br />
Novel Vascular Scaffolds<br />
Sponsor: Johnson and Johnson<br />
Piantadosi, Claude A., M.D.<br />
Particle Exposure and Acute Lung<br />
Injury<br />
Sponsor: Environmental Protection<br />
Agency<br />
Protection From Lung Injury by<br />
Blockade of Coagulation with FFR-VIIa<br />
Sponsor: Novo Nordisk<br />
Reves, Joseph G., M.D.<br />
Aging And Cognition After Cardiac<br />
Surgery<br />
Sponsor: National Institutes of Health<br />
Pharmacokinetic Based Drug Delivery<br />
In The Elderly<br />
Sponsor: Harvard Clinical Technology<br />
Reynolds, James D., Ph.D.<br />
Enhanced Research Training Programs<br />
For Medical Students<br />
Sponsor: National Institutes of Health<br />
Ross, Allison K., M.D.<br />
A Longitudinal MRI Study of Brain<br />
Development in Developmentally and<br />
Non-Developmentally Disordered<br />
Populations<br />
Sponsor: UNC (Sub-Contract)<br />
RESEARCH GRANTS 117
RESEARCH GRANTS<br />
Sanderson, Iain C., M.B., Ch.B.,<br />
FRCA<br />
Anesthesia Information System<br />
Sponsor: North American Drager, Inc.<br />
Schulman, Scott R., M.D.<br />
An Open Evaluation of the Safety and<br />
Clinical Utility of E-TRANS(fentanyl) for<br />
Management of Post-Operative Pain in<br />
Children and Adolescents<br />
Sponsor: Alza Corporation and Ppd,<br />
Inc.<br />
Schwinn, Debra A., M.D.<br />
Molecular Distribution and Regulation<br />
of Adrenergic Receptors<br />
Sponsor: National Institutes of Health<br />
Beta Adrenoceptors During<br />
Cardiopulmonary Bypass<br />
Sponsor: National Institutes of Health<br />
$3,500,000<br />
$3,000,000<br />
$2,500,000<br />
$2.000,000<br />
$1,500,000<br />
$1,000,000<br />
$500,000<br />
$428,178<br />
$864,736<br />
118 RESEARCH GRANTS<br />
Distribution Of A1-Adrenergic Receptor<br />
Subtypes In Human Spinal Cord<br />
Sponsor: Roche Bioscience<br />
Molecular Pharmacology of Vascular<br />
A1-Adrenergic Receptors<br />
Sponsor: National Institutes of Health<br />
Transcriptional Regulation of the<br />
Human A1-Adrenoceptors (Training<br />
Grant)<br />
Sponsor: National Institutes of Health<br />
Slaughter, Thomas F., M.D.<br />
Tissue Transglutaminase and Vascular<br />
Repair<br />
Sponsor: National Institutes of Health<br />
Assessment of the Utility of the PFA-100<br />
in Detecting Patients With Dysfunction<br />
in a High Risk Preoperative Setting<br />
Sponsor: Dade Behring, Inc.<br />
NIH GRANTS<br />
A Phase III Double-Blind, Randomized<br />
Study Comparing Transgenic Recombinant<br />
Human Antithrombin III and<br />
Plasma Antithrombin III In Patients<br />
Undergoing Elective Cardiac Surgery<br />
Requiring Cardiopulmonary Bypass<br />
Sponsor: Genzyme Corporation<br />
Evaluation of Heparin Activity Using the<br />
TAS COAG-1 Analyzer<br />
Sponsor: Cardiovascular Diagnostics Inc.<br />
Mechanisms Underlying Shear-Mediated<br />
Platelet Dysfunction During Cardiac<br />
Surgery<br />
Sponsor: Bayer Inc.<br />
Somma, Jacques, M.D., FRCP(C)<br />
A Novel Anesthetic Drug Delivery<br />
System<br />
Sponsor: Harvard Clinical Technology<br />
Dollar Amounts Ranking from #1 Position<br />
$$1,349,797<br />
$1,549,928<br />
0<br />
Fiscal Year 92 93 94 95 96 97 98 99 00<br />
$1,638,992<br />
$2,697,386<br />
$2,590,148<br />
$3,092,671<br />
$3,769,062<br />
Fiscal Year<br />
2000<br />
1999<br />
1998<br />
1997<br />
1996<br />
1995<br />
1994<br />
1993<br />
1992<br />
1991<br />
4<br />
2<br />
3<br />
4<br />
5<br />
7<br />
Ranking 1 5 10 15 20 25<br />
10<br />
15<br />
19<br />
22
A Randomized, Double-Blind, Parallel-<br />
Design, Placebo-and-Active-Controlled,<br />
Multicenter, Ascending Dose-Ranging<br />
Study of the Safety and Efficacy of<br />
Single Doses of Org 41793 in the<br />
Treatment of Post-Operative Pain in<br />
ASA Class I and II Surgical Inpatients<br />
Sponsor: Organon Teknika, Inc.<br />
Stafford Smith, Mark, M.D., C.M.,<br />
FRCP, DABA<br />
A Phase III, Randomized, Double-Blind,<br />
Placebo-Controlled Trial to Evaluate the<br />
Safety of Fenoldopam Mesylate in<br />
Preser<br />
Sponsor: Elan Pharmaceutical, Inc.<br />
Sum Ping, Sam T., M.B., Ch.B., FRCA<br />
A Phase IIIb, Multi-Center, Open-Label,<br />
Randomized Study Comparing the<br />
Safety and Efficacy of Dexmedetomidine<br />
to Propofol-Based Standard of Care<br />
for ICU Sedation Following Coronary<br />
Artery Bypass Grafting Surgery<br />
Sponsor: Abbott Laboratories<br />
Thalmann, Edward D., M.D.<br />
Establishing a Multi-Center, Multi-<br />
Disciplinary Program for Improving<br />
Diver Thermal Protection Hardware in<br />
Warm and Cold Water<br />
Sponsor: U.S. Navy<br />
Oxygen Acceleration of Nitrogen -<br />
Oxygen Decompression In Submarine<br />
Rescue<br />
Sponsor: U.S. Navy<br />
Vann, Richard D., Ph.D.<br />
Prebreathe Reduction Protocol (PRP)<br />
Trials<br />
Sponsor: National Aeronautics and<br />
Space Administration<br />
Determination of Safe Post-Drive Surface<br />
Intervals Before Military Free-fall<br />
Parachuting<br />
Sponsor: U.S. Special Operations<br />
Command<br />
RESEARCH GRANTS<br />
Warner, David S., M.D.<br />
Effects Of Allosteric Modulation of<br />
Hemoglobin Affinity on Outcome from<br />
Cerebral Ischemia<br />
Sponsor: Allos Therapeutics, Inc.<br />
Extracellular Oxygen Radicals and<br />
Ischemic Brain Injury<br />
Sponsor: National Institutes of Health<br />
Apolipoprotein E and the Ischemic<br />
Brain<br />
Sponsor: National Institutes of Health<br />
Integrated Training in Anesthesiology<br />
Research<br />
Sponsor: National Institutes of Health<br />
Morreene Road Pain Clinic Building Opened November 2000<br />
RESEARCH GRANTS 119
PETER B. BENNETT, Ph.D., D.Sc.<br />
Founder, President and CEO, Divers<br />
Alert Network<br />
Senior Director, Duke Hyperbaric<br />
Center<br />
Professor of Anesthesiology<br />
AREAS <strong>OF</strong> RESEARCH:<br />
Hyperbaric and Diving Medicine<br />
Efforts involve administrative and organizational<br />
responsibility for the nonprofit<br />
Divers Alert Network (DAN),<br />
a diving safety and emergency service<br />
organization located on Colony Drive<br />
at The Peter B. Bennett Center. DAN<br />
has a permanent staff of 70 and a budget<br />
of over $13 million. It is supported<br />
by a membership of over 200,000<br />
divers, the recreational diving industry,<br />
and large numbers of dive instructors<br />
and stores. Research at DAN ($500,000)<br />
has revolved around epidemiology<br />
analysis of accidents and deaths of U.S.<br />
divers to determine their cause. There<br />
are over 1,000 accidents with some 90<br />
deaths per year. The results are analyzed<br />
in an annual report and reported<br />
at many national and international<br />
meetings. DAN is an international organization<br />
with DAN Europe, DAN Japan,<br />
DAN Australia, DAN Southern Africa<br />
and is continuing to expand into South<br />
America.<br />
Other research projects at DAN<br />
have included the use of precordial<br />
doppler to determine the presence of<br />
bubbles heard in the heart as a warning<br />
indicator of decompression illness in<br />
divers carrying out normal recreational<br />
diving. Project Dive Exploration includes<br />
the collection of divers’ profiles<br />
and accident data from computers and<br />
downloading the data to DAN. This<br />
information provides a realistic accident<br />
database. Studies are underway in<br />
the Hyperbaric Center of the effects of<br />
ascent rate on the incidence of decompression<br />
illness. Risks due to flying<br />
after diving have recently been completed<br />
and a paper is in preparation.<br />
Studies on the risks of diabetes in diving<br />
are being completed. Further DAN<br />
120 LABORATORY PROGRAMS<br />
LABORATORY PROGRAMS<br />
research work can be found in the<br />
reports of Drs. Richard D. Vann and<br />
Richard E. Moon.<br />
HELENE D. BENVENISTE, M.D., Ph.D.<br />
Associate Professor, Department of<br />
Anesthesiology<br />
Assistant Research Professor,<br />
Department of Radiology<br />
Assistant Professor, Department of<br />
Neurobiology<br />
Co-Director, Center for In Vivo<br />
Microscopy<br />
AREAS <strong>OF</strong> RESEARCH:<br />
Magnetic resonance (MR) imaging of<br />
disease processes in the brain and the<br />
peripheral nervous system; MR imaging<br />
of local anesthesia toxicity<br />
Intrathecal lidocaine can potentially<br />
cause spinal cord injury in patients<br />
undergoing spinal anesthesia. The<br />
pathophysiological mechanisms underlying<br />
lidocaine-induced neurotoxicity<br />
are unknown. It has been hypothesized<br />
that lidocaine and other local anesthetics<br />
in higher than normal concentration<br />
might induce ischemia. We recently<br />
showed, by use of MR imaging in the<br />
rat, that excessive intrathecal concentrations<br />
of lidocaine do not cause spinal<br />
cord ischemia.<br />
3-D MR imaging of the paravertebral<br />
space in human cadavers<br />
Several investigators have attempted<br />
to spatially visualize the paravertebral<br />
space (PVS) in humans. Most 3D<br />
models of the PVS are illustrations<br />
based on standard anatomical textbooks.<br />
Two-dimensional models of the<br />
PVS have been reconstructed by injecting<br />
contrast medium into the paravertebral<br />
space in vivo or by observing the<br />
distribution of dye injected into the<br />
paravertebral space in human cadavers.<br />
We have constructed a three-dimensional<br />
model of the PVS in human<br />
cadavers using non-invasive high-resolution<br />
magnetic resonance imaging and<br />
3-D visualization algorithms. The 3D PVS<br />
models enable our conceptualization<br />
of the anatomical complexity of the<br />
PVS and facilitate teaching paravertebral<br />
blockade. Ongoing investigations<br />
are focused on extending the in vitro<br />
MR studies into the in vivo domain.<br />
Brain biopsy-induced hemorrhage and<br />
edema quantified by 3-D MR imaging:<br />
Effect of blood pressure<br />
In collaboration with Professor<br />
Allan H. Friedman, Chief, Division of<br />
Neurosurgery, we have conducted an<br />
investigation on the effect of mean<br />
arterial blood pressure (MABP) on<br />
intracerebral hemorrhage and edema<br />
after biopsy in the rat brain. We showed<br />
that only during acute hypertensive<br />
conditions (MABP ≈ 130 mmHg) does<br />
large intracerebral hemorrhages occur<br />
after biopsy.<br />
Defining neuropathology with MR<br />
microscopy: sensitivity and specificity<br />
This project is focused on creating<br />
a database of MR images illustrating<br />
specific brain pathologies. Dr.<br />
Benveniste is directing the neuropathology<br />
core of the Duke Center for In Vivo<br />
Microscopy and is systematically creating<br />
a neuroimaging database that will<br />
make explicit connection between MR<br />
images and specific pathologies.<br />
Currently the following pathologies are<br />
being characterized by MR: (a) Neuritic<br />
plaques in Alzheimer's disease; (b) hippocampal<br />
atropy; (c) ventricular<br />
enlargement and (d) gliosis.<br />
References to support this research<br />
are found in the Publication Section of<br />
this annual report.<br />
FRANK H. KERN, M.D., FCCM<br />
Chief, Division of Pediatric Anesthesia<br />
and Critical Care Medicine<br />
Professor of Anesthesiology<br />
Professor of Pediatrics<br />
AREAS <strong>OF</strong> RESEARCH:<br />
Brain, Lung, and Total Body Endothelial<br />
Injury During Pediatric Cardiac Surgery.<br />
Brain and Lung Inflammatory Effects of<br />
CPB.
Cardiac surgery in infants and children<br />
can result in activation of the inflammatory<br />
cascade and hypoxia/reperfusion<br />
injury. Mechanism for cardiac, lung<br />
and generalized endothelial injury are<br />
most likely mediated by endothelial cell<br />
injury. Protective strategies, including<br />
modified ultrafiltration, perflubron, high<br />
dose preoperative methylprednisolone<br />
and complement antagonists are being<br />
investigated by our group. In a laboratory<br />
setting, we have developed a<br />
sophisticated piglet model for evaluating<br />
CPB injury and protection. Important<br />
and protective strategies currently in<br />
use today, have had their roots in studies<br />
performed in our multi disciplinary<br />
laboratory. Modified ultrafiltration techniques,<br />
high dose steroids, perflubron<br />
and techniques to reduce the risks of<br />
neurologic injury associated with circulatory<br />
arrest such as pH stat, intermittent<br />
perfusion, and prolonged lengths<br />
of brain cooling have received extensive<br />
trials in animal based research in<br />
our laboratories.<br />
MADAN M. KWATRA, Ph.D.<br />
Associate Professor in Anesthesiology<br />
Assistant Professor of Pharmacology<br />
and Cancer Biology<br />
AREAS <strong>OF</strong> RESEARCH:<br />
Substance P Receptor/G Proteins/Protein<br />
Kinases/Receptor Desensitization/<br />
Aging/Post-operative Delirium<br />
A wide array of physiological functions<br />
(including vision, smell, taste, heart<br />
rate, neurotransmission, and cell proliferation)<br />
are mediated through receptors<br />
of the G protein-coupled receptor superfamily.<br />
Characterized by the presence<br />
of seven transmembrane spanning<br />
domains, G protein-coupled receptors<br />
function by interacting with heterotrimetric<br />
G proteins. On receptor activation,<br />
these G proteins dissociate into<br />
alpha and beta-gamma subunits which<br />
modulate the activities of various enzymes<br />
(adenylate cyclases, phospholipases)<br />
and ion channels. Our labora-<br />
tory seeks to understand the function of<br />
G protein-coupled receptors in normal<br />
and disease states. Toward this end, we<br />
are currently working on two NIH-funded<br />
projects. Our first project is to<br />
understand the function of the human<br />
substance P receptor (SPR) at the molecular<br />
level. SPR is a G protein-coupled<br />
receptor that plays a key role in pain<br />
transmission and has also been identified<br />
as a novel target for anti-depressants.<br />
Our goal is to delineate the molecular<br />
components involved in SPR function;<br />
this information on SPR is needed<br />
to identify novel targets to control pain<br />
and depression. Our second project is<br />
to study the effect of age on the function<br />
of G protein-coupled receptors in<br />
the human heart. Normal functioning<br />
of the heart involves several G proteincoupled<br />
receptors (such as (-adrenergic,<br />
muscarinic cholinergic, angiotensin,<br />
endothelin) and an age-dependent<br />
decrease in the responsiveness of these<br />
receptors has been observed in a variety<br />
of animal models. Our studies are<br />
designed to explore the mechanism of<br />
age-induced decreases in G proteincoupled<br />
receptor function. An understanding<br />
of these mechanisms should<br />
help in developing pharmacological<br />
and genetic therapies to improve the<br />
cardiac function of older people. In<br />
addition, we recently initiated studies<br />
to delineate the molecular mechanism<br />
of post-operative delirium in the elderly.<br />
These studies will focus on post-operative<br />
delirium in the elderly undergoing<br />
hip replacement and will use modern<br />
techniques of DNA microarray and<br />
proteomics.<br />
LABORATORY PROGRAMS<br />
MARK F. NEWMAN, M.D.<br />
Vice-Chair, Department of<br />
Anesthesiology<br />
Chief, Division of Cardiothoracic<br />
Anesthesiology and Critical Care<br />
Medicine<br />
Director: Neurologic Outcomes<br />
Research Group<br />
Assistant Professor of Medicine<br />
Professor of Anesthesiology<br />
J.G. REVES, M.D.<br />
Professor and Chair<br />
Department of Anesthesiology<br />
AREA <strong>OF</strong> RESEARCH:<br />
Neurologic and Neuropsychologic<br />
Outcome after Cardiac and Noncardiac<br />
Surgery<br />
The Neurologic Outcome Research<br />
Group of Duke Heart Center is a multidisciplinary<br />
group of cardiac anesthesiologists,<br />
cardiac surgeons, neuropsychologists,<br />
neurologists, neuroscientists,<br />
and nurse coordinators assessing the<br />
incidence and significance of central<br />
nervous system injury after cardiopulmonary<br />
bypass. Efforts over the last<br />
nine years have resulted in recent publications<br />
defining preoperative risk<br />
factors for and the extent of adverse<br />
neurologic outcomes after cardiopulmonary<br />
bypass, published in the New<br />
England Journal of Medicine and<br />
Circulation. Most recently, Dr. Newman<br />
published an article in the New England<br />
Journal of Medicine that highlights the<br />
detrimental impact of early cognitive<br />
decline on long-term cognitive dysfunction<br />
after cardiac surgery.<br />
This research group is currently<br />
funded through three NIH grants, an<br />
American Heart Association Roundtable<br />
grant, and multiple industry<br />
sources to allow nineteen full-time<br />
research personnel to carry on perioperative<br />
and longitudinal assessments in<br />
more than three hundred patients a<br />
year undergoing cardiopulmonary<br />
bypass. In addition, several new studies<br />
are examining the relationship between<br />
neurological deficits and genetics, the<br />
inflammatory response to cardiopul-<br />
LABORATORY PROGRAMS 121
LABORATORY PROGRAMS<br />
monary bypass (CPB), and bypass<br />
surgery conducted without CPB.<br />
In conjunction with the Department<br />
of Neurology and Duke Clinical<br />
Research Institute, the newest focus<br />
of the neurologic outcomes research<br />
group is the development of the Multicenter<br />
“Perioperative Organ Protection<br />
Consortium.” This is a collection of 38<br />
Academic Sites in the United States and<br />
Canada whose goal is to determine the<br />
impact of clinical practice on organ<br />
(brain, heart, kidney) protection during<br />
and after CPB.<br />
At the basic science level, research<br />
directed by Dr. Hilary Grocott in an experimental<br />
model of cardiopulmonary<br />
bypass in the rat, has been complementary<br />
to the ongoing clinical research<br />
aims. Through this model, investigations<br />
have been undertaken to examine<br />
the potential molecular mechanisms<br />
(including CPB-induced diferential<br />
cerebral gene expression) contributing<br />
to the neurologic injury associated with<br />
cardiac surgery.<br />
LAURA E. NIKLASON, M.D., Ph.D.<br />
Assistant Professor, Department of<br />
Anesthesiology<br />
Assistant Professor, Department of<br />
Biomedical Engineering<br />
Assistant Professor, Department of<br />
Surgery<br />
AREAS <strong>OF</strong> RESEARCH:<br />
Tissue engineering of vascular prostheses;<br />
cell-biomaterial interactions; biomechanical<br />
modeling.<br />
Atherosclerosis manifesting in small—<br />
and medium—caliber arteries accounts<br />
for the majority of deaths annually in<br />
the United States. Surgical bypass of<br />
diseased arteries if most often done<br />
using autologous artery or vein, but<br />
many patients lack suitable conduit for<br />
replacement of their diseased vessels.<br />
For these reasons, efforts in my laboratory<br />
have been focused on the development<br />
of techniques to culture arbitrary<br />
lengths of engineered artery using a<br />
122 LABORATORY PROGRAMS<br />
small biopsy of autologous vascular tissue.<br />
Vascular endothelial and smooth<br />
muscle cells are harvested from vascular<br />
biopsies and expanded in culture.<br />
Vascular cells are then seeded onto<br />
biocompatible and degradable scaffold<br />
substrates, and are cultured under pulsatile<br />
bio-mimetic conditions using<br />
defined culture media. Vascular cell<br />
growth coupled with substrate degradation<br />
during culture yields a confluent<br />
tubular tissue with impressive mechanical<br />
properties.<br />
Current specific areas of interest<br />
include understanding the effects of<br />
various mechanical stimuli that are<br />
applied during culture on the phenotype<br />
and mechanical characteristics of<br />
the engineered vessels. We are pursuing<br />
autologous implantations in a swine<br />
model to characterize the biological<br />
response of the engineered vessels to<br />
the in vivo environment. The effects of<br />
the degradable substrate on cellular differentiation<br />
and phenotype are being<br />
studied. In addition, we are exploring<br />
methods by which the techniques for<br />
culturing vessels from cells that are<br />
obtained from young animals may be<br />
translated to apply to cells that are<br />
obtained from elderly human donors.<br />
JAMES D. REYNOLDS, Ph.D.<br />
Research Director, Division of Women's<br />
Anesthesia<br />
Assistant Professor in Anesthesiology<br />
Assistant Professor in the Department of<br />
Surgery<br />
ELLEN M. LOCKHART, M.D.<br />
Associate in the Department of<br />
Anesthesiology<br />
AREAS <strong>OF</strong> RESEARCH:<br />
Elucidating the Fetal Brain Responses<br />
to Pathophysiologic Insult (e.g. hypoxia,<br />
maternal surgery) and Maternal Drug<br />
Exposure (e.g. ethanol, cocaine). Adult<br />
Physiologic Responses to Surgical<br />
Manipulations.<br />
The Obstetric Anesthesia Research<br />
Laboratory is the basic science arm<br />
of the Division of Women's Anesthesia.<br />
Laboratory members conduct in vivo<br />
and in vitro experiments that are<br />
designed to mimic a variety of different<br />
clinical scenarios. Specific ongoing<br />
studies include: the use of Near Infrared<br />
Spectroscopy to measure changes in<br />
fetal cerebral oxygen levels caused by<br />
ethanol, volatile anesthetics, or pneumoperitoneum;<br />
the use of tissue culture<br />
to evaluate the potential CNS protective<br />
abilities of neurosteroids; monitoring<br />
the hemodynamic and tissue blood<br />
flow changes produced by insufflation;<br />
and conducting outcome investigations<br />
and postnatal animal behavioral assessments<br />
following surgery during pregnancy.<br />
The lab also functions as a<br />
resource for clinical investigations, e.g.<br />
quantitating human plasma and CSF<br />
ionized magnesium levels.<br />
The laboratory has seen a number<br />
of changes during the past year. In<br />
June, Dr. Donald Penning departed<br />
North Carolina for a position at<br />
Sunnybrook and Women's College<br />
Health Sciences Center at the University<br />
of Toronto. Dr. Penning's departure<br />
was soon followed by that of Mr. Ben<br />
Hopkins who enrolled at Wake Forest<br />
Medical School and Dr. Yaozhi “Walter”<br />
Wang who accepted a fellowship position<br />
at the University of New Mexico.<br />
Incoming personnel included Mr. Saeed<br />
Mehrabani, who was recruited to help<br />
Dr. Ellen Lockhart complete the second<br />
year of her FAER-funded research<br />
on brain protection by neurosteroids;<br />
Ms. Nina Athar and Mr. Bassem El Daif,<br />
two third-year medical students enrolled<br />
in the ASEP study track program;<br />
and Ms. Kristy Thompson, the laboratory’s<br />
new staff assistant. Through the<br />
work of Drs. James Reynolds and Santi<br />
Punnahitananda (who is entering the<br />
final year of his neonatology fellowship),<br />
the lab continues its close association<br />
with the Neonatal-Perinatal<br />
Research Institute.
An exciting development is the<br />
establishment of formal ties with Dr.<br />
Steve Eubanks in the Department of<br />
Surgery and the members of the US<br />
Surgical Endosurgical Research Center.<br />
Utilizing the different strengths of each<br />
group, collaborative projects will focus<br />
on understanding the physiologic<br />
responses to surgery, with a special<br />
emphasis upon the fetal effects of nonobstetric<br />
related maternal surgery<br />
during pregnancy.<br />
DEBRA A. SCHWINN, M.D.<br />
Director, Molecular Pharmacology<br />
Laboratory<br />
Professor of Anesthesiology,<br />
Pharmacology/Cancer Biology, and<br />
Surgery<br />
AREAS <strong>OF</strong> RESEARCH:<br />
Molecular Pharmacology and Genetics of<br />
Adrenergic Receptors<br />
Our laboratory combines molecular<br />
pharmacology approaches with translational<br />
human functional genomics.<br />
The laboratory is involved in studying<br />
mechanisms underlying regulation of<br />
adrenergic receptors (ARs) in health<br />
and disease. Over the last ten years, we<br />
(with help from several collaborators)<br />
initially described and determined<br />
mechanisms underlying acute myocardial<br />
βAR desensitization during cardiopulmonary<br />
bypass (a procedure<br />
required to provide oxygenated blood<br />
during heart surgery at most medical<br />
centers world-wide) (Circulation, 1991;<br />
84:2559; Circulation, 1998; 98:II275;<br />
Anesthesiology, 1998; 89:602). Based on<br />
successful animal studies, we initiated a<br />
clinical interventional trial designed to<br />
prevent acute myocardial βAR desensitization<br />
during heart surgery. By<br />
enhancing myocardial βAR functioning<br />
after cardiopulmonary bypass, fewer<br />
inotropic drugs should be required during<br />
heart surgery, facilitating patient<br />
recovery with fewer side effects.<br />
In addition to studying βARs during<br />
heart surgery, the laboratory primarily<br />
focuses on regulation of α 1ARs in<br />
health and disease. Since these receptors<br />
are important in smooth muscle<br />
and the heart, diseases such as hypertension,<br />
myocardial hypertrophy, and<br />
benign prostate hypertrophy are our<br />
main focus. Three α 1AR subtypes exist<br />
(α 1a, α 1b, and α 1d); over the years we<br />
have been involved in cloning cDNAs<br />
encoding each of these subtypes from<br />
both animal and human sources<br />
(PNAS, 1988; 85:7159; J Biol Chem,<br />
1990; 265:8183; J Biol Chem, 1991;<br />
266:6365; JPET 1995; 272:134). Our laboratory<br />
recently demonstrated that<br />
α 1aARs are present and functional in<br />
human vasculature (particularly resistance<br />
vessels and coronary arteries)<br />
and are modified (increased, along<br />
with the α 1aARs) by age (Circulation,<br />
Dec 1999). In order to understand<br />
mechanisms underlying these changes,<br />
our laboratory is currently examining<br />
regulation of the human α 1aAR at transcriptional<br />
and protein levels (J Biol<br />
Chem, 1997; 272:28237). After identification<br />
of the α 1aAR in human prostate<br />
smooth muscle (J Urol, 1993; 150:546),<br />
we more recently examined a novel<br />
role of other α 1ARs (specifically the<br />
α 1dAR) in bladder hypertrophy associated<br />
with BPH (J Urol, 1998; 160:937).<br />
A new emphasis in the laboratory<br />
is the role of genetic variability on human<br />
cardiovascular disease. Specifically<br />
the role of naturally occurring single<br />
nucleotide polymorphisms (SNPs) and<br />
insertions/deletions of α 1-adrenergic<br />
receptors in hypertension is being investigated.<br />
This involves using classical<br />
genetic approaches, large scale genomic<br />
sequencing, SNP identification, and<br />
analysis for association with disease in<br />
highly phenotyped populations. It also<br />
includes investigating the biology of<br />
each SNP in terms of α 1AR signal transduction<br />
pathways.<br />
A broad spectrum of individuals<br />
interact and study in our laboratory<br />
(undergraduates, medical students,<br />
graduate students, postdoctoral fellows,<br />
LABORATORY PROGRAMS<br />
junior faculty, various collaborators),<br />
and wide ranging approaches are utilized<br />
(e.g. molecular biology, classical<br />
pharmacology, biochemistry, pharmacogenetics,<br />
and clinical trials). The<br />
goal of our laboratory is to examine<br />
clinically important questions using<br />
basic science approaches, with the final<br />
goal of ultimately taking answers back<br />
to the clinic.<br />
THOMAS F. SLAUGHTER, M.D.<br />
Assistant Professor of Anesthesiology<br />
AREAS <strong>OF</strong> RESEARCH:<br />
Perioperative Hemostasis and<br />
Thrombosis; Coagulation Factor XIII and<br />
Tissue Transglutaminase<br />
Both clinical and basic science investigations<br />
are currently in progress to<br />
define mechanisms of excessive bleeding<br />
and thrombosis in the perioperative<br />
period. Our clinical studies continue<br />
to focus on the role of the fibrinolytic<br />
system in perioperative abnormalities<br />
of hemostasis and thrombosis and to<br />
define pharmacologic approaches to<br />
alleviate fibrinolytic bleeding in the<br />
surgical patient. In addition, we are<br />
engaged in field trials to develop novel<br />
point-of-care assays of coagulation for<br />
use in the perioperative setting. Basic<br />
laboratory investigations continue to<br />
focus on tissue transglutaminase and<br />
factor XIII, members of an enzymatic<br />
gene superfamily essential for intermolecular<br />
stabilization. Recent evidence<br />
suggests that transglutaminases<br />
play an important regulatory role in the<br />
life cycle of the cell by modulating cell<br />
growth and angiogenesis. Our laboratory<br />
is specifically interested in the role<br />
of these enzymes in modulating the<br />
extracellular matrix and consequently<br />
the processes of thrombosis, angiogenesis,<br />
and atherosclerosis. Recent<br />
investigations have focused on mechanisms<br />
for the post-translational regulation<br />
of transglutaminase activity as well<br />
as the role of transglutaminases in fibrin<br />
stabilization.<br />
LABORATORY PROGRAMS 123
LABORATORY PROGRAMS<br />
JACQUES SOMMA, M.D., FRCP(C)<br />
Assistant Professor of Anesthesiology<br />
Director, Human Neurophysiology and<br />
Pharmacology Laboratory<br />
AREA <strong>OF</strong> RESEARCH:<br />
Phase I Studies<br />
The Human Pharmacology Laboratory<br />
is a fully equipped laboratory supported<br />
by a comprehensive team of professionals<br />
who have the skills required to efficiently<br />
design, perform and analyze<br />
data for Phase I studies.<br />
Faculty<br />
John C. Keifer, M.D.<br />
David B. MacLeod, M.B., B.S., FRCA<br />
Eugene W. Morretti, M.D.<br />
Kerri M. Robertson, M.D., FRCP(C)<br />
David R. Wright, M.B., Ch.B.<br />
Fellow<br />
Yung-Wei Hsu, M.D.<br />
Support Staff<br />
Jennifer K. Fier, Staff Assistant<br />
Aaron K. Harrison, B.S., Clinical Trial<br />
Research Associate<br />
Karen W. Ramsey RN, BSN, M.B.A.,<br />
MHA, Non-Cardiac Clinical Research<br />
Coordinator<br />
The Facility<br />
The Human Pharmacology Laboratory<br />
is located on the fourth floor of the<br />
Orange Zone in Duke South. It is fully<br />
equipped with standard life support<br />
and exhaustive monitoring equipment,<br />
which includes: EKG, NIBP, arterial<br />
blood pressure, end tidal CO 2, pulse<br />
oximetry, nerve stimulator, Respitrace,<br />
Medoc computer-controlled thermode,<br />
4 channels EEG, Bispectral Index and<br />
Evoked Potentials. All the data is collected<br />
on a powerful data acquisition<br />
system based on a LabView platform.<br />
The Human Pharmacology Laboratory<br />
is also equipped with Computer Controlled<br />
Infusion Pumps. It stands that<br />
Duke is the leader in the field and owns<br />
the patent for CACI (Computer Assisted<br />
Continuous Infusion). The laboratory<br />
124 LABORATORY PROGRAMS<br />
can, actually, host up to two hundred<br />
subjects per year.<br />
The Service Provided<br />
The Human Pharmacology Laboratory<br />
offer a complete solution for phase I<br />
study including:<br />
• using existing preliminary data (animal<br />
or human) to perform simulations<br />
that will help designing the protocol.<br />
• recruiting and performing the trial<br />
• analyzing, modeling and publishing<br />
the results of the study.<br />
Designing the protocol<br />
Using existing preliminary data (animal<br />
or human) simulations are performed to<br />
help design the protocol. Simulations<br />
are made for the lowest and the highest<br />
expected Cl’s and V’s using a reasonable<br />
inter and intra-individual variability.<br />
Simulated experimental data are generated<br />
according to different potential<br />
protocols. The protocols are then tested<br />
for their ability to answer the clinically<br />
relevant question. Different scenarios<br />
are considered and the best protocol is<br />
selected. Simulations help design better<br />
cost-effective studies by optimizing the<br />
quality of the results as well as minimizing<br />
the number of subjects needed for<br />
Phase II studies.<br />
Performing the study<br />
The Human Pharmacology Laboratory<br />
is a state of the art facility operated by<br />
a skilled team of professionals that offer<br />
superior and timely service. Duke University's<br />
excellent reputation for research,<br />
as well as the large population<br />
of healthy young adults living in the<br />
area, are the two key factors for fast and<br />
efficient enrollment.<br />
Analyzing the data<br />
State-of-the-art tools, such as NONMEM,<br />
are used to analyze and model the<br />
data. NONMEM is a sophisticated and<br />
powerful software package designed to<br />
perform population analysis for pharmacokinetics<br />
and dynamics. Intra and<br />
inter-variability can be modeled simultaneously<br />
with NONMEM. One of the<br />
strength of NONMEM includes the ability<br />
to adequately model PK/PD data sets<br />
with very few data points per subjects.<br />
Providing an adequate number of subjects,<br />
data sets can be modeled with as<br />
little as three data points per subjects.<br />
Active Protocols<br />
Two protocols are currently active:<br />
“A Double Blind Randomized Study to<br />
Compare the Analgesia and Respiratory<br />
Effect of Dexmedetomidine and<br />
Remifentanil," and “Age Effect on the<br />
Interaction between Propofol and<br />
Remifentanil.”<br />
The Human Neurophysiology and<br />
Pharmacology Laboratory in 2001<br />
There will be an expansion of the<br />
Human Neurophysiology and Pharmacology<br />
Laboratory in 2001 with the<br />
addition of Dr. Lucian Radu Radulescu<br />
and Dr. Luis Ignacio Cortínez. Dr.<br />
Radulescu is a trained anesthesiologist<br />
from Romania. Since 1995, Dr.<br />
Radulescu has acquired a strong background<br />
in clinical trials through working<br />
in Dr. Steven L. Shafer’s Pharmacology<br />
Laboratory at Stanford University,<br />
and at Roche Laboratory. Dr Radulescu<br />
will join the Human Neurophysiology<br />
and Pharmacology Laboratory as an<br />
Associate in Research. Dr Cortinez is a<br />
Chilean anesthesiologist with a strong<br />
interest in pharmacology and computer<br />
controlled infusions. He is anticipated<br />
to start a two-year clinical-research fellowship<br />
with us in summer 2001.<br />
Our Labview data acquisition system<br />
is a project in constant evolution.<br />
In 2001 and in the future years the<br />
Labview project will expand and evolve<br />
in a very powerful research tool that<br />
will integrate CACI and network capabilities<br />
in addition to its powerful data<br />
acquisition capabilities. The project<br />
will be programmed using MFC and<br />
the visual C++ tools for Labview.<br />
In the upcoming year the Human<br />
Neurophysiology and Pharmacology<br />
Laboratory will broaden its research<br />
activities and will offer its expertise and
services to pharmaceutical companies<br />
in fields outside anesthesia. The<br />
Human Neurophysiology and Pharmacology<br />
Laboratory is now being promoted<br />
on the World Wide Web at<br />
www.pharmacokin.com.<br />
RICHARD D. VANN, Ph.D.<br />
Director of Applied Physiology,<br />
F.G. Hall Hyperbaric Center<br />
Director of Research, Divers Alert<br />
Network<br />
Assistant Research Professor of<br />
Anesthesiology<br />
EDWARD D. THALMANN, M.D.<br />
Assistant Medical Director, Divers Alert<br />
Network<br />
Assistant Clinical Professor of<br />
Anesthesiology<br />
Assistant Clinical Professor of<br />
Community/Occupational Medicine<br />
NEAL W. POLLOCK, Ph.D.<br />
Adjunct Assistant Professor of<br />
Anesthesiology<br />
Georgia Southern University<br />
JOHN J. FREIBERGER, M.D., M.P.H.<br />
Hyperbaric Fellow<br />
AREAS <strong>OF</strong> RESEARCH:<br />
Hyperbaric, Diving, and Aerospace<br />
Physiology; Ventilatory Control; Bubble<br />
Formation; Decompression Sickness;<br />
Hypoxia; Oxygen Toxicity; Breathing<br />
Apparatus Design; Biomaterials.<br />
Fields of study at the F.G. Hall Hypo/<br />
Hyperbaric Environmental Laboratory<br />
include the physiology, medicine, and<br />
epidemiology of special respiratory<br />
environments and the development of<br />
equipment and operational procedures<br />
that allow humans to live and work<br />
in them safely. Relevant environments<br />
include diving, compressed air work,<br />
mountaineering, and aerospace. High<br />
altitude and high pressure are simulated<br />
in laboratory chambers under wet or<br />
dry conditions while inspired oxygen,<br />
carbon dioxide, inert gas, and total<br />
pressure are controlled to desired levels.<br />
Measurement capabilities include arterial<br />
blood gases, tidal volume, respiratory<br />
frequency, respiratory minute volume,<br />
oxygen and carbon dioxide partial pressures,<br />
oxygen consumption, and nitrogen<br />
uptake or elimination. Specific<br />
investigations have included: (1) environmental<br />
and physiological factors<br />
affecting cerebral blood flow, cerebral<br />
oxygenation, and CNS oxygen toxicity;<br />
(2) nitrogen elimination during oxygen<br />
breathing; (3) effect of hypercapnia on<br />
arterial oxygen saturation and cerebral<br />
oxygenation during hypoxia; (4) effects<br />
of hyperventilation and oxygen breathing<br />
on breath-hold; (5) mechanisms<br />
and locations of in vitro and in vivo<br />
bubble formation and their relation to<br />
decompression sickness; (6) physiological<br />
damage resulting from in situ bubbles<br />
and from bubbles associated with<br />
implanted biomaterials. Respiratory<br />
physiology studies include optimizing<br />
oxygen delivery equipment for sea level<br />
and altitude. Human decompression<br />
studies have included: (1) factors affecting<br />
decompression sickness in astronauts<br />
during extravehicular activity in<br />
space; (2) surface interval oxygen and<br />
in-water oxygen repetitive dive tables;<br />
(3) determination of safe surface intervals<br />
before flying after diving;<br />
(4) use of dive computers to record<br />
recreational dive profile and medical<br />
outcome data for the Divers Alert<br />
Network; (5) development of statistical<br />
models of decompression sickness. Ongoing<br />
projects include: (1) optimization<br />
of oxygen delivery equipment for medical<br />
emergencies and mountain climbing;<br />
(2) development of decompression<br />
procedures for Extravehicular Activity<br />
from the Space Station; (3) breath-hold<br />
diving with oxygen; and (4) investigation<br />
of safe ascent rates after diving.<br />
LABORATORY PROGRAMS<br />
DAVID S. WARNER, M.D.<br />
Professor of Anesthesiology,<br />
Neurobiology and Surgery<br />
Director, Experimental Anesthesiology<br />
AREAS <strong>OF</strong> RESEARCH:<br />
Mechanisms and Treatment of Ischemic/<br />
Traumatic Brain Injury; Mechanisms of<br />
Cerebral Vasospasm; Perinatal Hypoxia/<br />
Ischemia; Management of Intraoperative<br />
Cerebral Ischemia; Effects of Anesthetic<br />
Agents on Patients with Intracranial<br />
Space-Occupying Lesions<br />
The Multidisciplinary Neuroprotection<br />
Research Laboratory is dedicated to<br />
examining the pathophysiology of<br />
acute brain injury with particular reference<br />
to disease states managed in the<br />
perioperative or neurointensive care<br />
environments. Rodent recovery models<br />
of cerebral ischemia, head trauma,<br />
cardiopulmonary bypass, subarachnoid<br />
hemorrhage, and perinatal hypoxia<br />
have been established with requisite<br />
control of relevant physiologic variables.<br />
Experimental protocols examine<br />
the pathophysiologic response to these<br />
insults and seek to define appropriate<br />
therapeutic interventions. Additional<br />
work examines the roles of excitatory<br />
neurotransmitters and reactive oxygen<br />
species in acute brain injury with emphasis<br />
on how pharmacologic or genetic<br />
variants modulate these processes.<br />
Effects of altered synthesis of superoxide<br />
dismutase and apolipoprotein E are<br />
investigated in transgenic/knock out<br />
mice. Outcome studies allow definition<br />
of efficacy of pharmacologic agents<br />
including superoxide dismutase mimetics,<br />
allosteric modifiers of hemoglobin<br />
affinity for oxygen, recombinant apolipoprotein<br />
E and its peptide fragments,<br />
and anesthetics on histologic and<br />
behavioral recovery from ischemic/<br />
traumatic insults. Advanced neurochemical<br />
techniques are used to define<br />
the mechanistic basis of observations<br />
made in outcome studies. Primary neuronal/glial<br />
cultures are used to investigate<br />
mechanistic interactions between<br />
pharmacologic agents and metabolic<br />
LABORATORY PROGRAMS 125
LABORATORY PROGRAMS<br />
stresses. This year the laboratory initiated<br />
research models employing genomic<br />
and proteomic analytic methods. Additional<br />
space (1232 sq. ft.) in the Sands<br />
Building was obtained and renovated<br />
for expansion of the molecular biology<br />
and neurochemistry domains in the<br />
laboratory.<br />
The laboratory has become a focus<br />
of both research and physician-scientist<br />
Cardiothoracic Anesthesia–Vincent Gaver, B.A. and<br />
Beverly Perry<br />
126 LABORATORY PROGRAMS<br />
training for a variety of disciplines within<br />
the Medical Center including anesthesiology,<br />
neurology, neurosurgery,<br />
pediatrics, biochemistry, pediatric neurology,<br />
radiology, and neurocritical<br />
care. In 2000, the MNL was home to<br />
nine post-doctoral fellows, three medical<br />
students, and one undergraduate.<br />
Computer Support–Christopher Wester
Gerontological Research in<br />
Anesthesia and Surgery<br />
Program (GRASP)<br />
MADAN M. KWATRA, Ph.D.<br />
Associate Professor in Anesthesiology<br />
Assistant Professor of Pharmacology<br />
and Cancer Biology<br />
J.G. REVES, M.D.<br />
Professor and Chairman of<br />
Anesthesiology<br />
AREA <strong>OF</strong> INTEREST:<br />
Geriatric Research and Education<br />
Focusing on the Special Needs of the<br />
Elderly Patient Undergoing Surgery<br />
FOCUS<br />
GRASP seeks to identify areas of basic<br />
and clinical research that will reduce<br />
the incidence of adverse post-surgical<br />
outcomes that frequently occur in the<br />
elderly. To this end, GRASP holds<br />
monthly meetings, organizes biennial<br />
conferences entitled “Surgery and the<br />
Elderly,” and develops research projects.<br />
MONTHLY GRASP MEETINGS<br />
These meetings, attended by basic<br />
science and clinical faculty, residents,<br />
fellows, and medical students from the<br />
departments of anesthesiology, surgery,<br />
and the center for aging research, discuss<br />
a variety of topics related to the<br />
elderly. Topics covered in GRASP meetings<br />
are listed in the Lectures, Conferences,<br />
and Didactic section of this<br />
report.<br />
BIENNIAL SURGERY AND THE<br />
ELDERLY CONFERENCES<br />
These conferences are held biennially<br />
and focus on specific issues affecting<br />
the elderly surgical patient. The first<br />
Duke conference on surgery and the<br />
elderly was held on September 17,<br />
1997; anesthesiologists, basic scientists,<br />
geratricians, and surgeons from major<br />
medical centers across the country<br />
were in attendance. This conference<br />
highlighted the risks faced by an elderly<br />
patient undergoing surgery and how<br />
age affects the various organ systems. In<br />
addition, this meeting was instrumental<br />
in establishing contacts between the<br />
American Society of Anesthesiology<br />
(ASA) and the American Geriatric<br />
Society (AGS). These meetings were<br />
attended by basic scientists (AGS/the<br />
Hartford Foundation) whose goals are<br />
to introduce geriatrics into the curricula<br />
of various non-primary specialties.<br />
The second Duke conference on<br />
surgery and the elderly was held on<br />
September 30, 1999. The focus of this<br />
conference was on cognitive dysfunction<br />
in the elderly after non-brain<br />
surgery. The conference was divided<br />
into morning and afternoon sessions.<br />
The morning session was devoted to<br />
understanding the incidence of postoperative<br />
cognitive dysfunction after<br />
cardiac, hip fracture, and major noncardiac<br />
surgeries. The afternoon session<br />
focused on two issues: whether regional<br />
anesthesia produces less post-operative<br />
cognitive dysfunction and the cholinergic<br />
hypothesis of post-operative cognitive<br />
dysfunction. A total of 40-50 people<br />
were in attendance including anesthesiologists,<br />
basic scientists, geratricians,<br />
and surgeons from Duke and other<br />
universities.<br />
The third Duke conference on<br />
surgery and the elderly will be held<br />
on September 20, 2001. The theme of<br />
this conference will be “What we know<br />
and need to know about the elderly<br />
from existing databases.”<br />
RESEARCH PROJECTS<br />
A major aim of GRASP is to pursue<br />
research that will lead to better postoperative<br />
outcomes for the elderly. To<br />
this end, we are currently developing<br />
projects devoted to understanding post-<br />
LABORATORY PROGRAMS<br />
operative delirium in the elderly.<br />
Several projects are identified and<br />
include the following:<br />
1) What is the role of pain in postoperative<br />
delirium?<br />
2) Is regional anesthesia accompanied<br />
by a lower incidence of delirium?<br />
3) Are certain combinations of<br />
anesthetics contributing to a higher<br />
incidence of post-operative delirium?<br />
4) What is the molecular basis of<br />
post-operative delirium?<br />
Duke Chapel outdoor walkway<br />
LABORATORY PROGRAMS 127
RESEARCH<br />
ASSOCIATE<br />
Ivan T. Demchenko, D.Sc.<br />
Yung-Wei Hsu, M.D.<br />
128 RESEARCH STAFF<br />
RESEARCH STAFF<br />
Mitsuo Aono, M.D.<br />
Peter J. Denoble, M.D., Ph.D.<br />
Jason D. Kilts, Ph.D.<br />
Gopa Biswas, Ph.D.<br />
Tracey V. Du Laney, Ph.D.<br />
Kyo Sang Kim, M.D.
Masaya Kudo, M.D.<br />
Daniel Morris, Ph.D.<br />
Barbara Phillips-Bute, Ph.D.<br />
Yoonki Lee, M.D., Ph.D.<br />
Carlos L. Nebreda, M.D.<br />
Mark D. Richardson, Ph.D.<br />
Habib El-Moalem, Ph.D.<br />
Bengt M. Nellgard, M.D., Ph.D.<br />
Yukie Sato, M.D.<br />
RESEARCH STAFF<br />
RESEARCH STAFF 129
RESEARCH STAFF<br />
Yaozhi Wang, M.D. Kengo Warabi, M.D.<br />
Keisuke Yamaguchi, M.D.<br />
130 RESEARCH STAFF<br />
NOT PICTURED<br />
Banalata Sen, Ph.D.<br />
William D. White, M.P.H.<br />
FACULTY<br />
MULTIDISCIPLINARY NEUROPROTECTION LABORATORIES (Left to Right) Carla Calvi; Yukie Sato, M.D.; Hercilia Homi, M.D.; Ann Brinkhous
RESEARCH<br />
ASSISTANT<br />
Amy L. Kondyra Vikas Prabhakar<br />
RESEARCH STAFF<br />
FACULTY<br />
RESEARCH STAFF 131
Abstracts<br />
Airey PJ, Ruroede K, Myers RM, Thom SR, Ferguson BJ,<br />
Moon RE. Hyperbaric oxygen for the treatment of<br />
rhinocerebral mucormycosis. Undersea Hyperb Med<br />
2000; 27(Suppl):64.<br />
Apfelbaum J, Gan TJ, Chen C. Current hospital acute<br />
pain management practices: patient education and<br />
post-discharge follow-up. American Pain Society 2000;<br />
759.<br />
Apfelbaum J, Gan TJ, Chen C. Patient perception of postoperative<br />
pain experience after outpatient surgery:<br />
patient survey. Anesthesiology 2000; 93:A1.<br />
Aronson S, Buckingham R, Cahalan M, Konstadt S, Mark<br />
J, Ramsay J, Savage R, Savino JS, Shanewise JS, Smith<br />
J, Thys D. Relationship between training and experience<br />
with performance on the Certification Exam for<br />
Perioperative TEE. Anesth Analg 2000; 90(4): SCA75.<br />
Bailey AG, Ross AK, Bukowski T, Eck J. Caudal ropivacaine<br />
and the optimal concentration for elective lower<br />
abdominal pediatric surgery. Anesthesiology 2000; 93:<br />
A1270.<br />
Bell EB, Olufolabi AJ, Booth JV, Muir HA. Does anesthetic<br />
technique affect the time spent managing labor<br />
analgesia? Anesthesiology 2000; 93:A1041.<br />
Booth JV, Grossman D, Sheffield D, Lineberger CK, Reves<br />
JG. Substance abuse among anesthesiologists: a<br />
survey of academic institutions in the USA. Anesthesiology<br />
2000; 93(3A):223.<br />
Booth JV, Spahn D, El-Moalem H, McRae RL, Chesnut L,<br />
Leone BJ, Schwinn DA. Esmolol administration during<br />
cardiopulmonary bypass prevents acute myocardial<br />
adrenergic receptor desensitization and improves left<br />
ventricular systolic function. Anestheology 2000;<br />
90(4):SCA40.<br />
Breen TW, Campbell DC, Kronberg JE, Nunn RT, Fick GH.<br />
The clinically relevant potencies of ropivacaine and<br />
bupivacaine: a PCEA study. Anesthesiology 2000; 93:<br />
A1101.<br />
Buch DA, Dovenbarger JA, Uguccioni DM, El-Moalem H,<br />
Moon RE. Effect of cigarette smoking on the severity<br />
of decompression illness (DCI) symptoms. Undersea<br />
Hyperb Med 2000; 27:29.<br />
Butler BD, Vann RD, Nishi RY, Gerth WA, Beltran E, Fife<br />
CE, Conkin J, Schneider SM, Loftin KC, Sullivan PA,<br />
Acock K, Foster PP, Dervay JP, Waligora JM, Powell<br />
132 PUBLICATIONS<br />
PUBLICATIONS<br />
MR, Gernhardt ML. Human trials of a two hour prebreathe<br />
protocol for extravehicular activity. Aviat<br />
Space Environ Med 2000; 71(3): 278, A44.<br />
Campbell DC, Breen TW, Kronberg JE, Nunn RT, Fick GH.<br />
The motor blocking properties of ropivacaine and<br />
bupivacaine during labor analgesia. Anesthesiology<br />
2000; 93:A1044.<br />
Caruso JL, Uguccioni DM, Ellis JE, Dovenbarger JA, Vann<br />
RD, Bennett PB. Ten years of diving fatality epidemiology:<br />
the Divers Alert Network database, 1989-1998.<br />
Undersea and Hyperbaric Medicine 2000; 27(Supp):180.<br />
Conkin J, Gernhardt ML, Foster PP, Pilmanis AA, Butler<br />
BD, Beltran E, Fife CE, Vann RD, Gerth WA, Loftin KC,<br />
Acock K, Dervay JP, Waligora JM, Powell MR, Feiveson<br />
AH, Nishi RY, Sullivan PA, Schneider SM. Relationship<br />
of exercise, age, and gender on decompression sickness<br />
and venous gas emboli during two-hour oxygen<br />
pre-breathe prior to hypobaric exposure. Undersea<br />
Hyperbaric Med 2000; 27(Suppl): A10.<br />
Dear G de L, Uguccioni DM, Denoble PD, Vann RD.<br />
Recreational diving injuries, 1987 - 1997; a review.<br />
Undersea Hyperbaric Med 2000; 27S:51.<br />
Demchenko IT, Boso AE, Doar PO, Bennett PB,<br />
Piantadosi CA. Peroxynitrite production in hyperbaric<br />
oxygen-induced neurotoxicity. Undersea and Hyperbaric<br />
Medicine 2000; 27(Supp):117.<br />
Denoble PD, Vann RD, Gerth WA. Reported and estimated<br />
decompression sickness in recreational diving.<br />
Undersea Hyperbaric Med 2000; 27(Suppl): A137.<br />
Dovenbarger JA, Uguccioni DM, Sullivan KM, Dear G de<br />
L, Moon RE. Paralysis in 69 recreational scuba<br />
injuries. Undersea Hyperb Med 2000; 27(Suppl):43.<br />
Dunford RG, Vann RD, Gerth WA, Pieper CF. Huggins K,<br />
Wachholz C, Bennett PB. The incidence of venous gas<br />
emboli in recreational diving. Undersea and Hyperbaric<br />
Medicine 2000; 27(Supp):179.<br />
Finegan BA, Guenther CR, Hill SE, George PB, Carmichael<br />
L. O-raffinose crosslinked human hemoglobin (hemolink):<br />
effect on clinical chemistry in patients undergoing<br />
coronary arterybypass surgery. Anesthesiology<br />
2000; 93(3A):A184.<br />
Gan TJ, Apfelbaum J, Chen C. Acute pain management<br />
programs in the US: survey of 225 hospitals.<br />
Anesthesiology 2000; 93:A1207.
Gan TJ, Apfelbaum J, Chen C. Institutional impact of<br />
JCAHO pain management standards. American Pain<br />
Society; 2000; 648.<br />
Gan TJ, Apfelbaum J, Chen C. Patient surgery experience:<br />
primary concerns, analgesia preference and<br />
patient satisfaction. Anesthesiology 2000; 93:A880.<br />
Gan TJ, Franiak R, Reves J, Hartle A. Ondansetron disintegrating<br />
tablets (ODT) reduces post-discharge emesis<br />
and increases patient satisfaction. Anesthesiology<br />
2000; 93:A34.<br />
Gan TJ, Hill RP, Moretti E, Kucmeroski D, Pappas T,<br />
Eubanks S. Triple antiemetic prophylaxis involving<br />
propofol, droperidol and ondansetron is highly effective<br />
in preventing PONV. Anesth Analg 2000; 90:S4.<br />
Gan TJ, Klein SM, Slaughter TF, Alexander R.<br />
Thrombelastography as a measure of anticoagulation<br />
from low molecular weight heparin. Anesth Analg<br />
2000; 90:S501.<br />
Garcia-Oria MJ, Ali A, Cumming T, Fina MC, Clary E,<br />
Burch S, Penning DH, McMahon R, Reynolds JD,<br />
Gandsas A, McRae R, Eubanks S. The effects of pneumoperitoneum<br />
during pregnancy on fetal brain histology.<br />
Surgical Endoscopy 2000; 14:S185.<br />
Garcia-Rodriguez CR, Cassell C, Young C, Sum Ping J,<br />
Mark JB. Cardiac output measurement without central<br />
venous catheterization: a clinical assessment of the<br />
lithium dilution method. Anesthesiology 2000;<br />
93:A587.<br />
Gardner SF, Penning DH, Murtha AP, Hendrix BM, Booth<br />
JV. Medical management of the seizing pregnant<br />
patient maternal-fetal conflicts. Anesthesiology 2000;<br />
93:A1076.<br />
Gernhardt ML, Conkin J, Foster PP, Pilmanis AA, Butler<br />
BD, Fife CE, Vann RD, Gerth WA, Loftin KC, Dervay JP,<br />
Waligora JM, Powell MR. Design of a two-hour prebreathe<br />
protocol for space walks from the International<br />
Space Station. Aviation Space Environ Med 2000;<br />
71(3):277, A43.<br />
Gernhardt ML, Conkin J, Foster PP, Pilmanis AA, Butler<br />
BD, Beltran E, Fife CE, Vann RD, Gerth WA, Loftin KC,<br />
Acock K, Dervay JP, Waligora JM, Powell MR, Feiveson<br />
AH, Nishi RY, Sullivan PA, Schneider SM. Design and<br />
testing of a two-hour oxygen pre-breathe protocol for<br />
space walks from the International Space Station.<br />
Undersea Hyperbaric Med 2000; 27(Suppl):A11.<br />
PUBLICATIONS<br />
Gleaton CH, Rose RE, Hendircks DM, Carraway MS, Dear<br />
G de L, Moon RE, Piantadosi CA, Stolp BW, Thalmann<br />
ED, Dunn R, Logue PE, Cokgor I, Friedman AH,<br />
Fiedman HS. Hyperbaric oxygen for the treatment of<br />
radionecrosis of the brain. Undersea Hyperbaric Med<br />
2000; 27S:38.<br />
Grant SA, Nielsen KC, Greengrass RA, Steele SM, Klein<br />
SM. Continuous peripheral nerve blocks for ambulatory<br />
surgery. Anesthesiology 2000; 3A:A-9.<br />
Hampel C, Dolber PC, Bremer RE, Schwinn DA, Thuroff<br />
JW, Thor KB. Increased expression of gap junctions<br />
(connexin43) in rat bladder outlet obstruction.<br />
J Urol 2000; 163:4.<br />
Hampel C, Dolber PC, Savic SL, Schwinn DA, Thuroff JW,<br />
Thor KB. Changes in 1-adrenergic receptor (AR) subtype<br />
gene expression during bladder outlet obstruction<br />
of rats. J Urol 2000;163:228.<br />
Helsley SE, Bell E, Breen TW, Penning D. Total spinal<br />
anesthesia requiring tracheal intubation in parturients:<br />
the association with failed epidural anesthesia.<br />
Anesthesiology 2000; 93:A1078.<br />
Hendricks DM, Kraft KL, Moon RE, Piantadosi CA, Stolp<br />
BW. Dose-response for hyperbaric oxygen treatment<br />
of radiation cystitis. Undersea Hyperbaric Med 2000;<br />
27(Suppl): 39.<br />
Hill RP, Soppitt AJ, Gan TJ. The effectiveness of rescue<br />
antiemetics in patients who received a prophylactic<br />
antiemetic. Anesthesiology Analg 2000; 90:S8.<br />
Hobbs GW, Natoli MJ, Pollock NW, Stolp BW, Corkey WB,<br />
Gabrielova I, Hendricks DM, Schinazi EA, Almon AK,<br />
Pieper CF, Vann RD. Oxygen-enhanced breath-hold<br />
diving: immersion and temperature effects. Undersea<br />
Hyperbaric Med 2000; 27(Suppl):A130.<br />
Klein SM, Steele SM, Grant SA, Nielsen KC, Greengrass<br />
RA. Paravertebral somatic nerve block versus local<br />
infiltration for outpatient inguinal herniorrhaphy.<br />
Anesthesiology 2000; (3A):A885.<br />
Klein SM, Grant SA, Greengrass RA, Nielsen KC, Speer KP,<br />
White W, Warner DS, Steele, SM. Continuous ambulatory<br />
brachial plexus block with a new catheter insertion<br />
system and a disposable infusions pump.<br />
Anesthesiology 2000; (3A):A-83.<br />
Knudsen NW, Fulkerson WJ, Sebastian MW. Family communication<br />
enhanced by 24 hour in house intensivists.<br />
PUBLICATIONS 133
PUBLICATIONS<br />
Presented at SCCM in February 2001. Critical Care<br />
Medicine, December 2000; 28 (12S):A109.<br />
Kudo M, Lee Y, Massey G, Warner DS, Pearlstein RD.<br />
Effects of volatile anesthetics on NMDA excitotoxicity<br />
in primary and mixed neuronal/glial cultures.<br />
Anesthesiology 2000; 93:A729.<br />
Lee TWR, Jacobsohn E, Maniate JM, Schwinn D, Grocott<br />
HP and the Cardiac anesthesia and surgical groups<br />
at Manitoba HSC. High spinal anesthesia in cardiac<br />
surgery: effects on hemodynamics, perioperative<br />
stress response, and atrial ß-receptor function. Anesth<br />
Analg 2000; 90:SCA90.<br />
Lynch JR, Pineda J, Morgan D, Warner DS, Laskowitz DT.<br />
Apolipoprotein E modulates CNS cytokine expression<br />
and the development of edema after head injury. Soc<br />
Neurosci 2000; 26:A4925.<br />
Mackensen GB, Grocott HP, Pineda J, Nellgård B,<br />
Newman MF, Warner DS. Neurologic and neurocognitive<br />
dysfunction following cardiopulmonary by pass<br />
in the rat. Anesth Analg 2000; SCA36.<br />
Mackensen GB, Nellgård B, Kudo M, Sheng H, Pearlstein<br />
RD, Warner DS. Periischemic cerebral blood flow<br />
does not explain beneficial effects of isoflurane on<br />
outcome fromnear-complete forebrain ischemia in<br />
rats. Anesthesiology 2000; 93:1102-1106.<br />
Mackensen GB, Patel MN, Crapo JD, Batinic-Haberle I,<br />
Warner DS. Neuroprotection from delayed postischemic<br />
administration of a metalloporphyrin catalytic<br />
antioxidant in the rat. Anesthesiology 2000;<br />
93:A701.<br />
Mackensen GB, Ti LK, Grocott HP, Phillips-Bute B,<br />
Newman MF. Cerebral embolization during cardiac<br />
surgery: the impact of aortic atheroma burden.<br />
Anesthesiology 2000; 93:A400.<br />
Mackensen GB, Grocott HP, Cohen W, Phillips-Bute B,<br />
Newman MF. Post-operative temperature following<br />
cardiac surgery: the influence of warm versus cold<br />
bypass. Anesthesiology 2000; 93:A166.<br />
Maroof M, Gan TJ, York WS, Monnig A. Patient tailored<br />
infusion of cisatracurium during general anesthesia.<br />
Anesthesiology 2000; 93:A1021.<br />
Massey EW, Dovenbarger JA, Nord DA, Dear G de L,<br />
Moon RE. Seizures in divers. Undersea Hyperb Med<br />
2000; 27(Suppl):65-66.<br />
134 PUBLICATIONS<br />
McCammon MR, Moreland MR, Hickner RC, Shaw DK,<br />
Poehlman GS, Pollock NW. The effects of a moderateintensity<br />
exercise program on improving coronary<br />
artery disease risk factors in previously sedentary<br />
African-Americans. Abstracts of the Southeast<br />
American College of Sports Medicine Annual Meeting:<br />
2000; 40.<br />
Muir HA, Breen TW, Campbell DC, Halpern SH, Liston R,<br />
Blanchard W. A multicenter study of the effects of<br />
analgesia on the progress of labor. Anesthesiology<br />
2000; 92:A23.<br />
Natoli MJ, Hobbs GW, Pollock NW, Stolp BW, Corkey WB,<br />
Gabrielova I, Hendricks DM, Schnazi EA, Almon AK,<br />
Pieper CF, Vann RD. Oxygen-enhanced breath-hold:<br />
immersion and temperature effects. Undersea Hyperb<br />
Med 2000; 27(Suppl):49.<br />
Nellgård B, Mackensen GB, Pineda J, Wellons J, Pearlstein<br />
RD, Warner DS. Anesthetic effects on cerebral metabolic<br />
rate predict histologic outcome from near-complete<br />
forebrain ischemia in the rat. J Neurosurg<br />
Anesthesiology 2000; 12:168.<br />
Nielsen KC, Steele SM, Klein SM. Pietrobon RS,<br />
Greengrass RA. Continuous interscalene brachial<br />
plexus blockade at home after major shoulder surgery.<br />
Anesthesiology 2000; (3A):A15.<br />
Olufolabi AJ, Bell E, Hartle A. Probability of difficult<br />
tracheal intubation in the obstetric population: does<br />
ethnic origin matter? Anesthesiology 2000; 4:A1089.<br />
Parra A, Sheng H, Pearlstein R, Warner DS. Delayed transient<br />
arteriopathy resulting from subarachnoid hemorrhage<br />
in C57 B1/6 vs. EC-SDD transgenic mice: external<br />
vascular diameter measurement vs. histologic<br />
quantitative technique. Soc Neurosci Abs 2000;<br />
26:671.8<br />
Patel MN, Mackensen GB, Calvi C, Liang LP, Batinic-<br />
Haberle I, Day BJ, Fridovich I, Crapo JD, Pearlstein RD,<br />
Warner DS. A metalloporphyrin catalytic antioxidant<br />
protects against ischemic brain damage with a six-hour<br />
therapeutic window. Soc Neurosci Abs 2000;<br />
(2A):26:289.7<br />
Pierce BA, Young JA, Pollock NW. Validation of pulse<br />
oximetry measures of hemoglobin saturation. Abstracts<br />
of the Southeast American College of Sports Medicine<br />
Annual Meeting: 2000; 31.
Pineda JA, Lynch JR, Laskowitz DT, Warner DS, Zhang L,<br />
Beneveniste H. In vivo MR microscopy of C57BL/6J<br />
and apolipoprotein E deficient mice before and after<br />
closed head injury: a 6-week longitudinal study. Soc<br />
Neurosci 2000; 26:494.4.<br />
Pollock NW, Hobbs GW, Natoli MJ, Hendricks DM,<br />
Gabrielova I, Delphia BC, Vann RD. REMO2: an O2<br />
rebreather for use in emergency medical applications.<br />
Wilderness Environ Med 2000; 11(1):60.<br />
Pollock NW, Moreland MR, McCammon MR, Hickner RC,<br />
Shaw DK, Poehlman GS. Inability of low-intensity exercise<br />
to improve glycemic control in a rural, high-risk<br />
community. Med Sci Sports Med 2000; 32(5):5217.<br />
Ross AK, Bailey AG, Bukowski T, Eck J. Caudal ropivacaine<br />
and the optimal concentrations for elective<br />
lower abdominal pediatric surgery. Anesthesiology<br />
2000; 93:A1270.<br />
Schultz JR, Bell E, Muir H, Olufolabi Y. Does the PCEA<br />
technique reduce the number of physicians-administered<br />
“top-ups” required to maintain analgesia during<br />
labor? Anesthesiology 2000; 3A:A82.<br />
Sheng H, Batinic-Haberle I, Crapo JD, Fridovich I,<br />
Laskowitz DT, Pearlstein RD, Warner DS. Postischemic<br />
IV administration of Mn-TE-2PYP, a metalloporphyrin<br />
catalytic antioxidant, reduces histologic/neurologic<br />
damage after murine MCAO. Soc Neurosci 2000;<br />
(2A):26:289.<br />
Soppitt AJ, Robertson K, Moretti E, Weatherwax K, Gan<br />
TJ. Recovery profile of succinylcholine in severe<br />
hepatic failure. Anesth Analg 2000; 90:S464.<br />
Spear-Smith J, Reynolds JD. Maternal progesterone and<br />
17 - (estradiol levels in nearterm pregnant sheep during<br />
chronic exposure to ethanol. Alcoholism: Clinical<br />
and Experimental Research 2000 24; (Suppl.): 101A.<br />
Sreeram GM, Grocott HP, White WD, Stafford-Smith M,<br />
Newman MF. Transcranial doppler emboli count<br />
predicts rise in creatinine following cardiac surgery.<br />
Anesth Analg 2000; 90(4S):SCA 37.<br />
Sum Ping ST, Cassell C, Joseph A: Effects of dexmedetomidine<br />
on time to extubation. Crit Care Med 2000; 28:<br />
(12) A124.<br />
Ti LK, Mackensen GB, Grocott HP, Phillips-Bute BG,<br />
Mathew JP. Apolipoprotein E4 increases atheroma<br />
burden in cardiac surgical patients. Anesthesiology<br />
2000; 93:A401.<br />
PUBLICATIONS<br />
Ti LK, Mackensen GB, Grocott HP, Phillips-Bute BG,<br />
Mathew JP. The clinical significance of routine TEE in<br />
patients undergoing CABG with normal LV function.<br />
Anesthesiology 2000; 93:A349.<br />
Uguccioni DM, Dear G de L, Dovenbarger JA, Feinglos M,<br />
Moon RE, Pollock NW. Plasma glucose response to<br />
recreational diving in insulin-requiring diabetics and<br />
controls. Undersea Hyperb Med 2000; 27(Suppl):66.<br />
Vann RD, Natoli MJ, Hobbs GW, Gabrielova I, Hendricks<br />
DM, Schnazi EA, Pieper CF, Pollock NW. Oxygenenhanced<br />
breath-hold diving: O2 vs. air. Undersea<br />
Hyperb Med 2000; 27(Suppl):49-50.<br />
Vote DA, Rose R, Gleaton CH, Moon RE. Serial plasma<br />
glucose in diabetic patients during hyperbaric oxygen<br />
therapy. Undersea Hyperb Med 2000; 27(Suppl):62.<br />
Waligora JM, Conkin J, Foster PP, Schneider SM,<br />
Gernhardt ML, Loftin KC, Vann RD. Operational implementation<br />
of a two hour pre-breathe protocol for international<br />
space station. Aviat Space Environ Med 2000;<br />
71:278, A46.<br />
Wellons JC, Sheng H, Laskowitz D, Mackensen GB,<br />
Pearlstein RD, Warner DS. A comparison of strainrelated<br />
susceptibility in two murine recovery models<br />
of global cerebral ischemia. Brain Res 2000; 868:14-21.<br />
Wellons JC, Sheng H, Pineda J, Massey GW, Pearlstein<br />
RD, Warner DS, Laskowitz DT. Intracerebral infusion<br />
of human recombinant apolipoprotein E3 reduces<br />
global ischemia brain injury in apolipoprotein E deficient<br />
mice. Neurosurgery 2000; 47:532.<br />
Williams R, Gadde KM, Clary GL, Grichnik KP, Kuhn CM,<br />
Marchuk DA, Shanberg AM, Stafford-Smith M, Svenson<br />
IK. Serotonin transporter promoter genotypes, CNS<br />
serotonin turnover and cardiovascular reactivity to<br />
stress. Psychosomatic Medicine 2000; 62:101.<br />
Young CC, Garcia-Rodriguez CR, Cassell C, El-Moalem H,<br />
Mark JB. Lithium dilution versus thermodilution cardiac<br />
output measurement in cardiac surgery patients.<br />
Anesthesiology 2000; 93:B13.<br />
Young CC, Knudsen NW, Hilton AK, Reves JG. Sedation<br />
in the intensive care unit. Critical Care Medicine 2000;<br />
28(3):854-866.<br />
PUBLICATIONS 135
PUBLICATIONS<br />
Peer Reviewed Articles<br />
Allen, BW, CA Piantadosi, LA Coury. Electrode materials<br />
for nitric oxide detection. Nitric Oxide: Biol. And Chem.<br />
2000; 4(1):75-84.<br />
Arrowsmith JE, Grocott HP, Newman MF, Reves JG.<br />
Central nervous system complications of cardiac surgery.<br />
Br J Anaesth 2000; 84: 378-393.<br />
Arrowsmith JE, Grocott HP, Newman MF. Neurologic risk<br />
assessment, monitoring and outcome in cardiac surgery.<br />
J Cardiothorac Vasc Anesth 2000; 13: 726-743.<br />
Balakrishnan G, Raudzens P, Samra SK, Song K, Boening<br />
JA, Bosek V, Jamerson B, Warner DS. Safety and efficacy<br />
of remifentanil versus fentanyl in patients undergoing<br />
surgery for intracranial mass lesions. Anesth Anlg 2000;<br />
91: 163-169.<br />
Bell EA, Penning DH, Cousineau EF, White WD, Hartle AJ,<br />
Gilbert WC, Lubarsky DA. How much labor is in a labor<br />
epidural? manpower cost and reimbursement for an<br />
obstetric analgesia service in a teaching institution.<br />
Anesthesiology 2000; 92: 851-858.<br />
Benveniste H, Kim KR, Hedlund LW, Kim JW, Friedman<br />
GA. Cerebral hemorrhage and edema following brain<br />
biopsy in rats: significance of mean arterial blood pressure.<br />
J Neurosurgery 2000; 92: 100-107.<br />
Benveniste H, Kim KR, Zhang L, Johnson GA. Magnetic<br />
resonance microscopy of the C57BL mouse brain. Neuro<br />
Image 2000; 11: 601-611.<br />
Booth JV, Lindsay DR, Olufolabi AJ, El-Moalem HE,<br />
Penning DH, Reynolds JD. Subarachnoid meperidine<br />
(pethidine) causes significant nausea and vomiting during<br />
labor. Anesthesiology 2000; 93: 418-421.<br />
Borel, CO. Management of neurological ICU catastrophes:<br />
airway, breathing, and circulation. Critical Care<br />
Neurology Section, Current Treatment Options in<br />
Neurology 2000; 2(6): 499-506.<br />
Boushel R, Piantadosi CA. Near infrared spectroscopy for<br />
monitoring muscle oxygenation. Acta Physiol Scand<br />
2000; 168: 615-622.<br />
Brandom BW, Margolis JO, Bikhazi GB, Ross AK, Ginsberg<br />
B, Dear G, Kenaan CA, Eck JB, Woelfel SK, Lloyd ME.<br />
Neuromuscular effects of rapacuronium in pediatric<br />
patients during nitrous oxide-halothane anesthesia: comparison<br />
with mivacurium. Can J Anesth 2000; 47(2):<br />
143-149.<br />
136 PUBLICATIONS<br />
Breen TW, McNiel T, Dierenfield L. Obstetric anesthesia<br />
practice in Canada. Can J Anesth 2000; 47: 1230-42.<br />
Brown JM, Schulman SR. Sedation in the Paediatric ICU.<br />
S Afr J Crit Care 2000 Apr; 16 (1): 15-20.<br />
Buchheit T, Crews J. Lateral cervical epidural catheter<br />
placement for continuous unilateral upper extremity analgesia<br />
and sympathetic blockade. Regional Anesthesia<br />
and Pain Medicine 2000 May-June; 25(3): 313-317.<br />
Carraway MS, Ghio AJ, Carter JD, Piantadosi CA.<br />
Expression of heme oxygenase-1 in the lung in chronic<br />
hypoxia. Am J Physiol (Lung Cell Mol Physiol) 2000; 278:<br />
L806-L812.<br />
Carraway MS, Ghio AJ, Piantadosi CA. GM-CSF in pulmonary<br />
alveolar proteinosis. Am J Resp Crit Care Med<br />
2000; 161: 1294-1299.<br />
Chew ST, Newman MF, White WD, Conlon PJ, Saunders<br />
AM, Strittmatter, WJ, Landolfo K, Grocott HP, Stafford-<br />
Smith M. Preliminary report on association of<br />
apoplipoprotein E polymorphisms with postoperative<br />
peak serum creatinine concentrations in cardiac surgical<br />
patients. Anesthesiology 2000; 93: 325-331.<br />
Coles RE, Clements FM, Hey LM, Nunley JA, Levin LS,<br />
Pearsall AW. Transesophageal echocardiography in<br />
quantification of emboli during femoral nailing: reamed<br />
versus unreamed techniques. Southern Orthopedic<br />
Journal 2000; 9(2): 98-104.<br />
Cronin A, Keifer JC, Davies MF, King TS, Bixler EO.<br />
Melatonin secretion after surgery. Lancet 2000; 356<br />
(9237): 1244-1245.<br />
Dahm P, Roland FH, Vaslef SN, Moon RE, Price DT,<br />
Georgiade GS, Vieweg J. Outcome analysis in patients<br />
with primary necrotizing fasciitis of the male genitalia.<br />
Urology 2000; 56: 31-35.<br />
Darling E, Harris-Holloway S, Kern F, Ungerleider R,<br />
Jaggers J, Lawson S, Shearer I. Impact of modifying priming<br />
components and fluid administration using miniaturized<br />
circuitry in neonatal cardiopulmonary bypass.<br />
Perfusion 2000; 5: 3-12.<br />
Demchenko IT, Boso AE, O'Neill TJ, Bennett PB,<br />
Piantadosi CA. Nitric oxide and cerebral blood flow<br />
responses to hyperbaric oxygen. J Appl Physiol 2000; 88:<br />
1381-1389.<br />
Demchenko IT, Boso AE, O'Neill TJ, Bennett PB, Whorton<br />
AR, Piantadosi CA. Hyperbaric oxygen reduces cerebral<br />
blood flow by inactivating nitric oxide. Nitric Oxide 2000;<br />
4(6): 597-608.
East CJ, Clements F, Mathew J, Slaughter TF.<br />
Antiphospholipid syndrome and cardiac surgery:<br />
Management of anticoagulation in two patients. Anesth<br />
Analg 2000; 90: 1098-1101.<br />
Eck JB: Outpatient pediatric anesthesia. Current<br />
Anesthesiology Reports 2000; 2: 269-275.<br />
Eisenstein, E, Peterson E, Jollis J, Tardiff B, Califf R, Knight<br />
JD, Mark D. Evaluating the potential ‘economic attractiveness’<br />
of new therapies in patients with non-ST elevation<br />
acute coronary syndrome. Pharmacoeconomics<br />
2000 March 17; (3): 263-272.<br />
Fabling JM, Gan TJ, Guy J, El-Moalem HE, Molaisoodum<br />
T, Warner DS, Borel CO. A randomized, double-blind<br />
comparison of ondansetron, droperidol and placebo<br />
for prevention of post-operative nausea and vomiting<br />
after supratentorial craniotomy. Anesth Analg 2000;<br />
91: 358-61.<br />
Filntisis GA, Moon RE, Kraft KL, Farmer JC, Scher RL,<br />
Piantadosi CA. Laryngeal radionecrosis and hyperbaric<br />
oxygen therapy: report of 18 cases and review of<br />
the literature. Ann Otol Rhinol Laryngol 2000; 109:<br />
554-562.<br />
Gamoso MG, Phillips-Bute B, Landolfo KP, Newman MF,<br />
Stafford-Smith M. Off-pump versus on-pump coronary<br />
artery bypass and postoperative renal dysfunction.<br />
Anesth Analg 2000; 91: 1080-1084.<br />
Gan TJ. The esophageal Doppler as an alternative to the<br />
pulmonary artery catheter. Current Opinion in Critical<br />
Care. 2000; 6: 214-221.<br />
Garcia-Rodriguez C, Cassell C, Young C, Sum Ping ST,<br />
Mark JB. Cardiac output measurement without pulmonary<br />
artery or central venous catheterization: a<br />
clinical assessment of the lithium dilution method.<br />
Anesthesiology 2000; 93: A587.<br />
Ghio AJ, Roggli VL, Kennedy TP, Piantadosi CA. Calcium<br />
oxalate, iron accumulation and sarcoidosis. Sarcoidosis,<br />
Vasculitis and Diffuse Lung Diseases 2000; 7(2):<br />
140-150.<br />
Ginsberg B, Gan TJ, Grichnik K, Sullivan F, Muir M, Sibert<br />
K, Glass PSA. The use of patient-controlled analgesia<br />
to compare the efficacy and relative potency of sufentanil<br />
versus morphine after abdominal surgery.<br />
Journal of Pharmaceutical Care in Pain and Symptom<br />
Management 2000; 5: 3.<br />
PUBLICATIONS<br />
Grant SA, Nielsen KC, Greengrass RA, Steele SM, Klein<br />
SM. Continuous peripheral nerve blocks for ambulatory<br />
surgery. Regional Anesthesia and Pain<br />
Management 2000; 93(3A): A-9.<br />
Grant SA, Nielsen KC. Continuous peripheral nerve<br />
catheters for ambulatory anesthesia. Current<br />
Anesthesiology Reports 2000 July 2; 4: 304-307.<br />
Greengrass RA. Regional anesthesia for ambulatory<br />
surgery. Anesthesiology Clinics of North America,<br />
Regional Anesthesia 2000; 341-353.<br />
Greengrass RA, Steele SM. Regional anesthesia for ambulatory<br />
surgery. Problems in Anesthesia 2000; 148-158.<br />
Grigore AM, Grocott HP. Pro: epiaortic scanning should<br />
be used routinely during cardiac surgery. J Cardiothorac<br />
Vasc Anesth 2000; 14: 1-5.<br />
Grigore AM, Mathew JP. Con: magnesium should not be<br />
administered to all coronary artery bypass graft surgery<br />
patients undergoing cardiopulmonary bypass. J<br />
Cardiothorac Vasc Anes 2000; 14: 344-346.<br />
Grigore AM, Phillips-Bute B, Grocott HP, Butler A,<br />
Stanley T, Reves JG, Newman MF. The association of<br />
rewarming rate and neurocognitive dysfunction after<br />
cardiac surgery. Anesth Analg 2000; 90: SCA34.<br />
Grocott HP, Mackensen GB. A recovery model of complete<br />
cardiopulmonary bypass in the rat. Perfusion<br />
2000; 15: 1-7.<br />
Grocott HP, Schinderle D, Scales G, King KP. A new<br />
method for lung isolation in acute thoracic trauma. J<br />
Trauma 2000; 49: 1-3.<br />
Helsley SE, Bell E, Breen T, Penning D. Total spinal anesthesia<br />
requiring tracheal intubation in parturients: the<br />
association with failed epidural anesthesia.<br />
Anesthesiology 2000; 93(3A): A1078.<br />
Hendricks DM, Pollock NW, Natoli MJ, Vann RD.<br />
Mountaineering oxygen mask performance at 4572 m.<br />
Aviat Space Environ Med 2000; 71: 1142-1147.<br />
Hill RP, Lubarsky DA, Phillips-Bute B, Fortney J, Creed M,<br />
Glass PSA, Gan TJ. Cost effectiveness of prophylactic<br />
antiemetic therapy with ondansetron, droperidol or<br />
placebo. Anesthesiology 2000; 92: 958-967.<br />
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Hill SE, van Wermeskerken GK, Lardenoye J-W, Phillips-<br />
Bute B, Smith PK, Reves JG, Newman MF. Intraoperative<br />
physiologic variables and outcome in cardiac<br />
surgery: part in-hospital mortality. Ann Thorc Surg<br />
2000; 69: 1070-1076.<br />
Hilton AK, Jaggers J, Mathew J. An unexpected flow<br />
abnormality. J Cardiothorac Vasc Anes 2000; 14:<br />
347-349.<br />
Hogue S, Reese PR, Colopy M, Fleisher L, Tuman K,<br />
Twersky RS, Warner DS, Jamerson BD. Validation<br />
of a tool to measure patient functional ability following<br />
outpatient surgery. Anesth Analg 2000; 91: 97-106.<br />
Iselin-Chaves I, El Moalem H, Gan TJ, Ginsberg B, Glass<br />
PSA. Changes in the auditory evoked potentials and<br />
the bispectral index following propofol or propofol<br />
and alfentanil. Anesthesiology 2000; 92: 1300-1310.<br />
Joseph A, Cassell C, Garcia-Rodriguez C, El-Moalem HE,<br />
Sum Ping ST. Effects of dexmedetomidine on respiration.<br />
Anesthesiology 2000; 93: A483.<br />
Joshi G, Jamerson B, Roizen MF, Fleisher L, Twersky RS,<br />
Warner DS, Colopy M. Is there a learning curve associated<br />
with the use of remifentanil? Anesth Analg 2000;<br />
91: 1049-1055.<br />
Kantrow SP, Tatro LG, Piantadosi CA. Oxidative stress and<br />
adenine nucleotide control of mitochondrial permeability<br />
transition. Free Rad Biol Med 2000; 28:251-260.<br />
Kilts JD, Gerhardt MA, Richardson MD, Sreeram GM,<br />
Burkhard G, Grocott HP, White WD, Newman MF,<br />
Reves JG, Schwinn DA, Kwatra MM. (2-adrenergic and<br />
several other G protein-coupled receptors in human<br />
atrial membranes active both GS and GI: GI proteincoupling<br />
in human heart. Circulation Research 2000;<br />
87: 705-709.<br />
King KP, Stolp BW, Borel CO. Hidden Damage to a Reinforced<br />
LMA-Fastrach Endotracheal Tube (Response).<br />
Anesth Analg 2000; 90: 1251.<br />
Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass<br />
RA. Thoracic paravertebral block for breast surgery.<br />
Anesth Analg 2000; 90: 1402-1405.<br />
Klein SM, Grant SA, Greengrass RA, Nielsen KC, Speer KP,<br />
White W, Warner DS, Steele SM. Interscalene brachial<br />
plexus block with a continuous catheter insertion system<br />
and a disposable infusion pump. Anesth Analg<br />
2000; 91(6).<br />
138 PUBLICATIONS<br />
Klein SM, Slaughter TF, Vail PT, Ginsberg B, El-Moalem<br />
HE, Alexander R, D’Ercole F, Greengrass RA, Thangam<br />
TM, Welsby IJ, Gan TJ. Thromboelastography as a<br />
perioperative measure of anticoagulation resulting<br />
from low molecular weight heparin: A comparison<br />
with anti-Xa concentrations. Anesth Analg 2000; 91:<br />
1091-1095.<br />
Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass<br />
RA. Thoracic paravertebral block for breast surgery.<br />
Anesth Analg 2000; 90: 1402-1405.<br />
Klein SM. Ambulatory Anesthesia for the 21st Century.<br />
Surgical Services Management 2000; 6: 45-47.<br />
Klein SM. Clinical trial review. Current Anesthesiology<br />
Reports 2000; 2: 267-268.<br />
Klein SM. Ambulatory anesthesia, Current Anesthesiology<br />
Reports 2000; 2(4).<br />
Knudsen NW, Fulkerson WJ, Sebastian MW. Family communication<br />
enhanced by 24 hour in house intensivists.<br />
Critical Care Medicine 2000; 4(4): 256-264.<br />
Lardenoye HW, van Wermeskerken V, Hill SE, Grocott<br />
HP, Phillips-Bute B, Smith PK, Reves JG, Newman MF.<br />
Association of intraoperative physiologic variables<br />
with outcome in cardaic surgery: part II, neurologic<br />
outcome mean arterial pressure, minimum hematocrit<br />
and maximum glucose with neurologic. Ann Thorac<br />
Surg 2000; 69: 1077-1083.<br />
Lubarsky D, Fisher SD, Slaughter TF, Lineberger C, Green<br />
CL, Wildermann N, Greenberg CS, Inge W, Krucoff<br />
MW. Myocardial ischemia correlates with reduced fibrinolytic<br />
activity following peripheral vascular surgery.<br />
J Clin Anesth 2000; 12: 136-141.<br />
Mackensen GB, Grocott HP, Pineda J, Newman MF.<br />
Neurological and neurocognitive dysfunction following<br />
cardiopulmonary bypass in the rat. Anesth Analg<br />
2000; 90: SCA36.<br />
Mackensen GB, Nellgård B, Kudo M, Sheng H, Pearlstein<br />
RD, Warner DS. Periischemic cerebral blood flow<br />
does not explain beneficial effects of isoflurane on outcome<br />
from near-complete forebrain ischemia in rats.<br />
Anesthesiology 2000; 93: 1102-1106.<br />
Mackensen GB, Nellgård B, Sarraf-Yazdi S, Dexter F,<br />
Steffen RP, Warner DS. Postischemic RSR13 amplifies<br />
the effect of dizocilpine on outcome from transient<br />
focal cerebral ischemia in the rat. Brain Res 2000; 853:<br />
15-21.
Mackensen GB, Stanley TO, Grocott HP, Cohen WM,<br />
Phillips-Bute BG, Reves JG, Newman MF. Temperature<br />
after cardiopulmonary bypass: can we do better? The<br />
Annual of Thoracic Surgery 2000; 70: 1793.<br />
Martin G, Gan TJ. Gender: hype or fact. Seminars in<br />
Anesthesia, Perioperative Medicine and Pain 2000; 19:<br />
76-92.<br />
Michelotti GA, Price DT, Schwinn DA. Alpha-1 adrenergic<br />
receptor regulation: basic science and clinical implications.<br />
Pharmacol Ther 2000; 88: 1-2.<br />
Michelotti GA, Price DT, Schwinn DA. Regulation and<br />
clinical implications of alpha-1-adrenergic receptor<br />
function. Pharmacol and Therapeut 2000; 83: 281-309.<br />
Moon RE. Adjunctive therapy in decompression illness:<br />
present and future. SPUMS J 2000; 30: 99-112.<br />
Moon RE. All divers with decompression illness require<br />
recompression. SPUMS J 2000; 30: 149-151.<br />
Moon RE. Recompression treatment should only be<br />
administered in a hospital-based facility. SPUMS J<br />
2000; 30: 161-163.<br />
Moon RE. Recompression treatments should be to a pressure<br />
equivalent to 18 m depth. SPUMS J 2000; 30:<br />
152-154.<br />
Moon RE. The natural progression of decompression illness<br />
and development of recompression procedures.<br />
SPUMS J 2000; 30: 36-45.<br />
Muir H. Patient controlled analgesia in labor. Current<br />
Anesthesiology Reports. 2000; 2: 25-29.<br />
Nebreda CL, Urban BJ, Taylor AE. Upper extremity pain<br />
of ten years duration caused by glomus tumor.<br />
Regional Anesthesia and Pain Medicine 2000; 25(1):<br />
69-71.<br />
Nebreda CL, Urban BJ. Use of diagnostic spinal anesthesia<br />
in women with chronic pelvic/lower abdominal.<br />
American Journal of Pain Management 2000; 10(3):<br />
98-102.<br />
Nellgård B, Mackensen G, Pineda J, Wellons JC, Pearlstein<br />
RD, Warner DS. Anesthetic effects on cerebral metabolic<br />
rate predict histologic outcome from near complete<br />
forebrain ischemia in the rat. Anesthesiology<br />
2000; 93: 431-436.<br />
PUBLICATIONS<br />
Nellgård B, Mackensen GB, Massey G, Pearlstein RD,<br />
Warner DS. The effects of anesthetics on stress<br />
responses to forebrain ischemia and reperfusion in the<br />
rat. Anesth Analg 2000; 91: 145-151.<br />
Newman MF, Grocott HP, Stanley TO, Mackensen GB,<br />
Kirchner JL, Mark DB, Bluemthal JA. Neurocognitive<br />
dysfunction and quality-of-life after cardiac surgery.<br />
Anesth Analg 2000; 90: SCA4.<br />
Newman MF, Stanley TO, Grocott HP. Strategies to<br />
protect the brain during cardiac surgery. Sem<br />
Cardiothorac Vas Anesth 2000; 4: 53-64.<br />
Niklason, LE. Engineering of bone grafts. Nature<br />
Biotechnology 2000; 18: 929-930.<br />
Nozik-Grayck E, Dieterle C, Piantadosi CA, Enghild J, Oury<br />
T. Secretion of active EC-SOD in neonatal lung. Am J<br />
Physiol (Lung Cell Mol Physiol) 2000; 279: 977-984.<br />
Olufolabi AJ, Bell ED, Hartle AJ. Probability of difficult<br />
tracheal intubation in the obstetric population: does<br />
ethnic origin matter? Anesthesiology 2000; 93(3A):<br />
A1089.<br />
Olufolabi A, Booth JV, Wakeling H, Glass PS, Penning DH,<br />
Reynolds JD. A preliminary investigation of remifentanil<br />
as a labor analgesic. Anesth Analg 2000; 91: 606-<br />
608.<br />
Ongjoco RRS, Richardson CD, Rudner XL, Stafford-Smith<br />
M, Schwinn DA. Adrenergic receptors in human dorsal<br />
root ganglia: predominance of alpha-2b and alpha-<br />
2b subtype mRNAs. Anesthesiology 2000; 92: 968-976.<br />
Panten RR, Harrison JK, Warner J, Grocott, HP. Aortic dissection<br />
following angioplasy and stenting of an aortic<br />
coarctation: detection by intravascular ultrasound but<br />
not transesophageal echocardiography. Anesth Analg<br />
2000; 90: SCA95.<br />
Price DT, Rudner X, Michelotti GA, Schwinn DA.<br />
Immortalization of a human prostate cell line using a<br />
recombinant retroviral approach. J Urol 2000; 164:<br />
2145-2150.<br />
Reynolds JD, Grubbs EG, Dexter F, Punnahitananda S,<br />
Dense TA, Penning DH. Acute cord occlusion increases<br />
blood ionized magnesium concentration in preterm<br />
fetal sheep during maternal magnesium sulfate exposure.<br />
Can J Physiol Pharmacol 2000; 78: 301-306.<br />
Ross AK, Eck JB, Tobias JD. Pediatric regional anesthesia:<br />
beyond the caudal. Anesth Analg 2000; 91: 16-26.<br />
PUBLICATIONS 139
PUBLICATIONS<br />
Schulman SR. Sedation in the Pediatric Intensive Care<br />
Unit. Curr Anesth Rep 2000 Nov; 2(6): 504-509.<br />
Schwinn DA. Latest results of the research on alpha-1adrenoceptor<br />
subtypes. Drugs of Today 2000; 36: 7-9.<br />
Schwinn DA. Novel role for alpha-1-adrenergic receptor<br />
subtypes in lower urinary tract symptoms. Br J Urol<br />
Intl 2000; 86: 11-22.<br />
Schwinn DA, Michelotti GA. Alpha-1-adrenergic receptors<br />
in the lower urinary tract and vascular bed: potential<br />
role for the alpha1D-subtype in filling symptoms and<br />
effects of aging on vascular expression. Eur J Urol<br />
2000; 85: 6-11.<br />
Sharma AB, Bittner HB, Sreeram G, Slaughter TF.<br />
Diagnostic dilemma: interesting right ventricular<br />
transesophageal echocardiography findings. J<br />
Cardiothoracic Vasc Anesth 2000; 14: 617-619.<br />
Sharma AD, Slaughter TF. Utilization of a retrograde cardioplegia<br />
catheter for rapid central venous infusion.<br />
Anesth Analg 2000; 91: 1560-1565.<br />
Sharma AD, Sreeram G, Erb T, Grocott HP, Slaughter TF.<br />
Leukocyte-reduced blood transfusions: perioperative<br />
indications and implications. Anesth Analg 2000; 90:<br />
131-133.<br />
Sharma AD, Sreeram G, Slaughter TF. Renal cell carcinoma<br />
with extensive involvement of the inferior<br />
vena cava and right atrium: diagnostic utility of intraoperative<br />
transesophageal echocardiography. Am J<br />
Anesthesiology 2000; 27(7): 425-428.<br />
Sharma AD, Sreeram G, Slaughter TF. Spontaneous coronary<br />
artery dissection (SCAD) in a 24 y/o healthy<br />
female. J Cardiothoracic Vasc Anesth 2000; 14:<br />
312-313.<br />
Sheng H, Kudo M, Mackensen GB, Pearlstein RD, Crapo<br />
JD, Warner DS. Mice overexpressing extracellular<br />
superoxide dismutase have increased tolerance to<br />
global cerebral ischemia. Exp Neurology 2000; 163:<br />
392-398.<br />
Slaughter TF, Mark JB. Heparin-mediated hypotension<br />
associated with cardiac surgery. Anesth Analg 2000;<br />
91: 766-767.<br />
Soppitt AJ, Glass PSA, Howell S, Weatherwax K, Gan TJ.<br />
The use of propofol for its antiemetic effect: a survey<br />
of clinical practice in the United States. J Clin Anesth.<br />
2000; 12: 265-269.<br />
140 PUBLICATIONS<br />
Soppitt AJ, Gan TJ, Sanderson I, Weatherwax K, Glass<br />
PSA. Duration and recovery profile of cisatracurium<br />
after succinylcholine during propofol and isoflurane<br />
anesthesia. J Clin Anesth. 1999; 11: 652-656. (Omitted<br />
in the 1999 Annual Report publication section.)<br />
Spear-Smith J, Brien JF, Grafe M, Allrich R, Reynolds JD.<br />
Chronic ethanol exposure during late gestation produces<br />
behavioral anomalies in neonatal lambs.<br />
Neurotox Teratol 2000; 22: 205-212.<br />
Sreeram GM, Grocott HP, White WD, Stafford-Smith M,<br />
Newman MF. Transcranial doppler emboli count predicts<br />
rise in creatinine following coronary artery<br />
bypass graft surgery. Anesth Analg 2000; 90: SCA37.<br />
Stafford-Smith M, Phillips-Bute, Reddan D, Black J,<br />
Newman MF. The association of (-Aminocaproic with<br />
postoperative decrease in creatinine clearance in 1502<br />
coronary bypass patients. Anesth Analg 2000; 91:<br />
1085-1090.<br />
Stafford-Smith M, Redden D, Newman MF, Phillips-Bute,<br />
Winn M. Association of postop peak and fractional<br />
serum creatinine change with post-CABG mortality.<br />
Anesthesiology 2000; 90: A240.<br />
Stafford-Smith M, Redden DN, Philips-Bute, Newman MF,<br />
Winn MP. Markers of renal dysfunction as outcome<br />
predictors in coronary artery bypass (CABG) patients.<br />
J American Society of Nephrology (ASN), 2000;<br />
September, Toronto, Canada.<br />
Stafford-Smith M, Schwinn DA. In Situ hybridization<br />
of adrenergic receptor mRNA in brain. Adren Recep<br />
Protoc 2000; 136: 519-533.<br />
Stanley TO, Grocott HP, Phillips-Bute B, Newman MF.<br />
Aortic atheroma and the risk of stroke and encephalopathy<br />
after cardiac surgery. Anesth Analg 2000; 90:<br />
SCA38, 2000.<br />
Stover EP, Siegel LC, Body SC, Levin J, Parks R, Maddi R,<br />
D’Ambra MN, Mangano DT, Spiess BD. Institutional<br />
variability in red blood cell conservation practices for<br />
coronary artery bypass graft surgery. J Cardiothorac<br />
Vasc Anes 2000; 14: 171-176.<br />
Taekman JM, Web alert. Current Anesthesiology Reports<br />
2000 Jan 1; 2(1): 3-4.<br />
Taekman JM, Web alert. Current Anesthesiology Reports<br />
2000 July 1; 2(4): 259-260.
Taekman JM, Web alert. Current Anesthesiology Reports<br />
2000 Mar 1; 2(2): 90-91.<br />
Taekman JM, Web alert. Current Anesthesiology Reports<br />
2000 May 1; 2(3): 165.<br />
van Wermeskerken GK, Lardenoye J-W, Hill SE, Grocott<br />
HP, Phillips-Bute B, Smith PK, Reves JG, Newman MF.<br />
Intraoperative physiologic variables and outcome in<br />
cardiac surgery: part II. Neurologic Outcome. Ann<br />
Thorc Surg 2000; 69: 1077-1083.<br />
Warner DS, Petrozza P. Journal Club: J Neurosurg Anesth<br />
2000; 12: 152-158.<br />
Warner DS, Petrozza P. Journal Club: J Neurosurg Anesth<br />
2000;12: 279-86.<br />
Warner DS, Petrozza P. Journal Club: J Neurosurg Anesth<br />
2000; 12: 376-81.<br />
Warner DS. Opioid management for intracranial tumor<br />
resection. Eur J Anesth 2000; 17 19S: 96-8.<br />
Warner DS, Petrozza P. Journal Club: J Neurosurg Anesth<br />
2000; 12: 62-69.<br />
Weissleder R, Moore A, Mahmood U, Bhorade R,<br />
Benveniste H, Chiocca EA, Basilion JP. In Vivo MR<br />
Veltkamp R, Warner DS, Domoki F, Brinkhous AD,<br />
Toole JF, Busija DW. Hyperbaric oxygen decreases<br />
infarct size and behavioral deficit after transient focal<br />
cerebral ischemia in rats. Brain Res 2000; 853: 68-73.<br />
Wellons JC, Sheng H, Laskowitz D, Mackensen GB,<br />
Pearlstein RD, Warner DS. A comparison of strainrelated<br />
susceptibility in two murine recovery models<br />
of global cerebral ischemia. Brain Res 2000; 868: 14-21.<br />
Welty-Wolf KE, Carraway MS, Ghio A, Kantrow SP, Huang<br />
YCT, Piantadosi CA. Pro-inflammatory cytokines increase<br />
in sepsis after anti-adhesion molecule therapy.<br />
Shock 2000; 13: 404-409.<br />
Wright D, Gan TJ. Do we need a measure of anesthetic<br />
depth? Current Anesthesiology Reports 2000; 2: 283-<br />
287.8.<br />
Young CC, Knudsen NK, Hilton AK, Reves JG. Sedation in<br />
the intensive care unit. Critical Care Medicine 2000; 28:<br />
854-866.<br />
Books<br />
PUBLICATIONS<br />
Gallagher CJ, Hill SE, Lubarsky DA. Board Stiff Too:<br />
preparing for the anesthesia orals. 2nd ed. Miami:<br />
Butterworth-Heinemann; 2000.<br />
Nebreda, CL, Urban BJ. Fields H, Scholz R, eds. Manual<br />
de Drogas Usadas en el Manejo del Dolor Cronico. Seattle<br />
WA: IASP Press; 2000.<br />
Book Chapters<br />
Booth JV, Schwinn DA. Sites of drug action. Hemmings<br />
H, Hopkins P, editors. Basic and applied science for<br />
anesthesia. Philadelphia: Mosby International; 2000.<br />
p. 65-72.<br />
Clements FM. Transesophageal echocardiography in<br />
minimally invasive cardiac surgery. Skarvan K,<br />
Poelaert J, editors. Transesophageal echocardiography<br />
in anaesthesia. London: BMJ; 2000. p. 242.<br />
Croughwell ND, Newman MF. Jugular bulb monitoring.<br />
Newman S, Harrison M, editors. The brain and cardiac<br />
surgery. Switzerland: Hardwood Academic Publishers;<br />
2000. p. 165-171.<br />
Dear GL, Panten RR, Lubarsky DA. Operating room information<br />
systems. Katz RL, Ward DS, editors. Seminars<br />
in Anesthesia, Perioperative Medicine and Pain.<br />
Philadelphia: WB Saunders Company; 1999. p. 322-333.<br />
(Omitted in the 1999 Annual Report publication<br />
section.)<br />
Garcia-Rodriguez CR, Hilton AK, Mark JB. Intraoperative<br />
hemodynamic monitoring. Willerson JT, Cohn JN, editors.<br />
Cardiovascular Medicine. 2nd ed. New York:<br />
Churchill Livingstone; 2000. p. 2116-2141.<br />
Grocott HP, Laskowitz DT, Newman MF. Markers of cerebral<br />
injury. Newman S, Harrison M, editors. The Brain<br />
and Cardiac Surgery. Switzerland: Hardwood<br />
Academic Publishers; 2000. p. 113-142.<br />
Mark JB, Slaughter TF, Reves JG. Cardiovascular monitoring.<br />
Miller RD, editor. Anesthesia. 5th ed.<br />
Philadelphia: Churchill Livingstone; 2000. p. 1117-<br />
1206.<br />
Moretti E. Handbook of surgical intensive care. Chapter<br />
23: Anesthesia and Analgesia. 5th ed. Mosby<br />
International Ltd; 2000. p. 415-432.<br />
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PUBLICATIONS<br />
Piantadosi CA. Altitude Illness. Encyclopedia of Life<br />
Sciences. 2000.<br />
Piantadosi CA. RL Harris, editor. Physiology of altered<br />
barometric pressure. Patty's Industrial Hygiene, Fifth<br />
Edition, John Wiley & Sons, Inc, 2000. Vol. 2, Chapter<br />
23: 985-1014.<br />
Piantadosi CA. The Brain. Pulmonary and Peripheral Gas<br />
Exchange in Health and Disease. Roca, Rodrigues-<br />
Roisin and Wagner, editors. 2000. 16: 435-445.<br />
Vann RD, Denoble PJ, Gerth WA. Reverse Dives and<br />
Project Dive Exploration. Reverse dive profiles workshop.<br />
Lang and Lehner, editors. Oct 29-30, 1999;<br />
Washington, DC, Smithsonian Institution; 2000.<br />
p. 181-187.<br />
Warner DS, Todd MM. Anaesthesia and the nervous system.<br />
Crockard A, Hayward R, Hoff JT, editors.<br />
Neurosurgery. Oxford UK: Blackwell Science; 2000.<br />
p. 557-571.<br />
Conference Papers<br />
Gan TJ. Current controversies in the management of<br />
PONV. Advances in anesthesia research and patient<br />
management. Luncheon Symposium in conjunction<br />
with IARS 74th Clinical and Scientific Congress; Mar<br />
13; 2000. p. 2-4.<br />
Gan TJ. New perspectives in the management of PONV.<br />
Key issues in outpatient and office-based anesthesia.<br />
An educational symposium held in conjunction with<br />
the Society for Ambulatory Anesthesia 15th Annual<br />
Meeting; May 4; 2000. p. 19.<br />
Gan TJ. Postoperative pain still major concern of patients<br />
undergoing surgery.American Society of Anesthesiologist<br />
Annual Meeting; Oct 14-18; San Francisco,<br />
California; 2000. p. 9-12.<br />
Hill SE. Blood product use and blood substitutes.<br />
Grichnik K, editor. Third Annual Duke University<br />
Medical Center Cardiothoracic Update; Jun 22-25;<br />
Kiawah Island, South Carolina; 2000. p. 38-42.<br />
Hall J, Schulman SR, Kern FH, Erb T. Comparing the incidence<br />
of postoperative nausea and vomiting in<br />
radiofrequency catheter ablation: propofol versus<br />
isoflurane. Duke University Medical Center:<br />
Department of Anesthesiology Academic Evening; May<br />
2; Durham, North Carolina; 2000. p. 33.<br />
142 PUBLICATIONS<br />
Hill SE. Oxygen therapeutics. Cheng D, Feindel C, editors.<br />
Blood conservation in cardiac surgery. Canadian<br />
Cardiovascular Congress Satellite Symposuim; Oct 28;<br />
Vancouver, British Columbia, Canada; 2000. p. 25-30.<br />
Klonin H, Henry J, Moses JW, Clark RL, Schulman SR.<br />
Ambient noise in pediatric intensive care. World<br />
Congress on Pediatric Intensive Care; June 27;<br />
Montreal, Quebec, Canada; 2000.<br />
Klein SM. Novel regional anesthesia techniques in ambulatory<br />
surgery. FASA Update Oct 28-31; San Fransisco,<br />
California; 2000. p. 1473-1478.<br />
Lanzinger MJ, Moretti EW, Wildermann RF, Toffaletti JG,<br />
Moon RE. Mechanisms of acute postoperative hypomagnesemia.<br />
Society of Critical Care Anesthesiologist<br />
Annual Meeting. Oct. 14; San Francisco, California;<br />
2000.<br />
Lockhart EM, Boustany RM, Penning DH. Progesterone<br />
increases cellular growth in human NT2 cells. Thirtysecond<br />
Annual Society for Obstetric Anesthesia and<br />
Perinatology Meeting; May 31-Jun 4; Montreal,<br />
Canada; 2000. p.13.<br />
Lockhart EM, Boustany RM, Penning DH. Effects of<br />
Allopregnanolone on NMDA-induced excitotoxicity.<br />
Society for Neuroscience Annual Meeting; Nov 4-7;<br />
New Orleans, Louisiana; 2000. p. 593.<br />
Olson RP. Preoperative anemia in out patient surgical<br />
candidates. American Society of Anesthesiologists<br />
Annual Meeting; Oct 14-18; San Francisco, California;<br />
Oct; 2000. p. 198.<br />
Panten R, Grichnik KP, Newman MF, Kastkis P, Landolfo<br />
KP. Initial experience with off-pump coronary artery<br />
bypass shows decreased intubation time, ICU stay and<br />
ICU/respiratory costs. European Society for Cardiovascular<br />
Anesthesia Meeting; June; Quebec, Canada;<br />
2000.<br />
Panten R, Grichnik KP, Newman MF, Kastkis P, Landolfo<br />
KP. Off pump coronary artery bypass, intubation<br />
times, and ICU stays. The International Minimally<br />
Invasive Cardiac Surgery Congress; June; Atlanta,<br />
Georgia; 2000.<br />
Reynolds JD, Punnahitananda S, Wang Y, Hopkins M,<br />
Dexter F, Penning DH. Blood ionized magnesium<br />
concentration in preterm fetal sheep increases during<br />
umbilical cord occlusion. Society for Obstetric<br />
Anesthesia and Perinatology Meeting 32nd Annual<br />
Meeting; May 31-Jun 4; Montreal, Canada; 2000.<br />
S(A15).
Robertson KM. Donor management. Proceedings of the<br />
12th World Congress of Anaesthesiologists; June 4-9;<br />
Montreal, Canada; 2000. p. 668-671.<br />
Robertson KM. Laparoscopic cholecystectomy and the<br />
heart transplant patient. Problem-based learning discussion<br />
casebook. American Society of Anesthesiologists;<br />
Oct 14-18; San Francisco, California; 2000.<br />
p. 1-6.<br />
Ross AK, Bailey AG, Bukowski T, Eck JB. Comparison of<br />
three concentrations of caudal ropivacaine for elective<br />
groin or lower abdominal surgery in the pediatric<br />
patient. Society for Pediatric Anesthesia. Feb 24-27;<br />
Fort Myers, Florida; 2000. p. 133.<br />
Schultz JR. Does the PCEA Technique Reduce the<br />
Number of Physician-Administered “top-ups” required<br />
to maintain analgesia during labor? Thirty-second<br />
Annual Society for Obstetric Anesthesia and Perinatology<br />
Meeting; May 31-Jun 4; Montreal, Canada; 2000.<br />
p.12.<br />
Invited Articles<br />
Gan, TJ, Bennett-Guerrero E, Mythen M. Excessive use<br />
of hetastarch: an iatrogenic cause of bleeding and<br />
hypocalcemia? (response letter). Anesthesia and<br />
Analgesia 2000; 90: 1455-1456.<br />
Klein SM, Benveniste H. In reply [letter]. Reg Anesth Pain<br />
Med 2000; 25: 104.<br />
Klein SM, Greengrass RA, Steele SM, Grant SA, Nunley JA.<br />
Major ambulatory surgery with continuous regional<br />
anesthesia and a disposable infusion pump. In Reply<br />
[letter]. Anesthesiology 2000; 93: 582-3.<br />
PUBLICATIONS<br />
Kwatra MM. Cognitive function after non-brain surgery<br />
studied: second Duke conference on surgery and the<br />
elderly. (ASA Newsletter) 2000; 64(5): 10-11.<br />
Mythen M, Gan TJ. Intraoperative plasma volume optimization<br />
and postoperative outcome. (special report).<br />
Anesthesiology News 2000; 1-7.<br />
Ross AK. Lumbar epidurals should be performed in children<br />
under general anesthesia. (newsletter). Society<br />
for Pediatric Anesthesia 2000; 13: 10-12.<br />
Warner DS. Editorial Comment. Stroke 2000; 31: 191-192.<br />
Warner DS. Isoflurane neuroprotection: A passing<br />
fantasy, again? (editorial) Anesthesiology 2000; 92:<br />
1223-1225.<br />
Warner DS. Neuroanesthesia 2000 [editorial]. Anesth<br />
Analg 2000; 90: 1238-1240.<br />
Rosemary Cumbie Edward Cousineau<br />
PUBLICATIONS 143
144
145
HISTORY <strong>OF</strong> THE <strong>DEPARTMENT</strong> <strong>OF</strong> <strong>ANESTHESIOLOGY</strong><br />
Like many American Departments of Anesthesia, the roots of the current Department lay in nurse anesthesia.<br />
In fact, from 1930 to 1944 all anesthesia at Duke was administered by nurses under the supervision of surgeons.<br />
Duke had one of the first schools of nurse anesthesia, begun in 1931 and pioneered nurse anesthesia education<br />
by extending the duration of education to two years in 1966. Dr. Ruth Martin was recruited as the first physician<br />
anesthetist in 1944 and she was succeeded in 1950 by the brilliant and energetic leader of anesthesia, Dr Ronald<br />
Stephen from Canada. During the Stephen years, the anesthesia residency flourished, as did clinical research.<br />
The residency grew from a number of 3 to 16 when Dr. Stephen left Duke in 1966.<br />
The Division of Anesthesia of the Department of Surgery became an independent academic Department of<br />
Anesthesia in 1968 under the guidance of Dr. Sarah Dent. In 1971, the distinguished professor and Chairman of<br />
Anesthesia at New York Downstate Medical Center and at the Pritzker School of Medicine in Chicago, Dr. Merel H.<br />
Harmel was recruited to Duke to continue to develop the young Department. The Department grew in quality and<br />
quantity with the addition of faculty and residents as well as the inauguration of a basic science research program.<br />
Clinical programs also were developed during this time with new programs in critical care medicine, hyperbaric<br />
medicine and pain management. Dr. Harmel retired from the chairmanship in 1983 and was followed by Dr. W.<br />
David Watkins who was recruited from the Harvard system. Dr. Watkins emphasized a strong residency program<br />
and increased the size from 29 to 50 residents in the seven years of his leadership. The Department continued to<br />
play an important institutional role boasting the Clinical Director of the Hyperbaric Medicine Center, Director of the<br />
Pediatric Intensive Care Unit, Co-Director of the Surgical Intensive Care Units at the VA and Duke Hospitals, and<br />
Director of the Duke Heart Center. Research also continued to expand as reflected by additional Ph.D. faculty and<br />
the award of multiple outside grants.<br />
The Department is now led by Dr. Jerry Reves, a cardiac anesthesiologist, whose plans include the development<br />
of stronger subspecialty anesthesia programs, creation of more fellowships, and emphasis of research in molecular<br />
pharmacology, neurobiology, and clinical pharmacology. With steady progress through the years, the Department<br />
is now poised to be one of the very few centers of academic excellence in the field of anesthesiology. All the<br />
requirements are in place: an outstanding well organized residency education program, a large and diverse clinical<br />
case load of over 35,000 operations and deliveries, superb facilities, solid research base, a first-rate Department of<br />
Surgery with which to work closely, and a Medical Center Administration committed to an Anesthesia Department<br />
of the highest order. This is probably the most exciting time in the entire history of Duke Anesthesia.
Rosemary W. Cumbie<br />
Special Assistant,<br />
Clinical Programs<br />
Editor<br />
EDITORIAL STAFF<br />
Eris Joffe<br />
Staff Assistant<br />
Assistant Editor<br />
The editorial staff appreciates the helpful support of J.G. Reves, M.D., each physician,<br />
and support staff for their contribution(s) to this successful report.<br />
Lou Ellen Andrews<br />
Elizabeth Barbee<br />
Patsy Clifton<br />
Rosemary Cumbie<br />
Emily Coburn<br />
Tammy Evans<br />
Carmen Hurst<br />
Larry Dowell<br />
Tammy Evans<br />
Jessica Harris<br />
Linda Harris<br />
Malissa Harris<br />
COORDINATORS<br />
Photographs<br />
Lectures<br />
Tonya Meadows<br />
Richard Moon<br />
Julie Rosato<br />
Beverly Hester<br />
Gloria Howard<br />
Carmen Hurst<br />
Wanda Johnson<br />
Karen Ramsey<br />
Kimberly Westbrooks<br />
Connie Winstead<br />
Patti Yetsko<br />
Cases by Divisions/Sections Grant Ranking<br />
William Gilbert Patricia Cruse<br />
Institutional Review Board Research Grants and Anesthesiology Research Dollars<br />
T.J. Gan Patricia Cruse<br />
Angela Rogers<br />
Departmental Committees, Clinical Divisions and Sections, Laboratory Programs,<br />
Publications, Duke Faculty Chairs, ASA Alumni Reception, Division Chiefs and Committee Chairpersons<br />
Rosemary Cumbie<br />
Eris Joffe<br />
FRONT AND BACK PHOTOGRAPHY<br />
Ronald L. (Butch) Usery, Division of Audiovisual Education<br />
Shery Strickland<br />
Helen Trotter<br />
Pamela Upadhaya<br />
Patti Yetsko
Department of Anesthesiology<br />
Duke University Medical Center<br />
DUMC-3094<br />
Durham, NC 27710<br />
(919) 681-6646<br />
Fax (919) 681-2923