2011 BluePrint by Duke Anesthesiology

DUKE

DEPARTMENT OF ANESTHESIOLOGY

1971-2011

A distinguished past,

an exciting future...

BLUE PRINT Volume 3

2012

40th Anniversary Edition Editors Lauren Marcilliat Ratna Swaminathan Elizabeth Perez, RN, BSN David S. Warner, MD Joseph Mathew, MD, MHSc

Writer Lauren Marcilliat

Photography Elizabeth Perez, RN, BSN DUMC Archives Jared Lazarus Lauren Marcilliat Duke Anesthesiology faculty, staff, and family Donny Lofland

Art director Elizabeth Perez, RN, BSN

Website editor Elizabeth Perez, RN, BSN Lauren Marcilliat

Prepress Elizabeth Perez, RN, BSN Lauren Marcilliat

Print production Anesthesia Alumni Development & Affairs

Special thanks to DUMC Archives Duke Anesthesiology Executive Team Duke Anesthesiology faculty, staff, and family Duke Anesthesiology Senior Cabinet Duke Photography

Contact information BluePrint Magazine Anesthesia Alumni & Development Affairs DUMC 3094, MS #48 Durham, NC 27710 blueprint@duke.edu

Social Media Facebook: http://www.facebook.com/DukeAnes Twitter: Duke_Anesthesia

CONTENTS 8

Legendary Leaders

Our Distinguished Past 15

A Day in the Life: 1955

Duke Anesthesiology Off-Site 50

A Memoir Written by Dr. C. Ronald Stephen 16

Exploring New Frontiers

Fortieth Anniversary Reflections

Fine-Tuning

TEE at Duke

Changing Our World

DREAM Big. Think Big. Live Big. The Duke DREAM Campaign

A Memoir Written by Dr. Fiona Clements 23

Enriching Our Future Research in the Department of Anesthesiology

The Otolaryngology, Head, Neck, and Neuroanesthesiology Division 22

The Development of the Human Pharmacology Lab A Memoir Written by Dr. Peter S.A. Glass

A Memoir Written by Dr. Merel H. Harmel 20

Education: Bigger and Better Education in the Department of Anesthesiology

The Center for Hyperbaric Medicine and Environmental Physiology 19

Reaching Out

Career Reflections A Memoir Written by Dr. Joannes “Hans” Karis

The Next Forty Years of Duke Anesthesiology

DREAM Campaign Lifetime and 40th Anniversary Donors

The Cardiothoracic Division 27

My Memories of Duke A Memoir Written by Dr. Joseph “Jerry” Reves

Serving Those Who Have Served The Durham Veterans Affairs Anesthesiology Service

A Whole New Ball Game Duke Pediatric Anesthesiology

Memories of Duke A Memoir Written by Dr. Debra A. Schwinn

Class Notes

Juggling Act The General, Vascular, High-Risk Trauma, Transplant, and Surgical Critical Care Medicine Division

High Risk, High Reward, and in High Demand The Division of Women’s Anesthesia

Painless Progress The Division of Pain Management

Practice Makes Perfect The Orthopedics, Plastics, and Regional Anesthesiology Division

Passionate Change, Compassionate Care The Ambulatory Division

legacy of leadership; pioneering new technology; groundbreaking research; an emphasis on developing the careers of others; a relentless pursuit of excellence; and an inspiring vision for how things should be. Slowly but surely, the story of this department began to take shape. The process was both challenging and highly rewarding. It allowed for selfreflection and a unique insight into ways that we can improve going forward. It provided us with a priceless opportunity to reminisce and reconnect with alumni and former faculty as we heard our story told by many different voices and from countless perspectives.

Piecing together a publication in honor of the 40th Anniversary of our department was a year-long process. Hours were spent reconstructing the story of the department’s history, rummaging through dusty old annual reports, sorting through piles of blackand-white photos and film, and interviewing current and former department leaders. In addition to our rich past, however, we wanted to capture who we are today and, more importantly, who we will become tomorrow. As we examined our past, we identified common themes and character traits that we hope to maintain over the next 40 years. These themes include: a

You have received this publication because you are a part of the Duke Anesthesiology family. Whether you are current faculty or staff, a current trainee, an alumnus or alumna, a former faculty member, or simply a supporter of this program, you are a part of our legacy. On behalf of this department, I thank you for the role that you have played in our past growth and development. You are responsible for our current

success. It is my fervent hope that you will continue to play a strong role in our future. It is remarkable to think that Duke Anesthesiology began with fewer than 40 individuals. Today, I lead a department of over 500 people. It is truly astounding what this team has accomplished, and yet, the most exciting part about this department is the direction in which we are headed. Our future could not be brighter. I am proud to have the opportunity to compose a chapter in the ongoing story of this department. Join us in celebrating who we were, who we are, and who we will someday become. Sincerely,

Mark F. Newman, MD Merel H. Harmel Professor of Anesthesiology and Professor of Medicine Chair, Department of Anesthesiology

Duke Anesthesiology Faculty, 2011

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Duke Anesthesiology Faculty, 1961

Our Mission: Extraordinary care through a unique culture of innovation, education, research, and professional growth.

Duke Anesthesiology Faculty, 1980

Duke Anesthesiology Faculty and Staff, 1994

Left To Right: Drs. Joseph “Jerry” Reves, Merel H. Harmel, and Mark F. Newman (Chair)

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Legendary Leaders Our Distinguished Past

When James B. Duke decided to establish a university to rival the finest institutions in the nation, he faced a number of difficult decisions. Surprisingly, one of the decisions that plagued him the most was determining what type of stone should be used to construct the buildings. He wanted an antique, yet artistic look that would distinguish the university and set it apart from others. After scouring the nation, he finally settled on a local stone called “bluestone,” which occurs naturally in seven primary colors and seventeen different shades. Today, Duke University’s lovely gothic architecture is one of its most unique features. However, stone, wood, and brick and mortar alone do not make a university great. Rather, it is the people who have studied and worked inside of these walls who have made James B. Duke’s dream a reality. As the Department of Anesthesiology celebrates 40 years of history, recognizes current accomplishments, and looks to the future of the department, we pay homage to the unique blend of people, who form Duke Anesthesiology’s legacy of excellence and who are even more colorful and diverse than Duke University’s prized bluestone. Like the university itself, the department’s story begins with a strong foundation laid by men and women with great vision. Breaking Ground—C. Ronald Stephen, MD & Sarah J. Dent, MD: 1950-1971 Like many American anesthesiology departments, Duke’s Department of Anesthesiology began as a division of the Department of Surgery. In the mid-1940s as

World War II came to an end, the role of the anesthesiologist was redefined as military physicians returning home from the frontlines introduced more sophisticated intravenous and regional anesthetics to the civilian population. Anesthesiologists across the country called for a movement to establish independent anesthesiology departments at academic institutions. The first person to attempt this at Duke was C. Ronald Stephen, MD, who served as chief of the Division of Anesthesiology in the Department of Surgery for 16 years. During his tenure, Dr. Stephen recruited an excellent team of physicians, encouraged greater activity in clinical research, and established a residency program. In 1965, he made a highly controversial proposal: the successful anesthesia division should

Anesthesiology with the support it needed, Duke University School of Medicine agreed to create an independent Department of Anesthesiology in 1970. The young depar tment was placed under the leadership of one of Dr. Stephen’s former trainees, Sarah J. Dent, MD, who served as acting chair until a permanent chair could be recruited. Laying the Foundation— Merel H. Harmel, MD: 1971-1983 No one can appreciate our 40th Anniversary quite like Merel H. Harmel, MD. He has been a part of the Duke Anesthesiology family throughout our entire 40 years of existence. Dr. Harmel was recruited to Duke in 1971 to serve as chair of the newly created Department of Anesthesiology. Now in his 90s, he continues to give a lecture to Duke Anesthesiology faculty

...Duke Anesthesiology is undoubtedly one of the most respected departments of anesthesiology in the world. become an independent department. When the administration repeatedly refused his request, he resigned. The controversy surrounding Dr. Stephen’s resignation did significant damage to the division’s morale. Over time, the faculty dwindled, the residency program collapsed, and the division’s research became almost non-existent. To provide the Division of

and trainees on the history of anesthesiology every year without fail. Like Dr. Stephen, the young Dr. Harmel was determined to play his part in developing anesthesiology into a distinct and valued specialty within the surgical landscape. Before he came to Duke, Dr. Harmel had already founded two esteemed anesthesia departments at the State University of New 11

Above: Dr. Mark F. Newman, chair of Duke Anesthesiology, followed by Drs. Joseph “Jerry” Reves, W. David Watkins, and

Merel H. Harmel, former chairs, and Dr. Sarah J. Dent, interim chair

York (SUNY) Downstate Medical Center and the University of Chicago. This unique experience proved crucial to his success at Duke. Upon his arrival, Dr. Harmel was provided with a team of six physicians, twelve student nurses, approximately fifteen graduate nurses, and $250,000 with which to create an academic department on a par with the leading anesthesiology departments in the nation. Dr. Harmel met this challenge by establishing a firm foundation for the department in three primary areas: clinical care, education, and research. Perhaps Dr. Harmel’s most significant contribution, however, was the Duke Automatic Monitoring Equipment (DAME) system. Shortly after his arrival, Dr. Harmel recruited a physician scientist named David A. Davis, MD. Assisted by a bright young engineering technician named Larry Dowell, Dr. Davis experimented with telemetry and monitoring anesthetic depth using the electroencephalogram and the electromyogram. Dr. Davis created a successful four-channel telemetry monitoring system, which sparked Dr. Harmel’s interest in isolating physiological elements of anesthetics. As a result, Dr. Harmel recruited Joannes H. Karis, MD, two post-doctoral engineers, Larry Burton, PhD and Marc Rafal, PhD as well as Fritz Klein, PhD, from the Department of Electrical Engineering, and Frank Block, Jr., MD, to create a computer-based monitoring network. This network, which became known as the DAME, was the first computerized monitoring system in the world to produce an objective record of vital signs. This type of system, which was about 20 years ahead of its time, is now standard of care in the operating room. As a result of this and other similar innovations, such as the microDAME and ARKIVE, Duke Anesthesiology is now internationally recognized as a pioneer in monitoring and informatics. Even though technology has changed remarkably in the past 40 years, Duke’s reputation for pioneering new technology has not. There are some habits you just can’t kick. Just ask that young engineering technician, Larry Dowell. Thirty-five years later, he still enjoys working in the department as director of information systems.

Growing a Special Charm—W. David Watkins, MD, PhD: 1983-1990 In 1983, W. David Watkins, MD, PhD, was appointed chair. He held this position until 1990. During his tenure, the department attracted several faculty members from other parts of the country and became much more diverse. Dr. Watkins encouraged greater sub-specialization within the department and created several new leadership positions. “We were able to complete programs individually and pursue direct interests,” writes former faculty member Enrico Camporesi, MD, in a 1989 editorial for the department’s Annual Report. “The extensive contacts which Dr. Watkins allowed me to maintain, and which he supported, stimulated my growth and personal confidence. After visiting several programs around the country, I realized that Duke University’s Department of Anesthesiology had grown a special charm,” he adds. Another major change during this time was a dramatic growth in Duke University’s patient population. “Never in our history have we provided anesthetic care for as many, and such complicated patients,” writes Dr. Watkins in the 1987 Annual Report. “Importantly, in the process of expanding the quantity of patient care, we have assumed more thoughtful and mature approaches to the quality of our care. This emphasis on quality is reflected primarily in the growing pride and enthusiasm of our people— our major resource.” Dr. Watkins is best known for establishing bench research in the department. The Anesthesia Analytical Laboratory, directed by Mike Su, PhD, and the F.G. Hall Laboratory, directed by Peter Bennett, PhD, DSc, were integral to this effort. Dr. Watkins was actively engaged in several basic science experiments while serving as chair until he left Duke in 1990 and joined the University of Pittsburgh.

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Left: Drs. Mark Rogers, Merel H. Harmel and W. David Watkins Center: Drs. David C. Sabiston, Jr., Harmel, Ralph Snyderman, Reves, and Robert “Bob” Anderson Right: Drs. Newman and Reves

Focusing on the Outcome—Joseph “Jerry” Reves, MD: 1991-2001 Following Dr. Watkins’ departure, Joseph “Jerry” Reves, MD, became department chair. “During his remarkable tenure, Dr. Reves brought the department to its current place amongst the most distinguished departments in the nation,” wrote Dr. Harmel in 2003 in a historical account of the department. At Duke, where he served as chief of the Cardiac Division, director of the Duke Heart Center, and chair of the Department of Anesthesiology, Dr. Reves earned a reputation for challenging others to explore new ways to improve patient care. Under his leadership as chief of the Cardiac Division, Duke cardiac anesthesiology grew to international acclaim. As director of the Heart Center, Dr. Reves was instrumental in shaping and implementing the multidisciplinary model of cardiac perioperative care, which has become the standard for the entire country. When he became chair of the Department of Anesthesiology in 1991, he continued to encourage others to explore new ways to advance the field. “Sometimes you have to drag a department kicking and screaming to get to another level of quality and academic excellence,” recalls former resident and former faculty member Helene Benveniste, MD. “It takes a lot of guts and tenacity, which is what Dr. Reves has.” Dr. Reves encouraged Duke Anesthesiology faculty members to develop their individual niches and focus their careers on gaining international exposure in areas that interested them. Helping to develop the careers of others gave him great joy. His departure from Duke in 2001 was inspired not only by the opportunities that awaited him in Charleston, South Carolina,

where he assumed the role of dean and vice president for medical affairs at The Medical University of South Carolina (MUSC), but an eagerness to give someone else a chance to lead the department—a physician scientist by the name of Mark F. Newman, MD. Building a Legacy—Mark F. Newman, MD: 2001 to present Mark F. Newman, MD, Merel H. Harmel Professor of Anesthesiology and professor of medicine is a pioneer in the field of perioperative neurologic research. He discovered this passion while completing his fellowship here under the mentorship of Dr. Reves and James Blumenthal, PhD. He went on to play a significant role in defining the now widely accepted demographic, procedural, and genetic risk factors for cognitive dysfunction after surgery. After completing his fellowship, Dr. Newman spent a number of years in the Air Force, where he honed his leadership skills and gained an appreciation for the importance of contributing to the greater good. Like many Duke Anesthesiology alumni, Dr. Newman came back to Duke to do just that. He joined the faculty in 1992 as an assistant professor. By 1994, he was named chief of the Cardiac Division, where he was able to pursue research in neurological outcomes. By the time Dr. Newman became chair of the department in 2001, Duke Anesthesiology had developed an international reputation for excellence. He could have been content to simply sit back and enjoy the ride. Instead, he immediately set out to build an even stronger department.

Working with a multidisciplinary team, Dr. Newman has initiated a highly successful Perioperative Genomic Group that collects valuable information about the genetics and mechanisms behind perioperative organ injury in order to improve safety and outcomes after surgery and anesthesia. Furthermore, he has established an innovative mentorship program designed to support and develop faculty from the moment they enter the department. Always mindful of the department’s future success, Dr. Newman has placed a strong emphasis on development. He has successfully created five new endowed professorships through philanthropy and sound financial management. Another area of major emphasis has been on expanding the department’s educational program. To accomplish this, he created the Academic Career Enrichment Scholars (ACES) program, which equips outstanding clinicians with the skills and experience necessary for successful careers in academic anesthesiology. Dr. Newman hopes that training leaders in anesthesia around the world will become a legacy of the department. Thanks to Dr. Newman and the leaders who preceded him, Duke Anesthesiology is undoubtedly one of the most respected departments of anesthesiology in the world. With four decades of success behind us, our department continues to flourish under Dr. Newman’s leadership. The following pages will pay tribute to the department’s distinguished past by touching on each division in the department today, and highlighting their individual histories. What we hope you will take away from this story, however, is not simply a sense of pride in our remarkable past, but a spirit of excitement for our promising future. DUKE

1950’s

1970’s

1952: The Duke Inhaler, a hand-held inhaler for self-administration, is created. Those involved in its creation include Drs. C. Ronald Stephen, Leo Fabian, Kenneth Hall, Bill Nowill, Michel Bourgeois-Gavardin, George Margolis, and Mr. George Newton (a local machinist). 1956: Dr. C. Ronald Stephen and his team (notably Drs. Leo Fabian, Kenneth Hall, Michel Bourgeois-Gavardin, George Margolis, and William North) introduce nonflammable volatile Halothane to clinical anesthesia.

1980: Duke Anesthesiology implements the Duke Automatic Monitoring Equipment (DAME) recordkeeping system.

1956: The FNS (Fabian, Newton, Stephen) Vaporizer for the administration of Fluothane is created.

1980: Dr. Peter Bennett initiates the Diver’s Alert Network (DAN).

1961: Drs. Herbert A. Ferrari and C. Ronald Stephen introduce Innovar (Fentanyl/Droperidol) as “Neuroleptic Anesthesia.”

1981: During the Atlantis III experiment in the F. G. Hall Laboratory, Duke Anesthesiology physician scientists break the world record when they successfully send three volunteer divers to a depth of 2,250 feet.

1962: Dr. C. Ron Stephen begins a series of Ketamine (CI-581) clinical trials with Drs. Sarah J. Dent and Kenneth Hall. Dr. Stephen was first to promote its human administration as a single anesthetic agent with unstable vascular patients.

1983-1991: Dr. W. David Watkins serves as department chair.

1964: Dr. E Warner Ahlgren begins clinical trials of ventilatory support of premature infants with Respiratory Distress Syndrome. The Bird Ventilator ultimately led to the development of the Baby Bird Ventilator, which became the gold standard for neonatal ventilators.

1984: Duke University Medical Center performs the first liver transplant in the Southeast.

1980’s

1960’s

1963-64: Investigations of carotid endarterectomy and open-heart surgery under general anesthesia with hyperbaric oxygen begin.

1970’s

1978: Duke Anesthesiology establishes a separate Veteran’s Affairs Anesthesiology Service at the Durham Veteran’s Affairs Medical Center, becoming the fourth department in the country with this type of relationship to a VAMC hospital.

1984: TEE, transesophageal pacing, and automated continuous infusion of opioids are first used at Duke.

1965: Dr. Johannes Arnold Kylstra conducts liquid breathing experiments in rats and other animals, and earns national acclaim.

1984: Dr. Jerry Reves spearheads the creation of the CACI (Computer Assisted Continuous Infusion) system.

1968-1971: Dr. Sarah Dent serves as an interim chief for the anesthesiology division and then interim chair for the anesthesiology department beginning in 1970.

1985: The first studies of the effects of heavy exercise on pulmonary hemodynamics and gas exchange are conducted under simulated altitude conditions in a hypobaric chamber in the F.G. Hall Laboratory.

1970: The first liquid breathing experiment is performed on a human volunteer at Duke.

1986: The F.G. Hall Laboratory becomes an academic center called the Center for Hyperbaric Medicine and Environmental Physiology.

1971-1983: Duke’s Department of Anesthesiology is created, and Dr. Merel H. Harmel is appointed as its first chair.

1986: The Orthopedics Division uses patientcontrolled analgesia for the first time.

1989: An Epidural Opioid Service is introduced for inpatients.

2000: Ultrasound is first used in the administration of peripheral nerve blocks at Duke.

2004: A live filming of patients undergoing regional anesthesia for ambulatory surgery at Duke University was viewed at the annual meeting of the Society for Ambulatory Anesthesia (SAMBA).

2000: A Duke research team publishes a study revealing that 40 percent of patients undergoing coronary artery bypass surgery suffer from measurable cognitive decline five years after surgery.

2004: Dr. Lisa Wise-Faberowski identifies a “critical at-risk period” in the developing brain of the fetus when exposed to various anesthetic agents.

1991-2001: Dr. Jerry Reves serves as department chair.

2001: The Human Simulation and Patient Safety Center is created.

1992: Duke Anesthesiology coins the term “context-sensitive half-time.”

2002: The Ambulatory Surgery Center performs one of the first ambulatory joint arthroplasty procedures.

2008: Dr. Mark Newman is named the National Principal Investigator for Schering-Plough Research Institute’s RED-CABG Trial—the largest perioperative trial ever conducted to reduce mortality and stroke in cardiac patients.

2008: Dr. Terri Monk publishes a landmark study in Anesthesiology titled “Predictors of cognitive dysfunction after major noncardiac surgery.”

2005: Drs. Mihai Podgoreanu and Debra Schwinn publish a paper on perioperative genomics identifying genetic and molecular determinants that can identify increased risk for postoperative cardiovascular adverse events.

2008: Dr. Mihai Podgoreanu receives the American Society of Anesthesiologists Presidential Scholar Award.

2005: The Jerry Reves Professorship Campaign is launched.

2005: The first ever studies of the pulmonary arterial pressure response to immersed exercise are performed to understand mechanisms of hypercapnia and immersion pulmonary edema.

2002: Duke Anesthesiology becomes one of only six anesthesiology departments in the U.S. to receive a NIH Training Grant to train fellows and medical students as physician scientists.

2005: Dr. David S. Warner is the recipient of the American Society of Anesthesiologists Excellence in Research Award.

1994: Dr. Roy A. Greengrass employs paravertebral block for mastectomy, thereby revolutionizing breast surgery.

2002: Duke Anesthesiology defines the impact of postoperative atrial fibrillation on neurocognitive outcome after coronary artery bypass graft surgery.

2006: Dr. Iain Sanderson invents ORView, an innovative anesthesiology record-keeping software, and wins the ComputerWorld Honor Program’s 21st Century Achievement Award for Medicine.

1997: Drs. Roy Greengrass and Susan Steele, and CRNA David Gleason, created the Duke-Braun continuous catheter system.

2002: Efficacy of statins in treatment of subarachnoid hemorrhage is discovered in the Multidisciplinary Neuroprotection Laboratories.

2007: Duke Anesthesiology becomes one of the first departments in the nation to establish a formal relationship with a community hospital through affiliation with Durham Anesthesia Associates and Durham Regional Hospital.

1998: Duke first begins using continuous peripheral nerve block catheters.

2003: Dr. Tong Joo “TJ” Gan and his team collaborate with a panel of international experts to publish Postoperative Nausea and Vomiting Management Consensus Guidelines that have become an international standard of care.

2007: The Duke DREAM Campaign, a philanthropic program that supports the department’s research initiatives, is launched.

1998: The Ambulatory Surgery Center becomes the first center in the U.S. to equip patients with a home catheter infusion system for the management of postoperative pain.

2004: Dr. Scott Schulman receives one of the largest grants ever awarded by the NIH for evaluating drug safety in children: a $5.1 million grant to study the efficacy and safety of sodium nitroprusside in children.

1993: A team led by Dr. Peter S.A. Glass takes on the first human administration of remifentanil.

2008: The Academic Career Enrichment Scholars (ACES) program begins.

2009: Duke Anesthesiology becomes one of the first departments to extend TEE training to noncardiac anesthesiologists as part of the fellowship training experience.

2008 – 2010

2001-present: Dr. Mark Newman serves as department chair.

2000 – 2004

1990: Dr. Richard E. Moon discovers the cause and prevention of carbon monoxide formation in anesthesia circuits.

2004 – 2007

1980’s

2000: Dr. G. Burkhard Mackensen is the winner of the American Society of Anesthesiologists Resident Research Contest.

1990: Dr. Debra A. Schwinn discovers, clones, and characterizes the alpha 1-a receptor.

1990’s

2004: Dr. Catherine Kuhn becomes the first anesthesiologist in the nation to receive the Parker J. Palmer Courage to Teach Award from the Accreditation Council for Graduate Medical Education (ACGME).

1987: Drs. Fiona Clements and Norbert DeBruijn write the first manual for intraoperative TEE in anesthesiology.

2010: Duke Anesthesiology’s Pain Management Division is the first in the state and one of the first in the nation to offer a new procedure called percutaneous neuroplasty to patients with spinal stenosis and failed back surgery.

2010: Duke Anesthesiology’s research in phenylephrine infusion for blood pressure control results in the widespread use of this drug in obstetrics.

2007: Dr. Debra A. Schwinn receives the American Society of Anesthesiologists Excellence in Research Award.

Over 40 Years of Innovation and Excellence

DONNY LOFLAND

A Day in the Life: 1955 By C. Ronald Stephen, MD

In 1955, I was a Professor of Anesthesia and Head of the Division of Anesthesia at Duke University Hospital. In the division were several staff anesthesiologists, including Drs. Martin, Fabian, Hall and North, and a similar number of residents in training. All patients having elective surgery were admitted to the hospital at least one day prior to the operation. Each patient was seen the day before surgery by a staff anesthesiologist and a resident and plans made for the anesthesia the next day. The anesthetic drugs used in 1955 included thiopental, divinyl ether, nitrous oxide, cyclopropane, ether, succinylcholine, and d-tubocurare. Two potential difficulties were associated with these drugs: â&#x20AC;˘ The surgeries were limited in the use of the cautery because both cyclopropane and ether were explosive. â&#x20AC;˘ Nausea and vomiting postoperatively occurred in 20 to 25 percent of patients. An investigation was conducted in the use of Marezineâ&#x201E;˘ to reduce the incidence of vomiting. In this study, Marezine appeared to reduce the incidence by about 25 percent. Chlorpromazine also was evaluated in a study but was not found to be of value for this purpose. Clinical space for laboratory studies had been sorely needed for conducting research in anesthesia. Three years prior to 1955, in 1952, trichlorethylene had been evaluated as an analgesic to relieve the pain of labor. It had been found to be very useful, and a trilene inhaler was made so that patients could administer this drug to themselves as required for pain. A total of 50,000 of these inhalers were sold in the country, and they had been found to be useful. A sum of $2 in the sale of each inhaler was allocated to increase laboratory space in the division of anesthesia. Clinical lectures were held three times a week for the residents on a variety of anesthesia-related topics and to help to establish

where further studies might be appropriate. The actual teaching of the residents, however, occurred at the head of the table in the operating room while the resident was administering anesthesia under the care and supervision of a staff anesthesiologist. It was found to be important for the resident anesthesiologist to maintain a close watch not only on how the patient fared but on how the surgical operation progressed. In the mid 1950s, a new suite of operating rooms was opened, and directly adjacent to it was a 10-bed recovery room for which the Division of Anesthesia was responsible. Staffed by excellent nurses, this recovery area proved to be a great boon in the safe care of patients in the immediate postoperative period. One of the studies conducted in our expanded laboratory space concerned research in animals of a long-lasting depo-type of local anesthesia, which was called efocaine. The local anesthesia in this compound was procaine, and the solvents were propylene glycol and polyethelyene glycol. Such a compound provided excellent long-lasting local anesthesia, but it was found that the solvents themselves provided such anesthesia and, in some instances, damaged the tissue around which the compound had been placed. Further study of this compound was not undertaken. In 1955, little did we realize the tremendous changes that would occur in 1956 and future years by the introduction of halogenated anesthetics. DUKE This article is reprinted from a 2005 special commemorative issue of the ASA Newsletter with permission from the American Society of Anesthesiologists. PHOTO COURTESY OF VIVIEN WEBB

LAUREN MARCILLIAT

Exploring New Frontiers The Center for Hyperbaric Medicine and Environmental Physiology

Left To Right: Drs. Claude A. Piantadosi (Director), Ivan Demchenko, Richard E. Moon (Medical Director), Herbert Saltzman, John ”Jake” Freiberger, and Peter Bennett Not Pictured: Drs. Terrence Allen, Guy De Lisle Dear, Bryant “Bret” Stolp, and Hagir Suliman Opposite Page: Dr. Frank Gregory Hall in an altitude chamber with Dr. William “Bill” McLain, a former medical student, who is wearing one of the original pressure suits worn by aviators in WWII

It is impossible to recount the history of Duke Anesthesiology without mentioning The Center for Hyperbaric Medicine and Environmental Physiology (CHMEP). The histories of these two entities are undeniably linked. The CHMEP played a significant role in shaping and defining Duke Anesthesiology as a department, and consequently, in defining the numerous divisions that have been established over time. Perhaps even more importantly, the exciting work being done at the CHMEP today will play a significant role in defining both our future as a department, as well as the future potential of human exploration. A multidisciplinary facility, the CHMEP conducts research and provides clinical services to patients in need of pressure and oxygen as a form of treatment. The CHMEP was established as an academic center in 1986. Prior to 1986, hyperbaric and physiological research was limited to the F.G. Hall Laboratory, which is still a part of the CHMEP today. The F.G. Hall Laboratory was created in 1963 with funds provided by the National Institutes of Health (NIH). It began as a chamber complex with the ability to simulate pressure ranging from depths of 1,000 feet of seawater to 100,000 feet of altitude. When Merel H. Harmel, MD, arrived at Duke in 1971 to chair the newly created Department of Anesthesiology, he was disappointed to learn

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Together, Drs. Saltzman and Harmel recruited a bright young man from England, Peter Bennett, PhD, DSc, to serve as Duke Anesthesiology’s first director of research and co-director of the hyperbaric program. One of Dr. Bennett’s first goals was to strengthen the lab’s financial support. The best way to do this was to develop a strong clinical component to attract support from commercial and government agencies. With that goal in mind, Dr. Bennett recruited additional world-class physicians including Lennart Fagraeus, MD, Enrico Camporesi, MD, John Miller, MD, Richard E. Moon, MD, CM, MSc, FRCPC, who now serves as medical director, and Claude A. Piantadosi, MD, current director of the CHMEP. As a result of this collaborative effort, the laboratory’s funding increased tenfold. In 1980, Dr. Bennett founded the Divers Alert Network (DAN), an emergency hotline for recreational divers, now a $16 million non-profit organization. This increased financial support helped bolster the lab’s research initiatives, which had already gained international acclaim. The F.G. Hall Laboratory’s earliest experiments focused on mechanisms of anesthesia and deep diving physiology. At that time, ocean exploration was severely limited because of nitrogen narcosis and High Pressure Nervous Syndrome (HPNS). Both effects are caused by extreme pressure on the human body.

COURTESY OF DUMC ARCHIVES

that the department had no laboratory and, consequently, no research activity. At that time, the F.G. Hall Laboratory was affiliated with the departments of surgery and medicine, and was under the direction of Herbert Saltzman, MD. Soon after Drs. Saltzman and Harmel were introduced, they realized that the Department of Anesthesiology would be an ideal sponsor for the laboratory and would provide the fledgling department a turn-key facility with a well-established research reputation. The Department of Anesthesiology has sponsored the F. G. Hall Laboratory since 1972.

breathe liquids, and he later conducted the first human liquid breathing trial. Throughout the 1970s, the faculty continued to conduct liquid breathing experiments. Although liquid breathing in humans has not yet been put into practice, these experiments were instrumental in developing the lung lavage technique and in elucidating the HPNS mechanism. The lung lavage technique involves washing out one lung with a mild salt solution while ventilating the second lung with pure oxygen.

The center was instrumental in developing decompression tables enabling construction of the International Space Station. The early work of Johannes Kylstra, MD, had practical implications to both deep-sea exploration and clinical medicine. Dr. Kylstra conducted a number of experiments related to respiration of oxygen-rich liquids. He was the first to prove that land animals could

The CHMEP is among the few facilities in the world equipped with the necessary pressure chambers and personnel required to safely complete this procedure, which is commonly used to relieve the symptoms of pulmonary alveolar proteinosis.

Furthermore, with this discovery, Dr. Bennett was able to prove that HPNS is not caused by the gases breathed at intense pressure, but by the pressure itself. This led to the development of a mixture of nitrogen, helium and oxygen known as TRIMIX, which Dr. Bennett believed could effectively eliminate the symptoms of HPNS. In 1968, Dr. Saltzman had achieved simulated dives to the equivalent pressure of 1,000 feet in collaboration with the U.S. Navy. Dr. Bennett was anxious to see if he could break this record and obtain simulated depths of 2,000 feet. In 1976, the Navy sponsored the installation of two new chambers in the F.G. Hall Laboratory with the capability to achieve a simulated depth of 3,600 feet using a wet chamber so that Duke faculty could explore the limitations of the human body at even greater depths. Thus began a series of four highly acclaimed experiments known as the Atlantis Dives in which human volunteers were locked inside seven-foot-wide steel chambers for weeks at a time and subjected to extreme pressure. The success of these experiments depended on the proper composition of TRIMIX for the 19

PHOTOS COURTESY OF ALBERT BOSO

volunteers to breathe. During the Atlantis III experiment in 1981, three volunteer divers successfully reached depths of 2,250 feet, breaking the existing world record. In addition to pushing the limits of underwater exploration, the CHMEP has a history of collaboration with the National Aeronautics and Space Administration (NASA). In fact, the physiologist after whom the laboratory was named—Frank Gregory Hall—contributed to the development of the pressure suits that NASA astronauts use today. The center was instrumental in developing decompression tables enabling construction of the International Space Station. Over the years, the CHMEP researchers have honed the procedures for proper suit decompression so that astronauts can safely participate in extravehicular activity. In recognition of these efforts, the Duke flag has flown aboard the International Space Station. Currently, research at the CHMEP focuses on cardiopulmonary physiology, free radical

biology, and oxygen biochemistry. “Although we have used hyperbaric oxygen as a treatment method for years,” explains Dr. Piantadosi, “we are still trying to understand how and why this works at the biochemical and molecular level.” A new area of research suggests that oxygen derivatives act as signals for the body, stimulating its natural protective response to cellular injury. If this is correct, the use of hyperbaric oxygen could help improve the health and homeostasis of many body systems in a wide range of diseases. The CHMEP’s future goals will focus on obtaining a better understanding of these potential applications.

Top: Dr. Peter Bennett oversees operations at the CHMEP control panel during the Atlantis III experiment with William “Bill” Greeman, Thomas “Tommy” Edwards, and Owen Doar Middle Image: Dr. Herbert Saltzman Bottom Image: Drs. Bryant “Bret” Stolp, Richard Moon, John Salzano, and Enrico Camporesi

When Dr. Harmel acquired the F.G. Hall Laboratory, he gained much more than a convenient location to develop the department’s research component. This relationship instilled a strong spirit of inquiry within the young anesthesia department, which is still evident today in each subspecialty that has formed within the department. As long as this curiosity is maintained, the potential for future discovery is limitless. DUKE

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Fortieth Anniversary Reflections The story of how I came to Duke. By Merel H. Harmel, MD

My life has been a series of happenstances. The story of how I came to Duke in 1971 is no exception. In 1970, the American College of Surgeons was meeting in Chicago, where I was serving as chairman of the newly created Department of Anesthesiology at the University of Chicago. At that point in time, the thought of leaving Chicago had not occurred to me as it was a challenging and stimulating opportunity in an extraordinary intellectual environment. The thought had, however, occurred to my wife Armide, who had not been too happy in The Windy City. Interestingly, it all began with a birthday celebration in honor of two former Hopkins surgeons, Drs. Mark Ravitch and Henry Bahnson. As a former member of the Hopkins Department of Surgery, I had been invited to attend along with Armide. At the party being held at the Playboy Club in Chicago, Armide encountered Dr. David Sabiston, Jr. the then chairman of the Duke Department of Surgery and an old friend from Hopkins. Sensing her displeasure with Chicago, Dr. Sabiston asked my wife if she would like to come to Duke University in Durham, North Carolina. She sent him over to me. We exchanged words, and before I knew it, I had agreed to meet with Dr. Sabiston and Dr. William Anlyan, the dean of medicine at Duke, the following morning at the Drake Hotel.

program worthy of Duke University. With my arrival and the opening of an additional six newly refurbished operating rooms, the spirit of Duke Anesthesiology underwent a dramatic change from an attitude of “we can’t” to “we can.” How providential! Furthermore, with the appointment of a permanent chair, Dr. Charles Lanning, a resident in orthopedics, decided on a career change and became the first resident in the new department. Another early success was the appointment of Dr. David A. Davis, the former chair at the University of North Carolina (UNC) and Dr. Douglas Blenkarn, also of UNC. Shortly thereafter came the appointment of Dr. Philip Lumb from Mt. Sinai in New York, who initiated our effort in critical care. Last but not least, the transfer of respiratory therapy and the hyperbaric chamber from surgery to anesthesiology proved most fortuitous. The hyperbaric chamber has served to attract a splendid cohort of residents and faculty who have become major contributors to the anesthetic and hyperbaric scene as scientists and leaders.

My job was to create an academic and research program worthy of Duke University.

After a great deal of discussion and arranged visits to Durham, I accepted the invitation to become chairman of the new Department of Anesthesiology at Duke with Armide’s happy concurrence. The prospects at that time were somewhat bleak. There were only six faculty: Drs. Sarah Dent, Kenneth Hall, Patrick Breen, Jafar Sheikholisam, Ingeborg Talton, and Vartan Vartanian. There was no residency program, and little academic enterprise. Prior to my arrival, there were only 12 operating rooms. One can only imagine the stress on the surgeon and anesthesiologist coping with the limited operating space.

Thus, the department as we now know it began to take shape, and through its leaders in the past 40 years, Drs. W. David Watkins, Joseph “Jerry” Reves, and Mark F. Newman, it has mastered the field and taken its place as a force in Duke Medicine as well as nationally and internationally. DUKE

My job was to smooth this relationship over, recruit faculty, establish the residency program, and create an academic and research 21

Left To Right: Drs. David McDonagh (Chief ), Cecil Borel (Former Chief ), Hiep Dao, David S. Warner, Andrew Peery, Jeremy Dority, Bryant “Bret” W. Stolp, and Mingwen Ouyang Not Pictured: Drs. Michael “Luke” James, John Keifer, Jeffrey Taekman, and Grace McCarthy

Fine-Tuning The Otolaryngology, Head, Neck, and Neuroanesthesiology Division

Recently appointed chief of the Otolaryngology, Head, Neck, and Neuroanesthesiology (OHN) Division, David McDonagh, MD, has some very big shoes to fill. His predecessor, Cecil Borel, MD, is a pioneer in the field of neurocritical care. Dr. Borel is credited with establishing the third Neuroscience Critical Care Unit (NCCU) in the world at Johns Hopkins University. He came to Duke to create a similar unit and launch a neuroanesthesia program. Today, these units serve as models for countless other medical centers around the world. Fortunately, Dr. McDonagh is ambitious. While Dr. Borel focused on building the program during his tenure as chief, Dr. McDonagh plans to direct his energy toward fine-tuning one of the most mature neuroanesthesia programs in the country. In the early days of Duke Anesthesiology, Bruno Urban, MD, was primarily responsible for neuroanesthesia procedures. His principal interest, however, was pain management. Consequently, in the mid-1980s, he passed the torch to one of his former fellows, Ziaur Rahman, MD, who served as the first official division chief of neuroanesthesia at Duke. By the early 1990s, the department decided that neuroanesthesia would be better supported as a section within the Division of General Services Anesthesia. Even under this new direction, the program struggled due to a lack of staff and training necessary to excel in complex neuroanesthesia procedures.

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DUKE PHOTOGRAPHY

Left: Dr. Ziaur Rahman, first chief of the Neuroanesthesia Division Right: Dr. Cecil Borel with a patient

ELIZABETH PEREZ, RN, BSN

In 1993, department chair Joseph “Jerry” Reves, MD, recruited the highly qualified Dr. Borel to lead and enhance neuroanesthesia at Duke. Dr. Reves recognized, however, that it is impossible to grow a successful clinical enterprise without creating an equally strong research component. Consequently, in 1993, he recruited David S. Warner, MD, to develop a robust neuroanesthesia research program. For the next several years, Dr. Borel worked to establish an esteemed neuroanesthesia program and a worldclass NCCU at Duke. “This was no easy task,” says Dr. Warner. “The departments of neurology, neurosurgery, and anesthesiology were not accustomed to working together,” he recalls, “but Cecil worked tirelessly to ensure that everyone’s needs were met and that everyone understood they were working toward a common goal—a better experience for our patients.” Dr. Borel was assisted in his effort by Duke neurosurgeon Allan Friedman, MD, and neurointensivist Carmelo Graffagnino, MD. However, the biggest challenge they faced was the lack of continuous staff coverage in the intensive care unit. This was imperative to the success of the neurosurgical patient. Dr. Borel recruited and trained a new group of physician faculty and mid-level providers to maintain the critical care unit. Together with Joanne Hickey, PhD, RN, Dr. Borel established one of the earliest acute care nurse practitioner programs in the country—if not the world—with a focus on neurocritical care.

The OHN Division was separated from the Division of General Services Anesthesia in 1997. Clinical responsibilities of the division today include intracranial procedures (such as awake craniotomy and aneurysm clipping), endovascular treatment of intracranial vascular abnormalities, electroconvulsive therapy, complex spine

headway has been made in reducing postoperative nausea and vomiting following craniotomy. More recently, the division mastered the use of adenosineinduced transient asystole for intracranial aneurysm surgery. The division is also championing the use of therapeutic hypothermia as a neuroprotectant

“...no matter how good we are at something, we can always find ways to be better.”—David McDonagh, MD surgery with instrumentation, and radical head and neck surgery.

following hypoxic-ischemic brain insults in the perioperative setting.

Aside from excellence in clinical care, the OHN Division is known for pioneering innovative approaches to patient safety and education. Division member Bryant “Bret” Stolp, MD, PhD, director of Airway Emergency Services, is responsible for the creation of specialized emergency airway packs to be kept on all code carts in the operating rooms and other anesthetizing sites throughout the medical center. In addition, the OHN Division is heavily involved in medical simulation under the direction of Jeffrey “Jeff” Taekman, MD, assistant dean for educational technology at Duke.

Dr. McDonagh’s primary goals for the future focus on placing a stronger emphasis on research and growth of the division’s educational programs. Thanks to Dr. McDonagh, the division offers a formal Neurosurgical Anesthesiology Fellowship with a newly designed curriculum, in addition to the division’s well-established resident education program. Dr. McDonagh also leads the nationally-accredited Neurocritical Care Fellowship Program. As we move into the future, these trainees will enjoy even greater collaboration, multidisciplinary training, and cross-pollination with other training programs at Duke. “The fundamental strength and unifying theme of this department and of the Duke University Health System in general,” says Dr. McDonagh, “is a common belief that no matter how good we are at something, we can always find ways to be better.” DUKE 23

Furthermore, the division engages in a number of research initiatives that are transforming care for neurosurgical patients. For example, significant

TEE at Duke By Fiona Clements, MD

It was a warm summer’s evening in 1983 at the Carolina Inn. Norbert de Bruijn and I sat, rapt, listening to Dr. Mike Cahalan recount his early experience with TEE at The University of California, San Francisco. The renowned cardiologist, Dr. Kremer, had come over from Hamburg to work with cardiologist Nelson Schiller, and brought TEE into the operating room and the waiting arms of Mike Cahalan. Norbert and I decided we had to have TEE at Duke. When Dr. Jerry Reves arrived as the new division chief for the Cardiac Division, we announced that this was our ambition. Dr. Reves, who came to Duke from the University of Alabama at Birmingham (UAB), recalled that UAB had a Diasonics machine languishing unloved in an anonymous warehouse that could be expediently diverted to Duke. Knowing we should soon have our hands on this converted gastroscope, Norbert and I hastened over to the Duke South Clinics for an appointment with Dr. Joseph Kisslo, pre-eminent echocardiographer, developer of the phased array transducer, founder member of the American Society of Echocardiography, and conveniently, Duke faculty and director of the echo lab. Joe was excited at the idea of introducing TEE at Duke. What luck! What expertise! What an incredible teacher! Joe came frequently into the operating room and gave freely of his own time and that of his first class echocardiographers, notably David Adams, and his own wife, Kitty Kisslo. There was none of the resentment, suspicion, or turf-tension that is sometimes found between cardiologists and anesthesiologists.

cardiologists had even seen color for their regular echo studies. Even in 1989 when HP supplied me with a machine at the Royal Melbourne Hospital in Australia, it was the only machine with color flow in the entire hospital. Our first book on TEE was painfully put together in 1987 with the early, primitive word processing program available at the time. Dr. Sabiston kindly referred to our “little monograph” when Norbert and I were invited to give Grand Rounds to the Department of Surgery. A second book followed in 1991, but was almost dated by the time it was published, as single plane and bi-plane transducers were supplanted by omniplane imaging. The early transducers had only 32 piezoelectric elements. This quickly increased to 64, and then to

...everyone realized that intraoperative TEE was becoming indispensible.

Joe was a valuable consultant to Hewlett-Packard. When HP developed its TEE probe with Doppler color flow, Joe received a prototype and promptly brought it over to the operating room. Consequently, we were using TEE with color flow before most

128 elements, with improvements in image quality occurring also through rapid changes in software processing. Because color flow came on the scene about the time that Dr. Alain Carpentier introduced mitral valve repair techniques, everyone realized that intraoperative TEE was becoming indispensible. At Duke, the responsibility of interpreting the intraoperative images fell to the anesthesiologist. However, none of us had the least reservation about calling Joe or another cardiologist-echocardiographer if anything was in question. The collegial relationship had been established. DUKE

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Left to Right: Drs. Mark F. Newman, Mark Stafford Smith, Kathy Grichnik, Joseph Mathew (Chief ), Alina Nicoara, Brandi Bottiger, Madhav Swaminathan, Ian J. Welsby, Mihai V. Podgoreanu, Steven “Steve” Hill, Jorn Karhausen, Miklos David Kertai, and Federick W. Lombard Not Pictured: Drs. Solomon Aronson, Jose Mauricio Del Rio, Manuel T. Fontes, and Grace C. McCarthy ELIZABETH PEREZ, RN, BSN

Changing Our World The Cardiothoracic Division

As it turns out, members of the Division of Cardiothoracic Anesthesiology at Duke are skilled not only in the areas of clinical care, research, and education—they’re pretty good at marketing, too. The division’s tagline, “What we do changes our world,” epitomizes the team’s mission. As implied by their succinct tagline, these physicians are making breakthroughs to improve care for patients with cardiac and vascular disease at Duke and around the world. The Cardiac Division (later renamed the Cardiothoracic Division) at Duke was formed in 1984. Joseph “Jerry” Reves, MD, served as the first division chief. A keen proponent of investing in others, Dr. Reves quickly developed a series of faculty training days that he referred to as “career development days.” Dr. Reves’ philosophy continues to be cherished by the division today. “You can invest in the infrastructure all you want, but if you do not invest in the people, you will end up with nothing,” emphasizes current division chief, Joseph Mathew, MD, MHSc, Jerry Reves, MD, Professor of Anesthesiology. “People make the difference. Develop their careers

Above: Dr. Jerry Reves, at the airport with Dr. Tom Bashore and cardiac surgeon Dr. Bob Jones

and help them grow, then step back, and let them tell you what they think needs to be done,” he says. This philosophy has produced a spectacular lineage of leadership. In addition to creating

Over the years, cardiothoracic faculty members have been innovators of clinical care, education, and research. the cardiac division and serving as the division’s first chief, Dr. Reves was the founding leader of the Duke Heart Center. Among many other accomplishments, he is credited with fostering the unique environment that still exists in the division today where talented faculty can establish and grow their academic careers. He

went on to become department chair. After leaving Duke , he was appointed vice president for medical affairs and dean of the College of Medicine for the Medical University of South Carolina. Fiona Clements, MD, who became chief in 1991, is widely recognized as a pioneer of transesophageal echocardiography (TEE) during cardiac surgery. Dr. Clements and her husband (and fellow division member) Norbert de Bruijn, MD, authored the first Society of Cardiovascular Anesthesiologists monograph for intraoperative TEE in the ’80s and established the division as a leader in the perioperative application of TEE. Mark Newman, MD, the Merel H. Harmel Professor of Anesthesiology and professor of medicine, who followed Dr. Clements as chief, had an early passion for neurological outcomes research that developed into a lifelong mission to improve perioperative patient outcomes. He is now considered a pioneer in the field of perioperative neurologic research, having largely defined the now

widely accepted demographic, procedural, and genetic risk factors for cognitive dysfunction after surgery. Most importantly, he has been the prime force behind several (including the first) interventional trials attempting to reduce the incidence of this devastating outcome. Dr. Newman, along with Dr. Reves, was instrumental in defining the detrimental effect of rapid rewarming and high temperatures during surgery upon cognitive outcomes. These findings have fundamentally altered how patients undergoing cardiopulmonary bypass are managed throughout the world. Like Dr. Reves, Dr. Newman was later appointed department chair. Following in the tradition of Drs. Reves and Newman, Dr. Mathew is a recognized leader in the field of Postoperative Cognitive Decline (POCD) and in TEE. He is the co-editor of a leading TEE textbook and is engaged in genetic, metabolomic, and advanced neuroimaging studies designed to further elucidate mechanisms of POCD. In addition to his own studies, Dr. Mathew has assembled an exceptional team of physician scientists who

ELIZABETH PEREZ, RN, BSN

COURTESY OF JOSEPH MATHEW, MD, MHSc

COURTESY OF DUMC ARCHIVES

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Top to Bottom, Left to Right: Drs. Walter Ruffin, Thomas E Stanley III, and Burt McKenzie in the OR around 1986; Drs. Mihai V. Podgoreanu, and Joseph Mathew pose with Chair Dr. Lihuan Li from the Cardiovascular Institute at Fuwai Hospital in China; Dr. Madhav Swaminathan instructing residents on the use of TEE in the OR in 2009

are at the frontiers of modern science—exploring new applications of existing technologies and developing new methods of improving outcomes for cardiothoracic patients. Through his service as a division chief, Dr. Mathew has also acquired a passion to develop leaders around him, recognizing that “it is not the position that makes the leader but the leader who makes the position.” His desire is to not only train the next generation of leaders, but more importantly, to raise leaders who share his passion for developing the careers of others, thus ensuring the continued success of the division in years to come. Over the years, the cardiothoracic faculty members have been innovators of clinical care, education, and research. Although every divisional faculty member has made important contributions, only a few can be listed here: • Joannes H. Karis, MD, served as the director of one of the world’s first surgical intensive care units, and was recruited to Duke in 1975. At Duke, he was involved in basic science research to understand the physiologic

mechanisms of neuromuscular blockade agents and in the development of the Duke Automated Monitoring Equipment (DAME). • Dr. Norbert de Bruijn excelled not only in perioperative TEE, but also in operating room management. • Debra A. Schwinn, MD, James B. Duke Professor of Anesthesiology, now chair at the University of Washington in Seattle, spearheaded the study of mechanisms underlying regulation of adrenergic receptors in health and disease. • Hilary Grocott, MD, FRCPC, who completed a fellowship at Duke and is currently at the University of Manitoba, developed the first rat model of cardiopulmonary bypass (CPB) and made significant contributions to temperature management during CPB. • After refining Dr. Grocott’s original rodent model, G. Burkhard Mackensen, MD, PhD, extensively evaluated cerebral, hematologic, renal, and

ELIZABETH PEREZ, RN, BSN

Above: A cardiac surgery in 1958

pulmonary responses to perioperative ischemia-reperfusion injury and inflammatory stress. He is now the Cardiothoracic Anesthesiology division chief at the University of Washington. • Current faculty member Mihai Podgoreanu, MD, is an internationally recognized expert in perioperative genomics and led the discovery of several genetic variants associated with perioperative adverse events using a systems biology paradigm. He is now directing the multidisciplinary Duke Perioperative Genomics Program. • Current faculty member Ian J. Welsby, BSc, MBBS, FRCA, is widely considered an expert in perioperative coagulation disorders. • Mark Stafford Smith, MD, CM, FRCPC, is not only the world’s foremost expert in perioperative renal injury, but has also excelled in leading the Duke Cardiothoracic Anesthesiology Fellowship. Under his guidance, the fellowship program has garnered universal acclaim and is widely regarded as the best in the world. Since the first Duke cardiac anesthesia fellow graduated in 1985, more than 150 fellows have trained here. • Current faculty member Madhav Swaminathan, MBBS, is also an expert in perioperative renal injury, and is known worldwide for his expertise in TEE education and identifying echocardiographic predictors of adverse outcome. Under his directorship, Duke Anesthesiology was one of the first to use a TEE simulator to enhance the fellowship training experience, expanding TEE training to non-cardiac anesthesiologists. • Katherine “Kathy” Grichnik , MD, MS, is the associate dean for continuing medical education (CME) for the Duke Health System. She supervises a staff and faculty of 22 and is supported by more than $11 million in educational grants to certify more than 600 local, regional, and national educational programs. She is also the director of the Center for Educational Excellence at the Duke Clinical Research Institute, which manages educational programs outside of the CME realm, including clinical trials education, regional systems of care efforts, and patient safety education.

Above: A cardiac surgery in 2009

• Solomon “Sol” Aronson, MD, MBA, is an expert in perioperative hypertension and TEE. He is currently the president of the Society of Cardiovascular Anesthesiologists and also serves as department executive vice-chair. • Steven “Steve” Hill, MD, is an authority on blood conservation strategies. He is chair of the Transfusion Committee and has served as co-director of the Duke Center for Blood Conservation. • Manuel “Manny” T. Fontes, MD, is an expert in critical care medicine and in pulse pressure hypertension. Although the Cardiothoracic Division is made up of a number of nationally and internationally recognized leaders in the field, faculty members are humble, rarely taking individual credit for accomplishments and continuously emphasizing the importance of junior faculty. Teamwork is at the heart of this division’s philosophy, and teamwork is what will ensure its future success. Together, these faculty members are defining the future of clinical care. Together, they are changing our world. DUKE

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My Memories of Duke There are so many fond memories that I have of Duke University Medical Center and the Department of Anesthesiology. By Joseph “Jerry” Reves, MD

The medical center was committed to academic excellence in all that was done. Education and the generation of new knowledge through research and clinical care were tended to and honored better here than in most other places. One reason that these missions could all be accomplished was that more money was put into these essential missions rather than into the pockets of the faculty. I have often told people that when I moved in 1984 from the University of Alabama at Birmingham to Duke that I noticed a remarkable change in the parking lot ecology. Successful physicians in Birmingham drove fancy, imported sports cars that they parked in their own special parking lot. The faculty at Duke drove Fords or Chevrolets and parked with everyone else. In simply surveying the parking lot at Duke, one could immediately tell that it was different than most places. At Duke, I was recruited to help the departments of surgery and medicine to build a successful clinical heart program to complement the vibrant research that was already under way. When I asked Dr. David C. Sabiston, Jr. if we would have trouble getting support from the cardiac surgeons in attempting to do our own clinical cardiac investigation, he replied, “just let me know if you have any trouble.” I never had to bring it up in any of our weekly meetings. Another most influential leader at Duke with whom I had the pleasure of working was Dr. Joseph “Joe” Greenfield. I prized this relationship not only because of the fact that he was a fellow Southerner, but also for his gift of finding simplistic solutions to complex problems. For example, when asked how best to manage patients with coronary artery disease, Joe simply stated “the heart needs blood,” and we spent countless hours in the operating room and heart catheterization laboratories seeing that simple concept happen.

every Sunday to see their patients. This indicated to me that I was in a place that cared deeply about the physician-patient relationship. Our credo was “if you start a case, you finish it.” For the same reason that we did not relieve each other, we also came in on the weekend to evaluate and plan our cases not only for the next day, but also for the entire week. What I recall most fondly from my 17 years at Duke, however, was watching countless medical students, residents, junior and senior faculty (I would name them, but because of my flawed memory I am afraid I would omit someone) work together to improve their personal careers, and in doing so, accomplish things that were not thought to be possible. One example was the progression of cardiac anesthesia to become one of, if not the most influential team in the new specialty.

There is nothing more satisfying than watching a career blossom and bloom. Many of the wonderful people I had the privilege to work with and learn from at Duke have continued to pursue the impossible— transforming the standard of care, both at home and abroad. There is nothing more satisfying than watching a career blossom and bloom. The fact that this happens so often at Duke fills me with pride and admiration for my many colleagues. DUKE

When I first started working at Duke in the Cardiac Division, I was astounded by their strong work ethic. Division members came in 29

Serving Those Who Have Served

Left to Right: Drs. Thomas Van de Ven, Rebecca A. Schroeder, Jonathan B. Mark (Chief ), Terri G. Monk, David R. Lindsay, Dana N. Wiener, Amy M. Rice, Atilio Barbeito, and Andrew Shaw Not Pictured: Drs. Raquel R. Bartz, Charles S. Brudney, Thomas E. Buchheit, Heip Dao, Joel S. Goldberg, Juliann C. Hobbs, and Srinivas Pyati

LAUREN MARCILLIAT

The Durham Veterans Affairs Anesthesiology Service

COURTESY OF DUMC ARCHIVES

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Above: Dr. Jake Freiberger, former chief of Veterans Affairs, played an important role in establishing the VAMC’s anesthesia services

The tone of President Lincoln’s Second Inaugural Address was somber—it was 1865 and hundreds of thousands of lives had been lost in the Civil War. Remarkably, his address is not remembered for its dismal tone, but for the message of healing and hope in its conclusion. His promise “to care for him who shall have borne the battle, and for his widow and his orphan” is recognized today as the mission statement for the Department of Veterans Affairs and serves as an inspiration to countless veterans and those who serve them at the Durham Veterans Affairs Medical Center (VAMC). Duke Anesthesiology is proud to have played a vital role in accomplishing this mission for more than 30 years. Although united by a common Veterans Affairs (VA) mission, there is much to distinguish the Durham VAMC. Many attribute the success of the VA Anesthesiology Service to the historically strong emphasis on faculty recruitment, which began with Duke Anesthesiology’s first VAMC chief, Stanley W. Weitzner, MD. Even after the Duke Department of Anesthesiology was formed, anesthesia services at the VA remained under the Department of Surgery. Dr. Weitzner was given the formidable task of establishing a separate VAMC Anesthesiology Service. “This was a radical concept in 1978,” Dr. Weitzner reflects, “we were the fourth VAMC in the entire country to succeed in this endeavor.” Those who succeeded Dr. Weitzner, including Philip Lumb, MBBS, Jake Freiberger, MD, and Robert Sladen, MB ChB, benefitted from his hard work and commitment to excellence. “Today, the Durham VAMC is a unique environment where faculty are provided with the support and freedom they need to excel,” says current division chief, Jonathan Mark, MD. The VAMC’s unique Short Stay Unit, directed by Dana Wiener, MD, is one such example. Dr. Wiener oversees a team

Left to Right: Clinton Blumer, CRNA, Barbara Boyles, RN, and Drs. Joel Goldberg, Sue Kirkman, and Jonathan Mark attend a ribbon cutting ceremony to announce the official opening of the VAMC Pain Clinic

of seven physician assistants and laboratory staff who perform preoperative assessment and testing for patients scheduled for surgery and other nonsurgical procedures at the VAMC. Anesthesiologists at the VAMC also provide hospital-wide diagnostic transesophageal echocardiography (TEE) services, a procedure traditionally performed by cardiologists. Cardiothoracic anesthesiology, including TEE, has always been one of this group’s clinical strengths, along with regional anesthesia and care of highrisk surgical patients. These high-risk patients are managed perioperatively by the VAMC Surgical Intensive Care Unit service, under the direction of Scott Brudney, MB ChB, FRCA and his colleagues, Atilio Barbeito, MD, Raquel Bartz, MD, and Andrew Shaw, MBBS, FRCA, FCCM. In addition, the VAMC Anesthesiology Service has earned a reputation for excellence in research. Thomas Slaughter, MD, who studied perioperative coagulation abnormalities, led these efforts for a number of years. More recently, Dr. Bartz has focused on laboratory research and received funding from the National Institutes of Health for her work on mitochondrial function and oxygen radical injury in critical illness. Clinical research took on renewed emphasis at the VAMC with the arrival of Terri Monk, MD, MS, whose investigations in geriatric cognitive dysfunction and the role of anesthesia in operative mortality is changing the face of perioperative medicine. The VAMC Anesthesiology Service is also known for excellence in chronic pain management. Recently, the pain group has focused on Veterans Injury Pain Research (VIPR), a new initiative that seeks to prevent the development of chronic pain following traumatic injury. A $1.5 million Department of Defense grant awarded to Dr. Shaw and his team in 2010 is a significant

first step toward reaching this goal. As part of the VIPR initiative, Srinivas Pyati, MD, DA, FFARCSI, David Lindsay, MD, and Thomas Buchheit, MD, are exploring innovative methods to prevent chronic pain and have established new VAMC clinics for thoracotomy patients and amputees. The Durham VAMC Patient Safety Center of Inquiry (PSCI) serves as another example of how the VAMC Anesthesiology Service is working to improve patient care throughout the medical center. This unique center, funded continuously since 2007 by the VA National Center for Patient Safety and led by Drs. Mark, Barbeito, and Rebecca Schroeder, MD, conducts a wide variety of research, educational, and quality improvement initiatives aimed at improving patient safety through better teamwork, communication, and standardization of clinical practices. Furthermore, the VAMC Anesthesiology Service places a strong emphasis on education. More than 10 years ago, Joel Goldberg, MD, played a significant role in creating a VA-funded Pain Management Fellowship Program. Dr. Lindsay now serves as program director. As Duke Anesthesiology celebrates its 40th anniversary, a tribute must be paid not only to those who have helped advance the specialty of anesthesia at Duke and abroad, but also to those like President Lincoln who have inspired these individuals to do their best. Just as the Durham VAMC is proud of the veterans it serves, we are extremely proud of our Veterans Affairs Anesthesiology Service. Together, we are working to ensure that the future of patient care at this facility will set the national standard of excellence. DUKE

LAUREN MARCILLIAT

Left to Right: Drs. Warwick Ames, Edmund H. Jooste, B. Craig Weldon, Scott R. Schulman, Brad M. Taicher, H. Mayumi Homi, John B. Eck, Guy de Lisle Dear, and Allison Kinder Ross (Chief )

A Whole New Ball Game Duke Pediatric Anesthesia

When you walk through the doors of Duke Children’s Hospital and Health Center (CHC), it is instantly apparent that this is no ordinary medical center. Children laugh as they press their palms to the glass of giant fish tanks and enthusiastically point to spinning feather chandeliers overhead. From the brightly painted walls to the brightly patterned scrub caps worn by CHC faculty and staff, it is plain to see that pediatrics is a unique specialty. In the early days of Duke Anesthesiology, however, Pediatric Anesthesia was a section within the Division of General Services Anesthesia. Until the 1980s, there were no dedicated pediatric operating rooms, and faculty members were challenged with treating both adult and pediatric patients. Early leaders in pediatric anesthesia, notably Edmond Bloch, MB ChB, and William “Bill” Greeley, MD, The John J. Downs Professor of Anesthesiology, championed the need for an independent pediatric division. Ever since their dream was realized, pediatric services at Duke have thrived. Pediatric Anesthesia faculty members continue

LAUREN MARCILLIAT

COURTESY OF DUMC ARCHIVES

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Left to Right: Dr. Allison Kinder Ross with a patient in 1998; Dr. Steven Parrillo with a patient in 1985; The Pediatric Anesthesia Division

to promote pediatric anesthesia as a unique specialty by maintaining an active role in leadership positions at both the national and local levels. The division boasts multiple past board members, a past president, and current committee chair of the Society for Pediatric Anesthesia, the most prominent society for the specialty of pediatric anesthesiology. Furthermore, the team members have played a key role in the growth of pediatric services throughout Duke University Health System (DUHS), and have been instrumental in supporting the development of a separate Division of Pediatric Surgical Services. As a result of this collaboration, Pediatric Anesthesia now has access to several child-specific operating

This unique climate has also given rise to a highly successful program for the education of fellows, residents, and practicing physicians. • B. Craig Weldon, MD, leads the division’s fellowship program, which currently offers one position a year. The opportunity for exposure to a wide variety of surgical cases in such a broad patient population makes this fellowship program one of the most sought after training opportunities in the country. • The rotation of Pediatric Anesthesia for residents is well organized under the management of John B. Eck, MD. Dr. Eck jointly serves as rotation director for Pediatric Anesthesia and assistant residency director for the department.

The future of Pediatric Anesthesia is as bright as the environment in which these team members work. rooms equipped with the latest technology. Great care has been taken to fashion a childfriendly environment in which both the physical and mental wellbeing of the child is taken into consideration. With the opening of the Duke Medical Pavilion in 2013, there will be a consolidation of pediatric surgical services into a dedicated block of six to seven operating rooms that will be used exclusively for the care of children. DUHS will soon break ground on a new Duke Children’s Hospital, which will focus on intensive care and the perioperative needs of children. Division Chief Allison Kinder Ross, MD, has been actively involved in determining the direction this exciting new center will take, and is constantly seeking out new ways to promote the division and improve clinical care throughout the Duke University Health System and abroad.

In addition, Pediatric Anesthesia has a longstanding history of excellence in research that remains an important emphasis of the team today. • Scott Schulman, MD, MHS, serves as director of research in Pediatric Anesthesia. Dr. Schulman has had a remarkable research career, and was the recipient of a $5.1 million National Institutes of Health (NIH) grant in 2004 to study the efficacy and safety of sodium nitroprusside in children. This is one of the largest grants ever awarded by the NIH for evaluating drug safety in children. • Warwick A. Ames, MBBS, FRCA, is pioneering the use of cerebral oximetry in the cardiac catheterization lab while still maintaining a busy clinical schedule in pediatric cardiac anesthesia.

• H. Mayumi Homi, MD, PhD, is using cerebral oximetry to evaluate blood flow and oxygenation for pediatric liver transplant patients and has recently joined the pediatric cardiac anesthesia team. • Guy de Lisle Dear, MA,MB, BChir, FRCA, serves as clinical director of the Eye Center where clinical studies in a focused population are readily managed. • Heather Frederick, MD, manages pharmacodynamic studies at the Duke Eye Center and is a leader in informatics. • Brad Taicher, DO, MBA, is focusing his energy on pain management in the pediatric population by using ultrasound-guided regional anesthesia techniques for children undergoing a variety of procedures. • Edmund “Eddie” Jooste, MB ChB, DA, clinical director of Pediatric Cardiac Anesthesia, is making exciting breakthroughs in pediatric cardiac procedures through anesthetic techniques and is developing the Duke program to become a premiere center in the Southeast. Remarkable progress has been made at Duke since Pediatric Anesthesia first became a specialty. As we anticipate the opening of a new world-class pediatric center, and consider the many exciting future developments in clinical care, education, and research, it is clear that this unique specialty will continue to experience dramatic growth in years to come. Equipped with the necessary facilities, equipment, and an exceptional team of faculty and staff, the future of Pediatric Anesthesia is as bright as the environment in which these team members work. DUKE

Memories of Duke By Debra A. Schwinn, MD

One of the most unique aspects of Duke University Medical Center (DUMC) is the reality that interdisciplinary clinical care and research work together. Whether it is clinical collaboration with the Heart Center, Cancer Center, Institute for Genome Sciences & Policy (IGSP), or daily clinical care, DUMC faculty and practitioners think and act through interdisciplinary collaboration. While many institutions aspire to this goal, it is standard operating procedure at Duke. This has a positive impact not only on patients, but on research initiatives as well. Approximately 10 to15 percent of medical centers in the country are truly collaborative, and Duke is one of those institutions. My fondest memories in terms of interdisciplinary work were projects at the IGSP just before I left Duke for the University of Washington in 2007. In the IGSP, anesthesiology, cardiology, surgery, pulmonary, pediatrics, the Cancer Center, genome sciences, bioengineering, and other disciplines merged with one goal: predicting patient outcome and optimal therapeutic intervention using genomic predictors. It is one thing to merge medical disciplines, but to have bioengineering and medicine working side-by-side brings very different perspectives to the same problem.

I specifically remember a Keck Futures Initiative Grant where I worked with a senior bioengineering professor. In this project, our laboratories joined forces to work toward developing a genetic test that could be used in the field in Africa to diagnose not only the presence of malaria, but also specific subtypes, and whether the DNA predicted resistance to traditional drug therapy for each individual. Dr. Nan Jokerst, J.A. Jones Distinguished Professor of Electrical and Computer Engineering, and I worked collaboratively with our students and postdocs on this project. While the biologists worked methodically through DNA aspects of the question, with the traditional slow, exacting precision required of molecular scientists, the engineering students implemented diagnostic test methods before beginning to understand DNA methods. This crazy cross-linking of approaches gave all participants wonderful new insights into cultural/scientific biases and limitations while working together toward breaking through barriers of the project. This situation embodies one of Duke’s great, wonderful strengths. It is one that I recall with fondness. DUKE

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Class Notes 1960s

I live in Hunt, Texas (Texas Hill Country), approximately 80 miles west of San Antonio. My wife of 53 years, Phoebe, and I travel by motorhome throughout the USA. We also travel abroad, most recently to Paris and a barge trip in the Loire Valley. E. Warner Ahlgren, MD Retired Professor of Anesthesiology, Texas A&M School of Medicine Scott & White Clinic, Temple, Texas Chair of the Department of Anesthesiology Resident 1966

1970s

Christine and I had the great pleasure of being at Duke from 1979 to 1989. This was a transitional time for the department and those of us lucky enough to have transitioned along with it remember it with nostalgia, pride, and gratitude. We moved to Albany, New York in 1989, and to Hershey, Pennsylvania in1998, before making the unexpected move to Los Angeles, California, where I serve as the chair of the Keck School of Medicine of the University of Southern California Department Of Anesthesiology. I was privileged to be the chancellor of the American College of Critical Care Medicine (recently elected to the first Master Fellow Class) and president of the World Federation of Societies of Intensive and Critical Care Medicine. I am an ABA examiner and completed memberships on the Anesthesiology and Transitional Year Review committees.

We have two children (Alexine in Lancaster, PA, and Jean-Philip in Montreal, Quebec), and three grandchildren ranging in age from 5 months to 11 years. Some of the most gratifying legacies of Duke remain the warmth of Merel and Armide Harmel’s home and hospitality, the continuing friendships made during a very special time, and the reunions that keep us connected. Despite the fact that Cardinal and Gold has usurped my athletic loyalty, nonetheless there remains a high proportion of Duke Blue in our system, especially when thinking of the University of California, Los Angeles. Philip D. Lumb, MB BS Master FCCM Professor and Chairman Department of Anesthesiology, Keck School of Medicine of USC University of Southern California Duke Faculty 1979-1989

1980s

My wife Janet and I have five children (ages 17-27) and three grandchildren. We now live in Wisconsin where I serve as the Edwin L. Overholt Director of Medical Education for Gundersen Lutheran Health System in La Crosse, and professor of anesthesiology and associate dean for the Western Academic Campus of the University of Wisconsin School of Medicine and Public Health. For 12 years, I served as a director of the American Board of Anesthesiology (ABA), and I am currently a parttime executive director for professional affairs for the ABA. I also serve as a member of both the Board of Directors and the Executive Committee of the American Board of Medical Specialties. I was honored to deliver the first annual Gertie Marx Lecture at the 2011 ASA annual meeting in Chicago, Illinois. David H. Chestnut, MD Edwin L. Overholt Director of Medical Education, Gundersen Lutheran Health System Professor of Anesthesiology and Associate Dean, University of Wisconsin School of Medicine and Public Health Resident 1980

I spent 16 years on the faculty at the University of Arkansas for Medical Sciences (1993-2009). Next, I spent a year at Virginia Commonwealth University (VCU) with Dr. Carlos Arancibia (2009-2010). In the summer of 2010, I retired, though I continue to serve as the ASA liaison to the American Society for Testing and Materials (ASTM), a member of the International Organization for Standardization/ International Electrotechnical Commission (ISO/ IEC) Joint Working Group on Alarms, an occasional consultant to industry, and an occasional author and speaker. I am now trying to decide about the next phase of my life. Frank E. Block, Jr., MD Clinical Professor of Anesthesiology, Virginia Commonwealth University Fellow 1980 Duke Faculty 1980-1983

After leaving Duke in 1998, I completed a cardiovascular fellowship at New York University. I then moved to Florida in 1989 to start up a new open heart surgery program. I have been in private practice since then and I serve as president of a multi-site anesthesia group. My wife, Teresa, is a physician assistant, and we have three children. Our daughter, Alyssa, graduated from Duke with a B.A. in 2011, and is currently attending the Duke Fuqua School of Business for her master’s. Our son, Anthony, also at Duke, is currently an undergraduate student and a proud member of the Duke Track and Field Team. Our youngest son, Andrew, is currently a high school senior. Anthony Pollizzi, MD Peace River Anesthesiology Associates Resident 1988

1990s

After leaving Duke, I became chair at SUNY Stonybrook, a position I have held for almost 12 years now. During this time, the department has almost doubled in size. I have also served as the chair of our practice plan for six years. This year, I will also serve as the president of the Society for Ambulatory Anesthesiology (SAMBA). My son Sean’s company (ONE NYSE) went public in June 2011, and in October, he and his wife Kellee had a son, Alex (our first grandchild). Ryan, my younger son, has been a New York teaching fellow in the Bronx. He graduated in June 2011, and has been accepted into the Columbia M.Ed. program so he can become a headmaster. I look forward to getting news of other colleagues. Peter S.A. Glass, MB, ChB Chair, Department of Anesthesiology, SUNY Stonybrook Resident 1988 Duke Faculty 1984-1999

I left Duke University in 1989 after being appointed Chair at SUNY Upstate (Syracuse, NY), but I did not leave my Duke friends and mentors, as I continue to enjoy their company and collaboration! My wife Pat and I cherished 16 years at Upstate and the last 7 years in Tampa (FL) at the University of South Florida. I have trained over 250 residents and fellows and was able to continue research and publications from all the established laboratories. I started the Hyperbaric Facility in Syracuse and a Research Foundation in Tampa, where I continue as Emeritus Professor. Best wishes to all and our love to Merel! Enrico M Camporesi, MD Duke Faculty 1973-1989

Life is busy with practice and my three children: Gabrielle is a sophomore at Duke, Nicki is a freshman at Johns Hopkins, and Lewis is in middle school. Besides reading, my favorite pastime is vacationing and scuba diving with my wife of 30 years, Judy! Lewis R. Hodgins, MD Partner, Nash Anesthesia Associates Rocky Mount, NC Resident 1989 Duke Faculty 1989-2008

My wife Whitney and I have three children: a 6-year-old son, Teg, an 8-year-old daughter, Mikel, and a new baby boy, Duke Edward Alvis, born in August 2011. I am still practicing neurosurgery in Norman, Oklahoma. We recently went native, selling our two houses in Norman City, and bought about 850 acres of land south of here, and are official ranchers! We put in 7 miles of fencing, and horse bar, barn, etc. We started a cow-calf operation in the fall of 2011, and will escalate to about 100 cows over the next several years. In the next two years, we hope to be calving about 80-90 calves a year. Mike Alvis, MD Cardiac Fellow 1987

On completing residency and fellowship training in Cardiothoracic Anesthesiology at Duke, I joined the faculty with a research focus on perioperative hemostasis and thrombosis. After 10 years on the Duke faculty, I was recruited to the Virginia Commonwealth University Health System to serve as director of Cardiothoracic Anesthesiology— and subsequently to my alma mater Wake Forest University where I serve as head of the Section on Cardiothoracic Anesthesiology and fellowship program director in Adult Cardiothoracic Anesthesiology. My wife, Janie, has been very active in the community, working with social services programs directed at older adults, as well as with a number of community arts organizations. Most especially, we’ve both appreciated this opportunity to be so near our parents and other family. Thomas F. Slaughter, MD, MHA Professor of Anesthesiology, Head, Section on Cardiothoracic Anesthesiology, Program Director, Adult CT Anesthesiology, Wake Forest University School of Medicine Medical School Student 1987 Resident 1991 Cardiothoracic Fellow 1992 Faculty 1992-2002

I currently reside in Macon, Georgia, with my wife, Laura, and children, Christian, Keilee, and Chandler. I am an anesthesiologist with Anesthesia Associates of Macon. I am now enjoying a lighter shade of blue as a Professor of Anesthesiology at the UNC- Chapel Hill. I am innovating new graduate medical education programs and serving as President of the North Carolina Society of Anesthesiologists. David Hardman, MD, MBA Professor of Anesthesiology, Regional Anesthesia and Pain Management, University of North Carolina at Chapel Hill Resident 1985 Fellow 1986 Duke Faculty 1986-2008

Keith N Phillippi, MD Anesthesia Associates of Macon Resident 1993

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Since leaving Duke, I have been working at the Greater Baltimore Medical Center (GBMC) in Towson, Maryland. I serve as president of Physicians Anesthesia Associates, P.A., which provides anesthesia services at GBMC and numerous freestanding ambulatory surgery/ endoscopy centers in central Maryland. In addition to my clinical duties, I oversee OR operations at GBMC as medical director of perioperative services. I completed my MBA in Medical Services Management at Johns Hopkins in 2000. My wife Dene and I have been married for 28 years. We have two daughters: Stephanie—BS Georgia Institute of Technology ‘11 (Industrial & Systems Engineering) and Lindsey, a sophomore at William & Mary. In the next few years, I see myself transitioning out of clinical medicine to pursue either an administrative position in either a large hospital/health system or in a healthcarerelated business. Lewis H. Hogge, Jr., MD, MBA President, Physicians Anesthesia Associates, P.A., Medical Director of Perioperative Services, GBMC Chief Resident 1993

From 1995 to 2006, I worked in private practice at Saint Mary’s Medical Center, West Palm Beach, Florida. I served as president and CEO of Anesthesiology and Critical Care of the Palm Beaches from 2001-2006. During that time, I also served as director for the Department of Anesthesiology at Saint Mary’s Medical Center and medical director of Kimmel Outpatient Center from 2002-2005. I was a delegate for the Florida Society of Anesthesiologists during 2005 and 2006. In 2006, we moved to Stowe, Vermont, and I have worked as an assistant professor of anesthesiology at the University of Vermont ever since. I was a delegate for the Vermont Society of Anesthesiologists from 2006-2010, and since 2010, I have been the alternate director for the Vermont Society of Anesthesiology. I am still married to Susan, and we have a 17-year-old daughter, Gabrielle. Francisco Grinberg, MD Assistant Professor of Anesthesiology, University of Vermont School of Medicine Burlington, Vermont Resident 1995

After leaving Duke in September of 1991, I moved to Denver, Colorado, to work at Rose Medical Center, a large private teaching hospital. In 1996, my group merged with a larger group, and I am now a member of Colorado Anesthesia Consultants. We work at hospitals and clinics throughout Denver. Also in 1996, I became chairman of the Department of Anesthesiology at Rose Medical Center, and I have held that position for 16 years. Professionally, I practice general anesthesia with a focus on specialty areas, such as neurosurgery, cardiac surgery, obstetrics, and chronic pain management. Throughout my career, I have concentrated on developing special expertise in airway management, and I work closely with LMA-NA in evaluating new products and help to train their sales representatives. I am also involved with teaching airway management skills to the University of Colorado pulmonary fellows Approximately one-fourth of my workweek is devoted to administration in my role as chairman. More recently, I have had the privilege to travel on humanitarian medical missions with another Duke graduate, Dr. Bill Brown. Dr. Brown trained in plastic surgery at Duke and is now a highly respected plastic surgeon in Denver. For the past 17 years, he has made repeated medical trips to Tanzania to perform surgery on the

indigent population. I joined him in the fall of both 2010 and 2011, and each time, our small team performed between 70 and 80 surgeries over a one-week period, correcting congenital deformities, including cleft lips and palates, and releasing many severe burn scars. Of course, it’s a life-changing experience for both patients and healthcare workers. I plan to continue with Dr. Brown’s mission again this fall. I have been married to my wife, Patti, for 29 years. Patti has worked as an investment broker for nearly 31 years and still does this part time. She is also very active in our local public high school fundraising foundation, an entity made necessary because of continued budget cuts for education by the Colorado state government. We have two children. My son, Sam, 17 years old, is currently a junior in high school. He plays competitive golf. My daughter, Jackie, 13 years old, is currently in 8th grade. She is involved in dance and Tae Kwon Do. Since moving to Colorado 21 years ago, I have been an active rock and ice climber, and skier. However, over the past 6 years, I have spent more time playing golf with my son than climbing. Skiing is still a weekly family activity throughout the winter.

in the Duke hyperbaric lab with Drs. Richard Moon and Enrico Camporesi. Both these physicians were important in my career development and greatly influenced my decision to go into the field of anesthesiology. Dr. Moon has continued to be influential in my life, and I still consider him to be one of my most important mentors as well as a very close friend. Although I left Duke in 1991, I have stayed in close contact with the Department of Anesthesiology. I routinely attend the Duke reunion at the annual ASA meeting. I have also twice returned to Duke for continuing education; once for training in transesophageal echocardiography and another time for instruction in regional anesthesia techniques. I frequently attend lectures at the national meetings given by Duke faculty. I feel very fortunate to have trained at Duke, and I hold my continued affiliation with the Department of Anesthesiology as a tremendous professional asset. David Theil, MD Chair, Department of Anesthesiology, Rose Medical Center Denver, Colorado Resident 1990 Duke Faculty January 1991September 1991

I originally started at Duke in 1987 to perform pulmonary and high altitude research

I have been married for 10 years to my beautiful wife Anna. We have two boys: Hunter, 7, and Hayden, 5. I am the former president of Greater Houston Anesthesiology (GHA) and the current president of Paragon Health Care Management Group, the practice management company for GHA.

taking advantage of the many outdoor recreational opportunities. My family does a lot of skiing and boarding in the winter and mountain-biking, hiking, kayaking, and trail running in the summer. In the last couple of years, I have participated in several high-altitude ultra marathons in the 50 to 100-mile distance.

Ron Osborn, MD President of Paragon Health Care Management Group, Greater Houston Anesthesiology Resident 1996

I have worked for 10 years now with Anesthesia Associates of Colorado Springs (AACS), a 38-member all-physician group. We serve a high-acuity publicly owned health system called the Memorial Health System, as well as three outpatient surgery centers in the City of Colorado Springs. I served as medical director of Printers Park Surgery Center from 2008-2011, and director of recruiting for AACS from 2005-2007.

I have moved in my career and now hold the position as deputy chief of all health care in a small Swedish state with 5,000 employees. Bengt Nellgard, MD, PhD Malmö University Hospital, Department of Anesthesia Former Research Associate at Duke 1997-1999

I have a wide variety of clinical interests. I have the opportunity to give anesthesia in a variety of clinical scenarios ranging from high-volume outpatient regional-based anesthesia to highrisk OB, cardiovascular, pediatric, and trauma anesthesia. I even round on acute pain patients five to seven days a month. Think Duke on a smaller scale: same acuity, smaller venue. My group also hosts medical students from Colorado University. Looking back, I cannot imagine a better training program than what I received at Duke. I am grateful to the staff and to my fellow residents. Duke gave me the foundation I needed to jump back and forth between widely varying clinical scenarios on a daily basis while still providing great care to my patients.

From 2000 to 2006, I worked at the Clinica Atias Pain Clinic in Caracas, Venezuela. Since 2006, I have been at the Teknon Pain Clinic in Barcelona, Spain. As far as my future goals and ambitions are concerned, I hope to be a professional golf player by 2015 when I turn 60. I am currently looking for sponsorship for this project. Carlos L. Nebreda, MD, MSc Teknon Pain Clinic - Centro Medico Teknon Barcelona, Spain Duke Faculty 1997-2000

2000s I currently reside in Colorado Springs, Colorado, and have been married to Caren McCurdy for 18 years. We have four children: Morgan (17), who headed off to college last fall, Jack (14), Skye (11), and Benjamin (9). We enjoy living in Colorado and 38

Jay McCurdy, MD Anesthesia Associates of Colorado Springs Memorial Health System Chief Resident 2001 Cardiothoracic Fellow 2002

I moved to San Diego and began working with ASMG (Anesthesia Service Medical Group) in October 2005. This group has expanded to about 225 anesthesiologists, and we provide approximately one-half of the anesthesia care in San Diego County. I love my practice and living in San Diego. My eldest son, Grayson, is completing his junior year at Emerson College, Boston, and my younger son, Robin, is completing his freshman year at the University of Washington (Seattle). Nanci and I plan to continue living and working in San Diego, and one of my goals is to wear shorts 365 days of the year. My goal is to complete my working career with ASMG in San Diego. I love my MD-only practice and am doing all kinds of anesthesia. I plan to complete the ASA 1-year practice management program in 2013. Nanci and I are rediscovering life without children but are glad to have successfully launched the boys to college. We would love to

hear from past friends, so please email or give a call if you are coming to San Diego. Terry Breen, MD Anesthesia Service Medical Group, San Diego, CA Faculty 1999-2005

Michelle and I have lived in Charlotte, NC, since 2007. We have three children: Drew (6 years old), and 2-year-old twins, Ryan and Emma. I am the Clinical Practice Committee Chair for Presbyterian Anesthesia Associates. Richard Griggs, MD Presbyterian Anesthesia Associates Chief Resident 2003

Since leaving Duke, I moved to the University of Texas, Houston Medical School, where I worked as director of Obstetric Anesthesia. At UT, I was fortunate to continue to work closely with residents in obstetric anesthesia, as I did at Duke. I also received the “Teacher of the Year” award at UT just as I did at Duke. In 2008, I moved to my present position at the University of Florida College of Medicine, Jacksonville, as chairman of the Department of Anesthesiology and chief of anesthesiology at Shands Jacksonville Medical Center, where I continue to work with residents and trainees in anesthesiology. I established a new obstetric anesthesiology fellowship program in 2009 and was very honored this year to receive the 2011 SOAP Teacher of the Year Award. Moeen Panni, MD, PhD Chair, Department of Anesthesiology, University of Florida College of Medicine Chief of Anesthesiology, Shands Jacksonville Medical Center Duke Faculty 2002-2005

BluePrint Since I left Duke, I managed to complete my residency while having three children along the way, the first while I was at Duke! I now work halftime at an academic, level I trauma center in Indianapolis and love my job! I currently serve on the Residency Selection Committee for the Indiana University Department of Anesthesiology and am also serving on the Curriculum Reform Committee for the Indiana University School of Medicine, and on the Physicians Advisory Council for the New Wishard (Eskenazi) Hospital that is currently being built in Indianapolis. Professionally, in the short term, I’d like to continue in the same capacity and plan to get involved with a prospective transfusion study involving orthopedic trauma patients. Outside of work, I am also a NAFTA-certified boot camp instructor, and teach and attend fitness classes when I can. I’ve been happily married to Brian Mullis, MD, for 12 years, and we have three children: Hunter, who is 7, Colton, 6, and Taylor, 3. I want to continue volunteering with the school my children attend and maybe even become certified to teach Pilates. Leilani Mullis, MD Assistant Professor of Clinical Anesthesia, Indiana University School of Medicine, Department of Anesthesiology Wishard Anesthesia Group Anesthesiology Transitional Year Intern 2004

Other than staying busy at work, Dharmita, my wife, and I have two children (Kush and Avni). I have become very active in swimming also. I work at WakeMed Hospitals in Raleigh. Besides providing strong clinical care, involvement of my anesthesia group with WakeMed’s operations is also of great importance. The leadership of Duke’s anesthesia department and the exceptional training I received there made it clear to me that involvement within one’s organization is important.

2011. This is a combined role of managing anesthesiology, intensive care, pain medicine, and operating rooms, similar to the chair position at Duke. It is the biggest directorate in the biggest teaching hospital (Trinity College, Dublin) in the country. Nikolay Nikolov, MD, MPhil (Cambridge), FCARCSI, DEAA ORIAN Directorate, St James’ Hospital Cardiac Fellow 2007

I left Duke to join Mount Sinai Hospital in New York as an assistant professor in the cardiothoracic anesthesia field. I left Mount Sinai to take up a position in Columbus, Ohio, in April of 2010 at Midwest Physician Anesthesia Services. My wife Harshaw and I have a son, Sahil Singh Satyapriya, born on March 21, 2010. I was named chief of Cardiothoracic Anesthesia for my group in April 2011.

On a personal note, Catalina D’Alessio (from UNC) agreed to marry me in the Duke Gardens on April 2, 2011. Frederick Cobey, MD MPH Assistant Professor, Georgetown University, The Washington Hospital Center Cardiac Fellow 2010

Ajay Satyapriya, MD Midwest Physician Anesthesia Services Cardiac Fellow, 2008

I am the only U.S. Army anesthesiologist on the cardiothoracic team at Brooke Army Medical Center (BAMC), and have recently won the 2010-2011 Golden Apple Award for outstanding contributions to resident education. I am married with two sons, Matthew and Michael. Ross N. Thormahlen, MD Anesthesiologist at Brooke Army Medical Center, San Antonio, TX U.S. Army Medical Corps, Assistant Professor of USUHS (Uniformed Services University of the Health Sciences) Resident 2008

Andrew Lutz, MD American Anesthesiology Mednax, Inc. WakeMed Hospitals Resident 2006 Cardiac Fellow 2007

I was appointed director of ORIAN Directorate at St. James’ Hospital, Dublin, Ireland, in March

and am teaching echo to Georgetown, George Washington, and military residents. I am working to develop the echo program here at the Washington Hospital Center, and am starting a DC area perioperative echo society that I hope will meet four times a year. I also hope to initiate a few research projects looking at oxygen toxicity on bypass, multimodality pain therapy in cardiac patients, and 3D echo. I was also recently asked to start a cardiac anesthesia fellowship, but clearly this will take some time to develop and is a future project.

After finishing my time at Duke, I worked in Sudan at the Salam Cardiac Center and then eventually started at the Washington Hospital Center/Medstar Heart Institute in December of 2010. I have an appointment at Georgetown University as an assistant professor of anesthesia

We (Eimer and our three children) returned to Ireland in 2006 to be closer to my family after five very happy years in North Carolina. I have been working in one of the main university hospitals in Dublin since, where I continue to utilize regional anesthesia techniques for the majority of my patients. In addition, I also work in a number of private hospitals. I have maintained my keen interest in sport, and still play golf regularly. I have returned to the USA on a number of occasions either on vacation or to attend meetings. I am disappointed to say that we have not returned to North Carolina, but we plan to, particularly as the children were born there. We are in frequent contact with many of our friends and neighbors from our time in the USA. Dara Breslin, MD Consultant Anesthesiologist/Senior Lecturer Department of Anesthesia and Intensive Care Medicine Dublin, Ireland Duke Faculty 2001-2006

Juggling Act The General, Vascular, High-Risk Trauma, Transplant, and Surgical Critical Care Medicine Division

Left to Right, Front to Back: Drs. Gene Morretti, Amy Manchester, Elliott Bennett-Guerrero, Andrew Peery, Nancy Knudsen, Tong Joo “TJ” Gan, Kerri Wahl, Cathy Kuhn, Richard Moon (Chief ), Grace McCarthy, Chris Young, Tim Miller,

40 Ron Olson, Aaron Sandler, and Jake Freiberger

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Left to Right: Drs. Tong Joo “TJ” Gan, Nate Waldron, and Brian Barrett in the OR

The Division of General, Vascular, High-Risk Trauma, Transplant, and Surgical Critical Care Medicine (GVTCCM) brings a whole new meaning to the word multitasking. In our fastpaced society, this popular buzzword is claimed by many, but mastered by few. Members of the GVTCCM Division are experts in the art of multitasking—they’ve been doing it for years. This division provides world-class care for patients undergoing general, peripheral, and major vascular, urologic, trauma, and transplant surgeries. Responsibilities of the GVTCCM Division include overseeing multiple operating rooms and supervising the Preoperative Screening Unit and the Surgical Intensive Care Unit (SICU). Critical Care, led by Christopher Young, MD, and Liver and Bowel Transplant Services, led by Kerri Wahl, MD, FRCPC, are subsections within the division. In spite of its small size, the GVTCCM Division has attracted multitalented individuals since its inception in 2000 when the General, Vascular, Urology, and Transplant Anesthesiology (GVT) group combined with the Surgical Critical Care group. During its early years, the GVTCCM Division was praised for being the most academically prolific new group in the department. In the 2000 Annual Report, the first division chief, David Lubarsky, MD, MBA, described the GVTCCM Division as “a seasoned and productive group that has a variety of clinical and research interests.” This is certainly still the case today. A few examples of the many notable leadership roles and accomplishments of division faculty are highlighted below. • GVTCCM faculty members are adept at managing multiple positions. Examples include Ronald Olson, MD, who serves as medical director of the Preoperative Screening Unit, and Nancy Knudsen, MD, who is co-director of the SICU and is actively involved in the medical school curriculum. Even Division Chief Richard Moon, MD, CM, MSc, FRCPC, proudly wears

Drs. Kerri Wahl and Ross Thormahlen perform rapid sequence induction.

two hats; he also serves as medical director of the Center for Hyperbaric Medicine and Environmental Physiology. • Under the leadership of Dr. Wahl, proficiency in perioperative care of liver transplant patients at Duke has grown to national prominence. Aside from access to highly skilled and experienced physicians, liver transplant patients at Duke benefit from shorter wait times and higher survival rates than the national average. The GVTCCM Division also provides care to patients undergoing kidney and pancreas transplants and has recently expanded its services to include bowel transplants. • Tong Joo “TJ” Gan, MD, MHS, FRCA, serves as vice chair for faculty development for the department and is currently working to establish a department-wide perioperative outcomes database. Dr. Gan is also exploring new techniques to prevent blood loss during prostate removal surgery and is testing new technologies to measure cardiac output. He is a recognized

• Timothy Miller, MB ChB, FRCA, and Julie Thacker, MD, assistant professor of surgery, have led an initiative to implement the Enhanced Recovery After Surgery (ERAS) program. This protocol is designed to facilitate better recovery, shorter stays, and fewer complications for colorectal surgery patients. • Catherine Kuhn, MD, is director of residency education and vice-chair for education. She was the first anesthesiologist in the nation to receive the Parker J. Palmer Courage to Teach Award from the Accreditation Council for Graduate Medical Education (ACGME) in 2004. Dr. Kuhn works with several other division members to advance academic anesthesiology both at home and abroad through involvement in various overseas medical missions. She has also been named as a North Carolina Best Doctor. • Amy Manchester, MD, a member of the liver transplant team, has been working on central and peripheral venous pressure monitoring.

Members of the GVTCCM Division are experts in the art of multitasking... world expert in prevention and management of postoperative nausea and vomiting. • Drs. Young and Gene Moretti, MD, MHSc, are discovering more effective methods to monitor bowel blood oxygenation during anesthesia. • Elliott Bennett-Guerrero, MD, is conducting clinical studies related to anticoagulation management and blood transfusion for coronary artery bypass graft surgery. He has also investigated the use of antibiotic-impregnated sponges to prevent wound infection after cardiac and colorectal surgery.

• Aaron Sandler, MD, PhD, is the newest member of GVTCCM. He is also a liver transplant team member and has been working on predictors of PACU reintubation. Balancing multiple leadership positions, research initiatives, and educational responsibilities while continuing to provide world-class care to a highacuity patient population in a nontraditional academic discipline is no easy feat. The GVTCCM Division accomplishes this juggling act with aplomb, maintaining a level of poise and grace worthy of applause. DUKE 41

Left to Right: Drs. John R. Schultz, Terrence Allen, Ashraf S. Habib, Cheryl A. Jones, Abigail H. Melnick, Cathleen Peterson-Layne, and Holly Muir (Chief ) Not Pictured: Drs. Peter D. Dwane and Adeyemi J. Olufolabi

High Risk, High Reward and in High Demand The Division of Women’s Anesthesia The vocation of women’s anesthesiology requires flexibility, sacrifice, and steadfast dedication. At times, it can be exhausting—mentally, physically, and emotionally. For members of Duke’s Division of Women’s Anesthesia (DWA), however, these challenges are part and parcel of the incredible sense of fulfillment that comes from working in this specialty. The DWA is responsible for obstetric, gynecologic, oncologic, and urologic anesthesia at Duke. The majority of cases are obstetric. Although the work hours this specialty demands can be grueling, the opportunities for professional growth are limitless. Faculty and trainees 42

working in the DWA gain invaluable experience in a variety of complex and highly stimulating cases and enjoy the benefit of the unique spirit of collaboration that this type of work environment engenders. Furthermore, the specialty is constantly evolving. Over the years, division chief, Holly Muir, MD, FRCPC, has witnessed the steady improvement of the birthing experience. When she first came to Duke in 1998, the labor rooms were very small, forcing patients to be relocated to the operating area at the time of delivery. Only one close friend or family member could accompany the patient due to the lack of space. Labor analgesia was not always readily available.

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Left to Right: A Duke Birthing Center suite in the late ‘90s; Dr. C. Ronald Stephen (on right), was a pioneer in anesthesiology and the inventor of the Duke Trilene Inhaler, which allowed women in labor to self-administer pain relief

Today, 90% of parturient patients at Duke (including high-risk patients) receive epidural anesthesia for labor. Furthermore, this division was one of the first in the nation to offer patient controlled epidural anesthesia. In addition to an exceptional pain management strategy, the DWA promotes a relaxed, familyfriendly birthing environment by providing patients and their families access to expansive labor and delivery suites equipped with hardwood floors, hot tubs, fold-out couches, and televisions in every room.

faculty members meet with each patient to identify any possible complications. In recent years, the DWA’s research activity has focused on improving safety for these high-risk patients. Recently, the DWA’s research in phenylephrine infusion for blood pressure control resulted in the widespread use of this drug in obstetrics. Ongoing studies conducted by Ashraf Habib, MB BCh, ChB, MSc, FRCA, and Terrence Allen, MB BS, evaluate the effects of anesthesia techniques on maternal physiology.

These improvements have occurred in spite of the fact that the volume of deliveries the division handles annually has tripled since obstetric anesthesia first became a specialty at Duke in 1997. The number of Cesarean sections (C-sections) performed has more than quadrupled. This growth is directly related to a dramatic change in the patient referral pattern over time. With the development of a strong Maternal Fetal Medicine group and an impressive Neonatal Intensive Care Unit, Duke began to accept more high-risk pregnancies. Today, high-risk patients comprise a majority.

The division’s strong research component has contributed to the strength of its educational program. Many Duke Medical School students are drawn to the specialty as a result of their early interactions with Peter Dwane, MD,

The clinical operations of the division now fall under the leadership of Cheryl Jones, MD, a Duke residency graduate, who continues to evolve new and innovative approaches to meet the needs of Duke’s unique patient population. The DWA faculty members have developed and maintained close-knit relationships across all disciplines to improve patient safety. Faculty members meet with each patient early on in the pregnancy to assess and identify any possible risks. They attend weekly multidisciplinary conferences to develop delivery plans specific to each patient’s needs. They maintain contact with the patient throughout the perinatal period, and even provide an on-demand anesthesia consult service. Twenty-four hours after delivery,

who supervises a medical school elective. Many of these individuals go on to become some of the department’s most successful residency candidates.

equally strong fellowship program, directed by Adeyemi Olufolabi, MB BS, FRCA, is constantly improving and expanding. In fact, this year the DWA will initiate a two-year fellowship program in Global Health, which will allow candidates to obtain a master’s degree in global health while completing their fellowship. Global outreach is a major emphasis of the DWA. Division faculty and their colleagues in obstetrics and neonatology partner with The Duke Global Health Institute (DGHI) and a non-profit organization based in North Carolina, Kybele (www.kybeleworldwide.org), to improve delivery of maternal and neonatal care and prevent childbirth-related injury and death in developing countries. Division members share their knowledge and passion here at home

...the DWA faculty take the many challenges of working in obstetric anesthesia in stride, going well above and beyond the call of duty.

Residents spend a significant portion of their CA-1 year in the DWA learning the fundamentals of anesthesia under the guidance of Cathleen Peterson-Layne, MD, PhD, MS, who is responsible for resident rotations. In addition to mastering the fundamentals, residents are encouraged to pursue research ambitions. Trainees learn how to address regulatory requirements, collect data, and present research findings in an academic setting under the guidance of John Schultz, MD. The DWA’s

through continuing medical education (CME) programs. The DWA collaborates with the obstetric division to provide an annual CME conference directed by Abigail Melnick, MD, and Dr. Peterson-Layne. No matter where they are, no matter what obstacles they face, the DWA faculty take the many challenges of working in obstetric anesthesia in stride, going well above and beyond the call of duty. This unwavering dedication results in a highly rewarding experience not only for the patients, but also for the faculty members who care for them. It’s no wonder they are in such high demand! DUKE

Left to Right: Drs. Billy K. Huh (Interim Chief ), Anne Marie Fras, Winston C.V. Parris (Former Chief ) Lesco L. Rogers, and Dianne L. Scott

Painless Progress The Division of Pain Management

Statistics show that the problem of pain is both tangible and ubiquitous. The U.S. Department of Health and Human Services estimates that chronic pain affects 70 million citizens. According to the National Center for Health Statistics, pain affects more Americans than diabetes, heart disease, and cancer combined. The American Academy of Pain Management reports that painkillers are by far the most commonly purchased medications, with 200 million prescriptions filled annually. So what is Duke Anesthesiology doing to address this problem? The first step in providing world-class care in pain management is to recognize that people are not statistics. “One size does not fit all,” explains The Honorable Winston C.V. Parris, MB BS, DA, DABPM, recently retired chief of the Division of Pain Management and medical director of the Pain Clinic. Pain perception can vary dramatically from patient to patient. The greatest challenge in treating chronic pain is the lack of a scientifically reproducible method of measuring pain. Duke’s Pain Clinic at Morreene Road is one of the finest chronic pain clinics in the nation. Its faculty and staff are recognized for their competence, integrity, and innovative approach to pain management.

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Left to Right: Dr. Dianne L. Scott treating a patient in 1985 and Dr. Bill Wilson with a staff member

Before diagnosing and treating patients, faculty at the clinic carefully examine each patient’s overall physical and mental wellbeing. Physicians use several treatment modalities, including some non-pharmacological options.

Trainees acquire superb clinical experience through this program, which focuses on academic chronic pain management. Fellows also rotate at the Veterans Affairs Medical Center, thereby gaining expertise in managing both acute and chronic pain.

Bruno Urban, MD, was the first to provide formal pain management services in the Department of Anesthesiology in the mid-1970s. When the Division of Pain Management was established in 1999, he served as its first chief. After years of dedicated service, Dr. Urban retired from clinical practice in 2000—the same year that construction of the new Pain Clinic at Morreene Road was completed.

In June of 2011, Dr. Parris retired from clinical practice. Since then, Billy Huh, MD, PhD, has served as interim chief. Prior to his departure, Dr. Parris clearly stated his primary goal for the future of the pain management division: to complement the division’s robust clinical and educational components with an equally strong arm in research. The team is actively working to make this goal a reality.

The Pain Clinic has been very successful ever since it opened. Initially, Thomas Buchheit, MD, and Anne Marie Fras, MD, served jointly as leaders of the new Pain Clinic. Under their leadership, practitioners here saw a 50% increase in the number of patients after only one year. As of today, there has been an almost 100% increase in the number of pain management procedures performed at the clinic since it first opened to the public in 2001. When Dr. Parris assumed leadership of the clinic in 2005, he revamped its structure, introduced many new technologies, and expanded pre-existing interventional procedures, such as nerve stimulation, radio frequency lesioning, and morphine pumps. During his tenure, Dr. Parris was the only physician in the state, and among the few in the nation, to offer percutaneous epidural neuroplasty for treating spinal stenosis and failed back surgery. In addition to adopting a patient-centered approach and employing innovative technology, faculty members in the Division of Pain Management provide multidisciplinary access for their patients. Anesthesiologists can easily refer patients to other specialists at Duke, such as psychologists, neurologists, and neurosurgeons, if needed.

The division is especially interested in establishing a firm foundation in basic science. Chronic pain is an exciting area of research because, at this

“We have made tremendous strides and are now one of the best pain clinics nationwide.”—Dr. Winston C.V. Parris point in time, a great deal remains to be discovered about the mechanisms by which chronic pain develops. It is only now that the medical community is beginning to understand the nuances of neuroplasticity and the various mechanisms by which acute pain can develop into chronic pain. “We have made tremendous strides,” says Dr. Parris proudly, “and are now one of the best pain clinics nationwide.” He is confident that with a strong research program to match its outstanding clinical capability, the Pain Clinic will successfully reduce the burden of pain and will emerge as one of the best in the world. DUKE

Not only is this division known for providing exceptional patient care, it has earned a reputation for excellence in the training of residents and fellows.

JARED LAZARUS, DUKE PHOTOGRAPHY

Practice Makes Perfect The Orthopedics, Plastics, and Regional Anesthesiology Division

Front to Back Row, Left to Right: Drs. David B. MacLeod, Justin Shore, Gavin Martin (Chief ), Ellen M. Flanagan, Daniel S. Thomas, Alicia Shook, Michael Shaughnessy, MD, Joshua “Josh” Dooley, Jennifer T. Fortney, and Stephen J. Parrillo Not Pictured: Drs. Brian Ginsberg and Stuart Grant

The introduction of Regional Anesthesia (RA) is undoubtedly one of the most impactful advancements for the entire specialty of anesthesiology. RA provides exceptional pain management, enhances patient safety, alleviates costs, and allows for early convalescence in comparison to general anesthesia. Under the leadership of Division Chief Gavin Martin, MB ChB, DA, FRCA, Duke Anesthesiology’s Orthopedics, Plastics, and Regional Anesthesiology Division (a.k.a. the Regional Division) is taking steps to ensure that RA will continue to play an essential role in the future of Duke Anesthesiology. Duke Anesthesiology was among the first anesthesiology departments in the nation to adopt RA techniques such as patient-controlled anesthesia and ambulatory pain pumps, ultrasound for the administration of peripheral nerve blocks (PNBs), continuous epidural catheters, and PNB catheters. Ever since, faculty members have continuously sought out ways to hone this technology. Today, the

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Right: Dr. Stephen Parrillo and a staff member, 1985

Regional Division is exploring new methods to improve continuous peripheral nerve blocks and ultrasound technologies. The Regional Division has a unique advantage when it comes to providing top-notch patient care because of its close relationship to Duke’s Acute Pain Services (APS), directed by faculty member Brian Ginsberg MB BCh, FRCA. Having long suspected the detrimental long-term effects of acute pain, Dr. Ginsberg was the first to establish a formal APS at Duke in 1987. “Acute pain is much more than just a symptom,” Dr. Ginsberg says. “We now know that it can lead to a multitude of longstanding physical consequences, such as the development of chronic pain.” Seeking out new approaches to combat this devastating consequence, APS joined forces with the Regional Division in 1998. Thanks to Dr. Ginsberg, this team has adopted a highly effective multimodal approach that involves the use of several different classes of analgesics and varying sites of analgesic administration. This enables them to provide top-notch pain relief with limited side effects. Another way that the Regional Division improves care at the local, national, and international levels is through education. Duke’s Ambulatory and Regional Anesthesia Fellowship Program is one of the most sought-after programs in the nation. The division boasts a highly acclaimed teaching model for resident training in RA that is designed to increase resident exposure to PNBs. In 2002, this model was highlighted in the journal Anesthesia & Analgesia due to its resonating success. This model has clearly illustrated the old adage that practice really does make perfect (or at least nearly perfect). The success rate of PNBs at Duke is 95%. Upon completion of this program, dedicated block residents and fellows become highly proficient at independently administering RA using a variety of techniques. Furthermore, the division provides a variety of continuing medical education (CME) opportunities, which they hope to expand in the coming years. One way that this will be accomplished is through the department’s exciting new “DukeStream” channel, which not only provides taped grand rounds lectures to practicing physicians, trainees, and certified registered nurse anesthetists (CRNAs), but also allows them to watch these procedures live and interact with Duke faculty in real time. Stuart Grant, MB ChB, FRCA, and Joshua “Josh” Dooley, MD, are leading this initiative. In addition, the Regional Division hosts two annual conferences in Park City, Utah, and Lake Buena Vista, Florida that attract physicians from across the country and feature some of the most widely respected experts in RA from around the world. These conferences serve not only as an excellent opportunity for exposure to the most advanced RA techniques available, but also cover a wide variety of other topics such as non-invasive hemodynamic monitoring and fluid management optimization. Finally, Dr. Grant leads an ultrasound preceptorship during the second week of every month, and David MacLeod, MB BS, FRCA, provides a unique educational experience in cadaveric dissection at the Carolina Cadaver Course (C3 Course), held annually in conjunction with Wake Forest University.

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pharmacological trials. In the future, the division will place a strong emphasis on research studies focusing on the causes of acute and chronic pain, and the long-term effects of RA, particularly those related to cognitive function. A new and improved patient outcomes database will be key in the success of these studies.

Duke Anesthesiology was among the first anesthesiology departments in the nation to adopt regional anesthesia techniques... The future of Duke’s Regional Division is full of promise. No one can say with any certainty what the “next big thing” to significantly impact the current practice will be. However, one thing is certain: whenever it comes along, the Regional Division will be ready to take on the challenge. DUKE

In addition to leading the C3 Course, Dr. MacLeod is spearheading the division’s research initiatives through leadership of the Human Pharmacology Lab (HPL), where he governs a variety of studies and 47

Left to Right: Drs. Stephen M. Klein (Chief ), Karen C. Nielsen, Marcy S. Tucker, and M. Stephen Melton 48“Steve”

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Passionate Change, Compassionate Care The Ambulatory Division

It is often said that history repeats itself. Early leaders who championed the establishment of an independent Department of Anesthesiology faced immense resistance. Few thought that they could succeed after cutting the cord from the Department of Surgery in 1971. Nevertheless, over time, Duke Anesthesiology has become one of the most successful anesthesiology departments in the world. Twenty-seven years later, in 1998, a similar scenario played out when some of Duke’s most respected surgeons, anesthesiologists, nurses, and staff joined forces to form a stand-alone Ambulatory Surgery Center (ASC). Current Ambulatory Division chief, Stephen Klein, MD, was a member of the small team to embark on this ambitious new mission. The team, he admits, was a bit nervous upon arriving at the ASC. “The operating rooms were empty,” he explains, adding, “everything had to be organized from scratch.” Furthermore, when the ASC opened its doors to the public, it was greeted with a case volume 20% higher than predicted. The ASC team met the challenge head-on. And, just like Duke Anesthesiology, the ASC has since enjoyed a history of success. Much of this success can be credited to the introduction of a new model of care in which a dedicated perioperative team, comprising anesthesiologists, surgeons, and highly trained nurses, works together to make the patient experience seamless. From the outset, ASC faculty and staff have treasured this spirit of teamwork that crosses all service lines. The four faculty within the Department of Anesthesiology who work at the ASC—Dr. Klein, Karen C. Nielsen, MD, M. Stephen “Steve” Melton, MD, and Marcy S. Tucker, MD, PhD—consider themselves not only a division, but members of the broader ASC team. This unique model has withstood the test of time. Even as the center itself has grown from six operating rooms to nine, and the number

of patients seen has steadily increased, the ASC faculty and staff have continued to provide quality services and compassionate care, quickly transitioning patients in and out so that they can return home to their families and a normal lifestyle as quickly as possible. Furthermore, leaders in this division have pioneered a number of techniques that have now become standard procedure at Duke and, in some cases, worldwide. The Ambulatory Division’s first chief, Susan Steele, MD, played an instrumental role in Duke’s transition from using primarily general anesthesia to using regional anesthesia (RA). The move to the ASC provided Dr. Steele with the perfect opportunity to implement RA in an ideal patient population. Dr. Steele, along with Roy Greengrass, MD, also developed the Duke-Braun Continuous Catheter System. With this technology, the ASC became the first center in the U.S. to send patients home with catheters and pain pumps to manage postoperative pain. Furthermore, Dr. Greengrass is internationally known for discovering new applications for paravertebral nerve blocks (first used in the 1920s and 1930s) to facilitate better recovery for breast procedures, enabling complex surgeries

Since its inception, the ASC has methodically recorded patient outcomes information in a center-wide database now containing close to 100,000 patient encounters. With this knowledge at their fingertips, the future of research for the Ambulatory Division is full of exciting potential. By integrating this data with new information derived from cutting-edge technologies, such as ultrasound and sophisticated cerebral imaging, Ambulatory Division faculty are identifying, often for the first time, valuable long-term patient outcomes that result from ambulatory procedures. Currently, Dr. Melton is championing this field of study, which will remain a strong area of focus in the future. Another exciting area of future development is found in the division’s fellowship program, which has blossomed in recent years under Dr. Nielsen’s care. “She has built a solid framework for the fellowship program,” explains Dr. Klein, “and she continues to expand it every year—it’s never static, she is constantly working to see how she can improve it.” Trainees who complete the highly acclaimed fellowship program in ambulatory and regional anesthesia receive an unrivaled education in RA with a strong focus on the outpatient setting.

...an important chapter in the evolving story of Duke Anesthesiology. such as mastectomies to be performed in an ambulatory setting. In 2002, the ASC performed one of the first ambulatory joint arthroplasty procedures, proving once again that such extensive procedures can be carried out successfully on an outpatient basis with carefully coordinated teamwork and attention to pain control.

Time and time again, history has demonstrated that change is never an easy process. The Ambulatory Division’s openness to change and a wholehearted commitment to its mission of continuously improving patient care have made this division’s story an important chapter in the evolving history of Duke Anesthesiology. DUKE

Reaching Out Duke Anesthesiology Off-Site Throughout our history, Duke Anesthesiology has earned a reputation for ingenuity that has become a hallmark of the department, just as beloved and familiar as Cameron Indoor Stadium, the Sarah P. Duke Gardens, or that unmistakable shade of Duke Blue that distinguishes us from other universities. The affiliation that Duke Anesthesiology has formed in recent years with Durham Regional Hospital and Duke Raleigh Hospital was born out of this culture of innovation. It serves as a perfect example of how our leaders boldly transform challenges into opportunities by finding unique approaches to advancing patient care. “Duke Raleigh and Durham Regional are an instrumental and important part of our department,” explains Solomon “Sol” Aronson, MD, MBA, executive vice chair of the department and one of the key players who has fostered and developed this unique relationship. “Their efforts, although principally clinical, help our department fulfill its overall mission. They help us sustain the department’s resources necessary to maintain our academic and educational mission in a global way,” he says. Creating this type of affiliation with off-site entities has been a major initiative of Department Chair Mark F. Newman, MD, Merel H. Harmel Professor of Anesthesiology and professor of medicine. This is just one example of how forwardthinking leaders and pioneers in the department are safeguarding the next 40 years of Duke Anesthesiology. 50

Durham Regional Hospital’s Community Division The first off-site group to affiliate with Duke Anesthesiology was Durham Anesthesia Associates (DAA)—a medium-sized successful private-practice organization with a 30-year history. Although the practice worked in concert with Durham Regional Hospital, Edward G. Sanders, MD, and others in the organization knew that the DAA’s full potential could only be realized by aligning itself with a larger academic institution like Duke University. Dr. Sanders and key partners within the practice first began to discuss the creation of a formal relationship between DAA and Duke Anesthesiology in 1996 with former chair Joseph “Jerry” Reves, MD, former vice chair, Dr. Newman, and former faculty member David Lubarsky, MD, MBA. This relationship was consummated in 2007. Today, this remarkable team is referred to as the Community Division. Dr. Sanders serves as division chief. The 20 physicians within this division are members of Duke Anesthesiology who jointly serve as community physicians. This unique affiliation allows Duke Anesthesiology and the Community Division to straddle the systems of academic and community practice, and to integrate both with the Private Diagnostic Clinic (PDC)—a for-profit professional limited liability company associated with the Duke University Health System and School of Medicine. This unique positioning

BluePrint Opposite Page, Front to Back Left to Right: Durham Regional’s Community Division—Drs. Cathy Thomas, Eugene Lee, Eddie Sanders (Division Chief ), Warren Miller, Bill Norcross, Mike Stella, John Buckwalter, John Heath,. Gary Pellom, and Earl Ransom (Chair, Department of Anesthesia, at Durham Regional Hospital) This Page Left To Right: Dr. Solomon “Sol” Aronson; Duke Raleigh Hospital

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has allowed both the department and the Community Division to grow significantly. The Community Division, which began as a team of 10 physicians and 40 certified registered nurse anesthetists (CRNAs) has since expanded to 20 physicians and 60 CRNAs! Together, we now provide care to several local surgeon’s offices as well as other North Carolina hospitals, including Durham’s Davis Ambulatory Surgery Center, the North Carolina Specialty Hospital, Person Memorial Hospital in Roxboro, and the Mebane Surgery Center in Mebane. “This may be the most unique academiccommunity affiliation alignment in the country,” states Dr. Sanders. “Leadership in the department has allowed us to retain much of the original responsibility that we had as a private business, which allows us to continue to do what we do best.” What the Community Division does best is provide exceptional care to the local community with a unique sense of compassion. The Community Division also contributes to the department’s global mission of education and research. Their primary emphasis is placed on the training of CRNAs. In fact, DAA physicians and CRNAs, notably Ruth Long, who was Chief CRNA at the time, partnered with faculty at Duke to lay the foundation for what is now the highly respected Nurse Anesthesia Specialty Program at Duke University’s School of Nursing. When it was still an independent private practice, DAA sponsored a CRNA training program for many years, but the program was forced to terminate in 1994. Dr. Sanders and Ms. Long approached Dr. Reves, who was the chair of Duke Anesthesiology at the time, to discuss their goal. Like DAA, Duke once had a successful CRNA training program under the the leadership of Chief Nurse Anesthetist May Hoen Muller, CRNA, but it ceased to exist after 1955. Dr. Reves agreed that a CRNA training program would be an ideal solution to help meet the overwhelming need for anesthesia care, both at Duke and across the country. The DAA and Duke University worked together for a number of years to develop a school for these highly trained nurses. Today, Durham Regional

Hospital serves as the base clinical site for this nationally recognized CRNA training program. Duke Raleigh Hospital For the past three years, Duke Anesthesiology has been responsible for managing the intensive care unit (ICU) at Duke Raleigh Hospital. Two full-time Duke Anesthesiology faculty members—Michael W. Russell, MD, who serves as director of Critical Care Services, and Okoronkwo Ogan, MD—manage the unit. A team of PDC pulmonary medicine physicians and advanced practice providers assists them. The relationship between the Duke Raleigh ICU and the department has benefitted both parties tremendously. The Duke Raleigh ICU team now has unrivaled access to resources, greater potential for collaboration, and unique opportunities for continuing medical education (CME). By sponsoring this unit, we have become involved in critical care anesthesia in a more inclusive way. Like the Community Division, the Duke Raleigh team is an integral part of Duke Anesthesiology’s global mission. The team at Duke Raleigh focuses its efforts on developing innovative solutions to improve patient care through expertise in systemized information

identification of clinical trends at the earliest possible point. “The current ICU environment is awash in data and short of trained staff,” explains Dr. Russell. “Care is still largely reactive, responding t-o changes in isolated bits of information after the fact, as opposed to proactive and integrative. The latter approach allows us to combine subtle trends in multiple data elements to pinpoint significant changes in clinical course and potentially act at a much earlier point. This, coupled with remote access technologies,” he adds, “has the potential to allow a smaller number of intensivists to coordinate earlier, more effective intervention in a greater number of patients.” Under Dr. Russell’s leadership, the department will continue to look for ways to integrate technology and qualified providers into effective ICU solutions for community hospitals where resources may be limited. Goals for Future Expansion The progressive service models used for our affiliation with Durham Regional Hospital and Duke Raleigh Hospital have been extraordinarily successful. “Importantly, these affiliations have demonstrated that Duke Anesthesiology can successfully align its mission with community private groups to create significant advantages for everyone,” explains Dr. Aronson. In the future,

What the Community Division does best is provide exceptional care to the local community... management. “More robust information management allows for the study of how patients move from illness to health,” explains Dr. Russell.

the department will continue to explore opportunities for expansion and find new ways to fulfill our mission of extraordinary care through a unique culture of innovation, education, research, and professional growth.

Dr. Russell is particularly interested in the integration of data and information management tools—from integrated, remotely accessible ICU monitoring platforms, to predictive analytic software that allows the

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LAUREN MARCILLIAT

Left To Right: Duke Anesthesiology Education Leadership Team—Drs. Stuart Grant, John B. Eck, Catherine Kuhn, and Mark Stafford Smith Not Pictured: Dr. Jeffrey “Jeff” Taekman

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Education: Bigger and Better Education in the Department of Anesthesiology

For 40 years, Duke Anesthesiology has fostered the development of world-class physicians committed not only to clinical excellence and research, but also to a zealous, lifelong pursuit of learning. Our highly successful training programs are fueled by the passion and dedication of our department faculty. The Medical School Curriculum Medical students begin interacting with our faculty in their first year of medical school. We have been engaged in medical student education for many years, but an important milestone was reached in 1994 when we were granted a research study track in the third year, extending faculty involvement to all four years of the curriculum. Anesthesiology faculty members are always rated highly by the medical students. The department’s involvement in curriculum planning for the medical school has increased steadily in recent years. Several faculty members, including Christopher Young, MD, Jonathan Mark, MD, Katherine “Kathy” Grichnik, MD, MS, Jeffrey “Jeff” Taekman, MD, and Stuart Grant, MB ChB, FRCA, are currently involved with the Medical School Admissions Committee and/ or the Medical School Curriculum Committee. Tong Joo “TJ” Gan, MD, MHS, FRCA, and

Dr. Grichnik sit on the School of Medicine Faculty Development Committee, which is primarily focused on the development of physician educators. Former faculty member, Kathryn King, MD, is credited with creating the student-run Anesthesia Interest Group, which provides

with online application processes and the uniform use of the National Resident Matching Program, both for residencies and increasingly for fellowships. Currently, 800 to 1,000 applications are received annually, and only about 140 of these applicants are selected for interviews for 14 residency positions. We are fortunate to be able to recruit top-notch

We are fortunate to be able to recruit topnotch residents from all over the country... faculty mentorship and programs for students interested in pursuing careers in anesthesia. As a result of these efforts, Duke medical students have shown an increased interest in anesthesia as a career choice. Between 8% and 10% of any given medical school class at Duke now chooses to pursue anesthesia as a profession. The Residency Program The past 40 years have witnessed many developments in anesthesiology residency education. The duration of required training increased from two years to three years in 1986. Most current residents now pursue fellowship training as well. The resident application and selection process has become more automated

residents from all over the country, and in 2011, one of the first graduates of the new Duke-National University of Singapore Graduate School of Medicine matriculated to the residency. Despite the tremendous growth in clinical operations (there are now approximately 70 anesthetizing locations), we have intentionally kept the residency program small so that each resident can receive personalized attention, and excellent case volume and complexity. This allows residents and fellows to handle their own cases, rather than share them, providing each trainee with the greatest amount of hands-on experience possible. Trainees benefit from the subspecialized clinical structure

Left to Right: Dr. John Lemm participating in a multidisciplinary in-situ simulation exercise in labor and delivery (obstetric hemorrhage); Dr. Katherine “Kathy” Grichnik with a group of medical school students

of the department and the guidance of program leaders and faculty mentors in each subspecialty. CA-3 residents are able to tailor their final year of training toward their career ambitions, and many residents engage in research projects. Consequently, our residents and fellows are very confident in their ability to work independently in any setting once they graduate from the program. In 1998, the residency added a departmentsponsored internship program. This is the first such program at Duke. Medical students are able to match for all four years of training at Duke. The interns rotate on a variety of services, including medicine, surgery, pediatrics, critical care, and emergency medicine, and can take advantage of the expertise of other Duke departments. John B. Eck, MD, has played a significant role in managing this new internship in his role as assistant program director. In 2009, we received the American Board of Anesthesiology (ABA) and Accreditation Council for Graduate Medical Education (ACGME) approval for an innovative curriculum program known as ACES (Academic Career Enrichment Scholars). This program is intended to increase the number of graduates pursuing academic careers and help them gain status as independently funded researchers. This highly selective program matches up to two residents per year. An internship, core residency program, subspecialty fellowship training, and over a year of protected research time are incorporated into five years of training. Dedicated mentorship and a lecture series are integral to the program’s success.

We are among a handful of such programs in the country, and anticipate the graduation of our first class in 2013. Leadership Within the Residency Program The residency program director position that Catherine Kuhn, MD, now holds is another indication of the changing times. Earlier, this was the responsibility of the department chair, who was assisted by a director of resident education (DRE). In the past, this position was held by esteemed former faculty members: Jim Collins, MD, Lloyd Redick, MD, John Leslie, MD, David Hardman, MD, MBA, and Ronald Edgar, MD. Dr. Kuhn served as the director of resident education for seven years before becoming the residency program director in 2001. In addition to serving as program director, Dr. Kuhn is vice chair for education. Dr. Eck is integral to the success of the program as assistant program director. Although leadership of the education mission has evolved over time, residents continue to maintain a close relationship with the chair. Mark F. Newman, MD, Merel H. Harmel Professor of Anesthesiology and professor of medicine takes personal interest in every trainee and plays an instrumental role in their career planning. Another important leadership position within the residency program is the chief resident. The chief residents’ role is to foster a positive learning environment, boost resident morale, and serve as a liaison between residents and faculty. In 2008, the academic chief resident position was created in conjunction with the ACES Program. The academic chief resident works

closely with Dr. Kuhn and David S. Warner, MD, director of the ACES Program, to schedule ACES conferences and events. Finally, senior residents who are recognized as excellent teachers and mentors are named teaching scholars. The role of the teaching scholar is to enhance the educational experience of medical students and work with the chief residents on projects for residents. The Fellowship Programs Duke Anesthesiology’s fellowship programs have also experienced similar growth, creating the need for a director of fellowship education, a position currently held by Mark Stafford Smith, MD, CM, FRCPC. The department has nine fellowship programs: Adult Cardiothoracic Anesthesiology, also directed by Dr. Stafford Smith; Critical Care Medicine, directed by Dr. Young; Pain Medicine, directed by David Lindsay, MD; Pediatric Anesthesia directed by B. Craig Weldon, MD; Neurosurgical Anesthesiology and Neurocritical Care, directed by David McDonagh, MD; Obstetric Anesthesia, and The Global Health Residency and Fellowship Program both directed by Adeyemi Olufolabi, MB BS, FRCA; Regional & Ambulatory Anesthesia, directed by Karen C. Nielsen, MD; and Undersea & Hyperbaric Medicine directed by John Freiberger, MD, MPH. These programs have grown enormously in size and academic output since the department’s first fellowship—Cardiothoracic Anesthesiology—was inaugurated in 1984. As our most mature program, Cardiothoracic

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LAUREN MARCILLIAT

Right: Dr. Madhav Swaminathan leading a 3D echocardiography workshop

Anesthesiology has experienced great success, gaining international recognition for its proficiency in teaching transesophageal echocardiography (TEE). Training in TEE has recently been expanded to the Critical Care Medicine fellowship program as well. Furthermore, Duke Anesthesiology, which is known for pioneering the use of ultrasound in regional anesthesia and peripheral nerve catheters for ambulatory regional analgesia, has a tremendously successful Regional & Ambulatory Anesthesia fellowship program that continues to gain in popularity each year.

Simulation and Patient Safety Center (HSPSC). This educational center and applied safety laboratory was created in 2001 as a result of the

The use of technology in education has historically been one of our greatest strengths.

Continuing Medical Education and Innovation in Educational Technology The department offers a variety of opportunities for practicing physicians to gain continuing medical education (CME) credit through internal lectures and conferences as well as external educational programs that highlight the department’s expertise in many subspecialties. Two of the most sought after programs are the preceptorships in regional anesthesia and transesophageal echocardiography. Internally, the marquee event is the weekly Anesthesia Grand Rounds Series, which is complemented by a range of subspecialty conferences hosted by every division in the department. Finally, we have been approved as a simulation site for the American Board of Anesthesiology’s mandatory Maintenance of Certification in Anesthesiology (MOCA) process, which attracts a number of anesthesiologists to Duke.

joint effort of three groups at Duke: the School of Nursing, which provided the center’s first high fidelity simulator; the School of Medicine, which furnished the funds necessary to renovate the space; and the Department of Anesthesiology, which provided the faculty, research and support staff, and curriculum development for the unit. In addition to training medical school students, residents, fellows, and practicing physicians, the HSPSC focuses on human factors engineering and qualitative research. Through leadership of the HSPSC, Dr. Taekman and his team dramatically increased both interest and investment in educational technology at Duke. We will continue to develop simulation and the use of virtual environments in the new medical education building, currently under construction. The Future of Duke Anesthesiology’s Educational Programs

The use of technology in education has historically been one of our greatest strengths. Faculty member Dr. Taekman serves as assistant dean of Educational Technology at Duke, and director of the Human

The need to effectively manage the department’s array of conventional and innovative educational offerings has resulted in

Left to Right: A staff member performs an echocardiography in 1997; Former fellow Dr. Matthew Wood performing a bronchoscopy

the development of the Duke Anesthesia Center for Innovative Education (see table on page 54), led by Dr. Kuhn and executive vice chair Solomon “Sol” Aronson, MD, MBA. This umbrella organization will facilitate the development and commercialization of novel educational technologies, and integration with current traditional techniques. In the near future, the department plans to offer educational programs via web-based and handheld device-based platforms in a variety of formats, including medical games, interactive simulation, interactive lectures, and videos. Currently, the department offers virtual environments through the use of 3DiTeams, a first person video game that creates an interactive environment in which trainees care for patients and hone their communication skills in a clinical setting. Dr. Taekman has received a grant through the Doris Duke Foundation for a five-year project known as ILE@D (Immersive Learning Environments at Duke), which will develop enhanced virtual environments for healthcare education. A strong emphasis on the use of virtual environments combined with simulation will not only

provide a fun and interactive learning environment, but will also enable trainees and practicing physicians to gain important skills needed to respond to real life crises. Duke Anesthesiology fosters a unique and innovative educational environment that encourages physicians to devote their careers to the quest of knowledge and actively participate in shaping the next generation of learners. This is evidenced by the success of our alumni, many of whom have gone on to become department chairs, chiefs, and leaders in academic anesthesiology organizations, both nationally and internationally. We celebrate their success just as we take pride in the accomplishments of our current faculty and trainees. Together, we are ensuring the future success of both our department and the specialty of anesthesiology. DUKE

TABLE

Intra-Department

Simulation Lab

Human Factors

Innovation/

Inter-Department

Duke Advance

3Di Team Training

Research

Duke Stream

OB (Sim Ed)

Conferences on/off site

Med Student Education

Clinical Trials Research

3Di

Surgery (Sim Ed)

Grand Rounds

Allied Health Professionals Education

Health Systems Projects

e Manual

Peds (Lectures)

Resident Conferences

Resident Training (Anes)

Sentinel Event Research

Virtual Fellowship

Cardiology/Heart Center

Web-based education

Resident Training (Other)

Serious Games

Faculty Development

Wiki

Bronchoscopy Simulator

iPad, iPhone, Skype, Droid

ER (Airway, Sim)

External CME

TEE Simulator

Division conferences

Grants for Resident Education

Outreach

Skills Training Difficult Airway Cadaver/Nerve Block Anatomy Lab

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The Development of the Human Pharmacology Lab By Peter S.A. Glass, MB, ChB

The 15 years that I spent at Duke hold very special memories for me. I was blessed to have many incredible mentors and the support of a wonderful department and institution. It was an exciting time, and countless new drugs were being introduced in perioperative medicine. Shortly after my arrival in August of 1984, newly appointed chair Dr. W. David Watkins, persuaded me to perform Phase IV studies on the new drug, alfentanil, by Janssen. While leading this study, I worked closely with chief of the Division of Cardiovascular Anesthesia, Dr. Jerry Reves, and a postgraduate student working closely with him named Dr. James “Jim” Jacobs to utilize a new technology called CACI (Computer Assisted Continuous Infusion) to administer alfentanil. After completion of the Phase IV alfentanil protocols, Jerry and another close friend and mentor in the department, Dr. Enrico Camporesi, encouraged me to perform a Phase I protocol for a new opiate compound developed by Anaquest. Since it was a Phase I study, we would need a dedicated space where we could conduct human volunteer experiments. The department had access to a significant amount of space in Duke South that had been included as part of Dr. Watkins’ recruitment package. In this space existed a large library, which, after some negotiations, was equipped to become the first Human Pharmacology Laboratory (HPL). The funding obtained from Anaquest allowed me to hire my first research assistant, Dr. David Shafron. David Martel, who was already on the research staff, also played a vital role. This turned out to be an excellent Phase I study, giving us the ability to accurately identify and describe the initial pharmacokinetics and pharmacodynamics of the compound. Subsequently, Anaquest provided us with other compounds to test for potential clinical value, and several of them were introduced into our model.

Unfortunately, Anaquest never introduced any of their opiate compounds into clinical practice, but through these studies, we dramatically improved our techniques of assessing analgesia and pioneered new technology. The HPL became quite active, and numerous faculty, residents, research assistants, and even visiting faculty joined the group. Shortly thereafter, the HPL became an important site for the development of remifentanil—the lead compound developed by Glaxo, which had its U.S. headquarters in the Research Triangle Park. In fact, the first human administration of this compound took place in Duke Anesthesiology’s HPL. Grants for these studies helped fund several other clinical pharmacology studies of pharmacokinetic and pharmacodynamic principles, including an important one on the context sensitive half-time, a concept proposed by Dr. Jim Jacobs and myself. Furthermore, this is where we first demonstrated that the bispectral index provided a measure of sedation and loss of consciousness rather than being a measure of anesthesia. Finally, studies in the HPL demonstrated how noxious stimuli would increase the bispectral index value during sedation. This could then be ablated by the administration of opiates, thereby helping to define how the interaction between opiate and sedative provides the state of anesthesia. A few years before I left Duke in 1999, the clinical research unit was moved into an area in Duke South and Dr. Jacques Somma took over what is now referred to as the HPL II. Under Jacques, the HPL continued to be productive, publishing two important studies on remifentanil and dexmedetomidine. The HPL was instrumental in developing my own career, as well as the careers of many others at Duke who shared my interest in biological and medical sciences. At the same time, it helped develop new compounds and many important new concepts in pharmacokinetics and pharmacodynamics that we incorporate into the practice of anesthesia and drug delivery today. DUKE 57

Left to Right: Drs. Joseph Mathew, David S. Warner, and Tong Joo “TJ” Gan, leaders in clinical and basic research

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Enriching Our Future Research in the Department of Anesthesiology

The Department of Anesthesiology has made huge strides in research over the past 40 years, thanks to an environment that fosters growth, brilliant academics, and a strong focus on the future of patient care. The accomplishments of current and former faculty, clinical and research post-doctoral fellows, research staff, and residents have largely defined the department’s research program. Our current success can be credited to a spirit of teamwork and interdisciplinary collaboration. Examples of Duke Anesthesiology’s most prestigious research are highlighted below. Our research program began in the F.G. Hall Laboratory, where studies were focused almost entirely on human physiology. The work conducted here brought Duke Anesthesiology research to national and international prominence and set an early precedent for successful peer-reviewed extramural funding. The F.G. Hall Laboratory was critical not only in defining modern hyperbaric medicine, but also in developing the department’s basic science component. A formal process for organizing basic science research, which strives to further our understanding of cellular function, its response to stress and drugs, and translational significance, was established in 1994 when David S. Warner, MD, came to Duke to serve as chief of experimental anesthesiology. By 1998, Basic Science was considered a division within the department with Dr. Warner serving as chief. The Basic Science Division also encompasses translational research—an essential bridge between basic and clinical research that enables physician scientists to apply the information obtained from experimental disease models to human subjects.

nausea and vomiting (PONV). The study of PONV remains an active area of research in the department today. Dr. Gan has played an influential role in proving the efficacy of antiemetics and establishing PONV consensus guidelines, which now are an international standard of care. In addition to using acupuncture for the prevention of PONV and postoperative pain, Dr. Gan found acupuncture to be highly effective in reducing the severity and frequency of chronic headache. Drs. Gan and Peter S.A. Glass, MB ChB, who later went on to become chair of the Department of Anesthesiology at the State University of New York at Stony Brook, also conducted pioneering work in the concept of perioperative goal-directed therapy and the use of bispectral index to monitor the depth of anesthesia—a technology now used around the world. When David Watkins, MD, PhD, became chair in 1983, he launched bench research in the department and oversaw creation of the CRII Laboratory, which served as the department’s first Human Pharmacology Lab. In this lab, which was directed by Dr. Glass, numerous important concepts were developed. Examples include the context-sensitive half-time and the bispectral index, which ultimately helped to popularize the use of total intravenous anesthesia as a standard anesthetic technique in clinical anesthesia practice.

Our current success can be credited to a spirit of teamwork and interdisciplinary collaboration.

According to Vice Chair for Faculty Development Tong Joo “TJ” Gan, MD, MHS, FRCA, translational research is a relatively new concept in academic anesthesia. This important area was often overlooked by major extramural funding sources, such as the National Institutes of Health (NIH), until about 15 years ago. A stronger emphasis on translational research has enabled our clinical research program to thrive. The earliest high-impact clinical research in anesthesiology at Duke was conducted by Sarah J. Dent, MD, and focused on postoperative

Debra A. Schwinn, MD, James B. Duke Professor of Anesthesiology, who served as director of Perioperative Genomics and vice chair for research for several years, played a critical role in developing bench research at Duke. Dr. Schwinn set a standard for NIH-funded research in the department, made fundamental discoveries in alpha adrenergic receptor signaling, and recruited several NIH-funded faculty members, including Madan Kwatra, PhD, Elliott Bennett-Guerrero, MD, James Reynolds, PhD, and Dr. Warner, to expand the department’s research programs. “She set a standard for excellence for research conduct and

JARED LAZARUS, DUKE PHOTOGRAPHY

LAUREN MARCILLIAT

Upper Image: Dr. Debra A. Schwinn in the lab with Dr. Robert J. Lefkowitz Lower Image, Left to Right: The CARE Leadership Team: Narai Balajonda, Bonita Funk, Roger Hall, Robert Nelson, and Zarrin Brooks Opposite Page, Upper to Lower Images, Left to Right: Dr. Laura Niklason in the lab; Regina Delacy, Habib ElMoalem, Bill White and Dr. Barbara Phillips-Bute; Dr. Mihai Podgoreanu at work in his lab

Left to Right, Front to Back: The Basic Science Division: Drs. Qing Ma, David S. Warner, Zhiquan A. Zhang, M. Luke James, Noa Segall, W. Daniel Tracey, Wulf Paschen, Huaxin Sheng, and Wei Yang Not Pictured: Dr. Madan M. Kwatra

innovation that continues to permeate the entire department,” says Dr. Warner. Following Dr. Schwinn’s lead, Dr. Warner has helped to develop the careers of countless world-class physician scientists across a broad range of medical specialties. A world-renowned neuroanesthesiologist, Dr. Warner is known for his work in the mechanisms of stroke and brain protection, acute brain and spinal cord injury, and therapeutic interventions. By establishing a strong foundation in neuroanesthesia basic research at Duke, Dr. Warner has created a perfect environment in which to train and mold young physician scientists. In fact, Dr. Warner serves as the principal investigator for the department’s formal NIH-funded training grant designed to develop physician scientists at the fellowship level. Duke

Anesthesiology has maintained this grant since 1996, when it became one of six anesthesiology departments in the U.S. to receive this honor. Thanks to current chair, Mark F. Newman, MD, Merel H. Harmel Professor of Anesthesiology and professor of medicine, and vice chair for education, Catherine Kuhn, MD, this concept has since been extended to the residency with development of a pioneering American Board of Anesthesiology approved physician scientist track (Academic Career Enrichment Scholars) designed to substantively integrate formal research training with combined residency and fellowship clinical training over a five-year period. The Cardiothoracic Division has a history of highimpact research related to cognitive dysfunction following cardiac procedures that began with

the work of Joseph “Jerry” Reves, MD. Dr. Reves imparted both his knowledge and passion for the study of cognitive dysfunction to the current chair, Dr. Newman. Dr. Newman and his team pioneered the study of cognitive dysfunction following cardiopulmonary bypass. This work opened the concept of perioperative genomics and also led to major changes in bypass conduct now practiced universally. Joseph Mathew, MD, MHSc, Jerry Reves, MD, Professor of Anesthesiology and current chief of the Cardiothoracic Division, has worked with his team to take this research a step further. They are currently exploring the effects of extreme hemodilution during cardiac surgery, evaluating the use of lidocaine to prevent cognitive injury, and assessing the utility of functional magnetic

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resonance imaging to better understand postoperative cognitive dysfunction. Dr. Mathew serves as medical director of NORG (Neurological Outcomes Research Group) and CARE (Clinical Anesthesiology Research Endeavors). CARE began as an initiative within the cardiac division and was eventually extended to the entire department. The CARE group is focused on quality improvement and clinical research that lead to changes in clinical practice.

focused on mechanisms of chronic pain, a common affliction requiring breakthrough science to advance patient care. A rapidly emerging focus is on exploration of neural mechanisms of injury and pain. With a

Together, we are advancing the future of patient care for generations to come.

For the past several years, the department has held an event known as Academic Evening to showcase ongoing research activities in the department. This event has become a model for similar events organized by most leading anesthesiology departments across the U.S. Academic Evening was the brainchild of Robert Sladen, MB ChB, but is now led by Dr. Warner. Katherine King, MD, and Cathleen Peterson-Layne, MD, PhD, MS, have also been instrumental in its success. The event now presents over 80 research projects each year and has an attendance of 150-200 persons. The progress that we have made in research over a 40-year period is absolutely astounding. What is even more impressive, however, is the fact that we have seen a snowball effect. In recent years, the rate at which we are making these life-changing discoveries has multiplied. We have witnessed firsthand countless advances in surgical and critical care intervention that were unimaginable just a few years ago. Basic science in particular is exploding. The department has invested heavily in basic science research

strong translational science program now in place, these discoveries lead to changes in how perioperative patients are managed, improving long-term outcome and quality of life. As the population ages and physicians see a higher number of patients with significant co-morbidities, the importance of anesthesia research will continue to mount. In the future, the department will continue to push the limits of modern science through support of original research concepts, recruitment of world-class research faculty, and training the clinical and basic scientists of tomorrow. Together, we are advancing the future of patient care for generations to come. DUKE

â&#x20AC;&#x192;â&#x20AC;&#x192;â&#x20AC;&#x192;61

DREAM Big. Think Big. Live Big. The Duke DREAM Campaign

LES TODD, DUKE PHOTOGRAPHY

Front Row, Left To Right: The DREAM Campaign Advisory Board—Lauren Marcilliat (Program Coordinator), Elizabeth Allardice, Kevin McNeilly, Asun Mathew, Mary Pat Heath, Peter Heath, Jeaninne Wagner, Rebecca Hinshaw, RN (President), Mary Sidney Troidl, Elizabeth Perez, RN, BSN (Director of Strategic Planning & Development) Back Row, Left To Right: Drs. Joseph Mathew and Mark F. Newman, Bud Doughton, and Drs. M. Luke James and Wei Yang (2011 DIG Grant Winners) Not Pictured: Jim Anthony, Alice Chou, Scott Cutler, Jeff Drinkard, Janeen Drinkard, Drs. Merel Harmel and Ernestine Friedl, Sheill Lieberman, Anne Lloyd, Dr. Gerald A. Maccioli, Kit McConnell, Catherine Miller, Chuck Musciano, Dr. Jerry Reves, Jon Stewart, and Edward Bennett Vinson

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Dr. Jerry Reves with Whitney Alvis and Dr. Mike Alvis

This Page: Duke Anesthesiology family and friends celebrating the kickoff of the Jerry Reves Professorship Campaign, and the official launch of the Duke DREAM Campaign

Whether you are an alumnus or alumna whose career blossomed at Duke, a current or former faculty member who was given dedicated time in the laboratory to make critical scientific discoveries, or a member of our community who relies on Duke to deliver cutting-edge techniques and top-notch clinical care to you and/or your loved ones, chances are that Duke Anesthesiology’s research program has somehow positively impacted your life. That’s because at Duke we are always looking forward. As anesthesiologists, we understand that what is done in the operating room today will have a profound effect on your future quality of life. Departmental research has revealed that details, such as the rate at which the human body is warmed after hypothermic cardiopulmonary bypass surgery, can affect a patient’s memory, attention span, and overall quality of life years later.

became known as the DREAM Campaign) soon became a departmentwide initiative. The purpose of the DREAM Campaign is to raise philanthropic support for research initiatives focused on improving patient outcome, pain management, and quality of life, as well as to establish endowed

...we empower great minds to turn dreams into reality.

The Duke DREAM (Developing Research Excellence in Anesthesia Management) Campaign was established to support Duke Anesthesiology’s research programs and initiatives. As implied by our motto, “DREAM big, think big, live big,” we empower great minds to turn dreams into reality. By encouraging the entrepreneurial spirit, unfettered imagination, and unchecked ambition, the DREAM Campaign inspires Duke Anesthesiology faculty and provides them with the wherewithal to achieve the impossible. Together with our supporters, we are transforming the future of patient care. The History of the Duke DREAM Campaign In the mid-2000s, Joseph Mathew, MD, MHSc, Jerry Reves, MD, Professor of Cardiac Anesthesiology, had the foresight to launch a philanthropic program within the Cardiothoracic Division to provide bridge funding for research and endowed professorships. He appointed Elizabeth Perez, RN, BSN, as director of strategic planning and development. Under the leadership and support of Dr. Mathew and Chair Mark F. Newman, MD, Merel H. Harmel Professor of Anesthesiology and professor of medicine, this program (which

professorships. Rather than depending solely on extramural agencies to support essential programs within the department, we place power in the hands of our community. Consequently, one of our primary objectives is to educate the public on the importance of perioperative research and highlight the influential role the anesthesiologist plays in the medical arena. As the program grew, a team of advisors was established to serve as mentors, ambassadors, and supporters of Duke Anesthesiology’s philanthropic initiatives. Today, Rebecca Hinshaw, RN, serves as advisory board president. Like many DREAM Campaign supporters, Mrs. Hinshaw is a member of the local community who has been positively impacted by the role that Duke Anesthesiology has played in her health and quality of life. Other DREAM Campaign supporters include the department’s former faculty and alumni. The Future of the DREAM Campaign Since our inception, we have encouraged innovative research ideas and programs with the capacity to generate independent federal funding. The DREAM Campaign provides support to Duke Anesthesiology in two primary ways: endowed professorships and internal grants. 63

NARAI BALAJONDA

Dr. Mihai V. Podgoreanu accepting a DIG Grant in October 2011 from Dr. David S. Warner

• Endowed Professorships: Endowed professorships, or endowed chairs, are the most prestigious faculty appointments at Duke University Medical Center made possible by generous individuals and/or families who want to invest in Duke’s legacy of excellence and create a partnership with the department to work toward a brighter tomorrow. Those who choose to establish an endowed chair are given the honor of naming it after an individual of their choice. Endowed professorships established within the Department of Anesthesiology will be awarded to the department’s most distinguished physician-scientists or used to recruit the best and brightest individuals who have exhibited both outstanding achievement and strong potential for future accomplishment. These highly coveted, permanently named memorials, promote scientific discovery and the advancement of anesthesia care. “Duke Anesthesiology has a number of endowed chairs,” explains former chair and DREAM Advisory Board member, Joseph “Jerry” Reves, MD, “and that’s what sustains the department through the years . . . to have that sort of support and effort to strengthen the fundamental wherewithal of the academic department.” It was the legacy of Dr. Reves that inspired the DREAM Campaign’s first philanthropic initiative: The Jerry Reves Professorship Campaign. In 2011, the DREAM team celebrated the naming of Dr. Mathew as the first Jerry Reves, MD, Professor of Cardiac Anesthesiology. This year, we are proud to announce our newest professorship, the Joannes H. Karis Professorship, named in honor of the legacy of one of Duke Anesthesiology’s most distinguished former faculty. The Karis Professorship has been made possible through the generous donations of the Karis family. Like the Jerry Reves Professorship, this endowment will be used as a means to attract new world-class faculty to Duke Anesthesiology for generations to come. At Duke University, the cost of funding a professorship is $2.5 million. We invite you to take advantage of this opportunity to create a permanent legacy in honor of a mentor or a loved one. • DREAM Innovation Grant (DIG): The concept behind the DREAM Innovation Grant, or DIG, is simple, yet brilliant. DIG helps Duke Anesthesiology faculty apply for, and obtain, extramural funding, provides seed money for innovative pilot studies, creates an avenue for healthy competition among faculty, inspires ingenuity, promotes the careers of young physician investigators, enhances donor communication, and furthers the department’s academic mission. First launched in 2010, DIG is an annual competition held among Duke Anesthesiology faculty members. 64

The Duke Anesthesiology Racing Team (DART) at the 2011 ASA Run for the Warriors 5K. The department won first place for raising over $13,000 to benefit Hope for the Warriors

Competitors submit their most innovative research ideas to a panel of judges for review. Proposals that demonstrate the perfect blend of ingenuity and practicality are selected, and winners are announced at the department’s annual alumni reception. Research deemed innovative may introduce a new paradigm, challenge current paradigms, look at existing problems from new perspectives, or exhibit other uniquely creative qualities. Proposals may be high-risk but should have equally high potential for reward. Furthermore, concepts must be sound, exhibiting solid rationale and direct applicability to clinical care so that the likelihood of obtaining future extramural funding is high. Another unique aspect of DIG is that it encourages the participation of both junior and senior faculty. At least one grant each year is reserved to support a junior faculty who has completed his or her residency or fellowship within the past five years. Thus, DIG helps to bridge the gap between training and progression to independent investigator status. Funding provided by DIG will support a researcher for one year, during which pilot studies can be conducted. Investigators must submit quarterly reports to track their progress. Not only do these reports give each researcher an edge over their competition when submitting National Institutes of Health (NIH) R03-like applications, but they are also shared with DREAM Campaign supporters to provide them with tangible evidence that their donations are making a difference. At the conclusion of the one-year period, a new group of DIG winners are announced, and the cycle of innovation and discovery begins again. Help us extend this opportunity to a greater number of worthy applicants. The chances are strong that your initial gift will be matched or multiplied in the future by extramural funding sources. Please consider making a donation of any amount to support this worthy cause. With a gift of $30,000, you can independently sponsor one DIG applicant. How to Give Help us continue to train the leaders of tomorrow, develop the careers of our faculty, and protect your quality of life in the years to come. To make a donation, complete the enclosed pledge envelope or visit www.gifts. duke.edu/daa to give online. Please be sure to designate your gift to “anesthesiology.” For questions or to request more information about the DREAM Campaign, please contact Mrs. Elizabeth Perez at: elizabeth.perez@duke.edu or call 919.681.2849. DUKE

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Career Reflections By Joannes “Hans” Karis, MD

My medical career began shortly after the conclusion of WWII when I entered medical school at the University of Utrecht. The influx of a large number of medical students at the end of the war resulted in a significant backlog in available clinical rotations in Holland, forcing me to pursue an internship in the United States. I chose a rotating internship at New York City Hospital at the recommendation of one of my professors, who had visited Cornell University’s City Hospital of New York and encouraged me to pursue that option. When I arrived in New York, I found that New York City Hospital was, in fact, an understaffed indigent care hospital, not the City Hospital of New York that my professor had mistakenly recommended. I made the best of a very difficult rotating internship and then did a year of general surgery training at Kings County Hospital in Brooklyn. After my initial training in New York, I returned to Holland to fulfill my mandatory military service and complete the Dutch medical license process through the University of Leiden. I returned to Kings County Hospital in 1957 to complete my residency in anesthesiology. Afterward, I joined the faculty at Columbia Presbyterian Hospital in Manhattan, where I spent a total of 15 years. During this time, I became the director of one of the world’s first surgical intensive care units and pursued basic science research to understand the underlying physiologic mechanisms of neuromuscular blockade agents. In 1975, my close friend and mentor whom I had first met at Kings County Hospital, Dr. Merel H. Harmel, recruited me to Duke, where I spent the final 18 years of my career doing cardiac anesthesia. I loved the sense of university community that Duke engendered, and I developed a particular pride and affection for this phase of my life. I became involved with the development of physiologic monitoring for the operating rooms and was able to collaborate in the development of the Duke Automated Monitoring Equipment (DAME).

color-coded lines and additional lines were added during the course of the case. Another interesting case occurred when I was in the OR hallway, and there was a “Code Blue” called for an operating room across the hall. The patient was being operated upon in the prone position and had been accidentally extubated during the case. A junior anesthesia attending who was covering the case was struggling to get the patient reintubated. I entered the room to help and proceeded with the most unusual intubation of my career—replacing the endotracheal tube while upside down and under the table! Duke University also afforded me the opportunity to create an exhibit entitled “Triumph Over Pain” at The 1982 World’s Fair in Knoxville, Tennessee. I worked with anesthesia equipment manufacturers and Dr. William Sudduth of the North Carolina Museum of Life and Science to illustrate the history of anesthesia from the first anesthesia delivered by Drs. Crawford Long and Horace Wells through the development of state-of-the-art gas machines and monitoring equipment. During my final years at Duke, I represented the university as a volunteer with Project Hope to help develop cardiac anesthesia at university hospitals in Krakow, Poland, and Hangzhou, China.

I loved the sense of university community that Duke engendered...

While at Duke, I worked with a stellar team of operating room colleagues. One of my most interesting clinical cases was in 1978 when Dr. Edmond Bloch and I successfully separated 10-day-old thoracic conjoined twins. The case had two anesthesia teams, one led by me and color coded with yellow tape, and the other team, led by Dr. Bloch, that was color-coded blue. Each twin started with 14

I now reside in Phoenix, Arizona, with Martha, my spouse of 55 years. We have two children, both of whom pursued teaching careers in medicine. My daughter Margaret is an attending in infectious diseases at Yale University, and my son John is a neuroradiologist at the Barrow Neurological Institute in Phoenix, Arizona. My wife and I hope that our sponsorship of an endowed chair within the Duke University Department of Anesthesiology will help to build on the phenomenal level of research, teamwork, patient care, and physician education with which I am honored and proud to be affiliated. DUKE

LAUREN MARCILLIAT

The Next Forty Years of Duke Anesthesiology

Above: Construction of a new state-of-the-art Cancer Center and Duke Medicine Pavilion, a major expansion of surgery and critical care services at Duke University Hospital Photo taken in January 2012

Duke Anesthesiology has an incredibly broad sphere of influence. What began here in Durham has spread not only across the nation, but also across oceans, to countries all around the globe. Our research efforts have impacted those who explore the depths of the ocean, those who brave the heights of Mount Everest, and so much in-between. The department’s influence is, quite literally, out of this world, thanks to collaboration with the National Aeronautics and Space Administration (NASA). Furthermore, we treat an exceedingly broad patient population—from the unborn child to the geriatric—across the spectrum of human injury 66

and illness. It seems there are no limits to Duke Anesthesiology’s outrageous ambition. The astonishing growth the department has enjoyed in the past 40 years can be credited to a steadfast dedication to our department’s mission: Extraordinary care through a unique culture of innovation, education, research, and professional growth. This shared vision and the passion that fuels it have led Duke Anesthesiology to its rightful place among the greatest anesthesiology departments in the world. As we look to the next 40 years of Duke Anesthesiology, we will continue to fulfill our mission in the following ways:

Extraordinary Care • We will continue to be compassionate clinicians and treat our patients with respect and dignity. • We will continue to pursue cutting-edge basic, translational, and clinical research, which will directly impact patient care and quality of life. • We will be leaders in pain management, and will continue to explore the connection between acute and chronic pain, and find new ways to combat its devastating outcome.

BluePrint

• We will continue to refine and analyze our patient outcome databases to identify the many long-term effects of anesthesia and surgery on the human body. • We will find ways to facilitate better patient recoveries, shorter hospital stays, and fewer complications by mastering cuttingedge techniques, particularly regional anesthesia techniques. • We will actively seek out patient populations in great need and develop unique approaches to treat these individuals through our global initiatives and dedicated programs, such as the Veteran’s Injury Pain Research (VIPR) initiative to support wounded war heroes. • We will make the most of the many exciting new facilities that are currently under construction on Duke’s campus and will be good stewards of our resources so that we can develop these centers to their full potential. A Unique Culture of Innovation • We will cherish the spirit of ingenuity that is a part of Duke Anesthesiology’s legacy and will allow this spirit to permeate every aspect of what we do professionally, particularly in our education and research programs. • We will pioneer new technologies and refine those already in use, such as transesophageal echocardiography (TEE), ultrasound for regional anesthesia, and continuous peripheral nerve blocks. • We will recruit trainees and faculty who exhibit creativity and ambition. • We will continue to develop programs that reward and inspire our faculty, such as the department’s annual DREAM Innovation Grant (DIG). Education • We will empower the leaders of tomorrow through our educational programs and constantly explore new ways to enhance these programs. • We will continue to mentor physician scientists who share our passion for solving problems and for discovering new approaches to patient care through innovative programs, such as Academic Career Enrichment Scholars (ACES) and NIHfunded training grants, which inspire medical students, residents, and fellows alike.

• We will be leaders in educational technology and will continue to explore the power of interactive games and simulation that are made possible by departmental programs and centers like the Human Simulation and Patient Safety Center (HSPSC).

Safety Center of Inquiry (PSCI), and new protocols, such as the Enhanced Recovery After Surgery (ERAS) program. • We will continue to expand to off-site locations, as we have done at Durham Regional Hospital and Duke Raleigh Hospital.

Research • We will identify new ways to protect the body’s vital organs and systems from response to various forms of disease, injury, and stress that may compromise a patient’s health and wellbeing. • We will improve quality of life by reducing the incidence of negative outcomes, such as postoperative nausea and vomiting, and cognitive decline. • We will optimize drug development and delivery through investments in our Human Pharmacology Lab that will yield a better understanding of perioperative pharmacodynamics and pharmacokinetics. • We will gain insight into the health and homeostasis of the human body through study of free radical biology, oxygen biochemistry, and mitochondrial function. • We will make breakthroughs in perioperative genomics and identify new genetic variants associated with perioperative adverse events. • We will seek to advance our knowledge of the nuances of neuroplasticity and the various mechanisms by which acute pain can develop into chronic pain. • We will continue to explore the role of anesthesia in perioperative morbidity and mortality through an expansion of perioperative databases. We will improve patient safety through better teamwork, communication, and standardization of clinical practices. Professional Growth • We will treat one another with kindness and respect, and help our colleagues develop their careers. • We will mentor leaders of tomorrow.

• We will demonstrate the value the anesthesiologist brings to the medical field through innovation, research, and the anesthesia care team model. • We will collaborate with advanced practice providers to make anesthesia and analgesia safer for our patients. • We will recruit and retain world-class faculty through endowed professorships and philanthropic organizations like the Developing Research Excellence in Anesthesia Management (DREAM) Campaign. We are filled with pride as we reflect on our distinguished past. We honor the leaders of the past and those who have left Duke to lead elsewhere, looking to them as a source of knowledge as we learn from both their challenges and successes. We are filled with excitement as we experience our present, because of the work of our current faculty members as well as the accomplishments of over 1,000 alumni and former faculty in both private practice and academia who are a part of our family. We are filled with optimism as we look to our future. Some may claim that our goals are too ambitious, pointing to the many foreseeable challenges, such as the mounting cost of national healthcare, impending healthcare reform, and an ever-increasing patient population. At Duke, however, we believe that it is this very ambition that will ensure our future success. Like those who came before us, we will greet this change with open arms, using it as a catalyst to propel the department forward. With our mission to guide us, and our passion to sustain us, we will take control of our own destiny. There are no limits to what can be achieved in the next 40 years of Duke Anesthesiology. Our story has only just begun. DUKE

• We will improve patient safety by enhancing teamwork, communication, and standardization of clinical programs through the development of new centers, such as the VAMC’s Patient

40th Anniversary Donors Lifetime DREAM Campaign supporters, and those who gave between July 1, 2010 and February 29, 2012

Dr. John Aladj Alcoa Foundation Drs. Aaron and Genevieve Ali Mr. and Mrs. Robert D. Allardice Dr. and Mrs. Mike Alvis Mr. and Mrs. James I. Anthony, Jr. Dr. Paul G. Barash Dr. Elliott B. Guerrero and Mrs. Karin Bagin Dr. and Mrs. Jerry J. Berger Dr. and Mrs. Arthur Francis Bergh Mr. and Mrs. John Borrelli Dr. Randall P. Brewer Dr. Thomas Buchheit Dr. and Mrs. Robert McKinnon Califf Dr. Enrico M. Camporesi Dr. and Mrs. James Caswell Dr. James J. Chien and Dr. Michelle W. Lau Mr. and Mrs. Paul C. Chou Mr. Tim Clancy Dr. Thomas H. Collawn Drs. Steven and Anna Crowley Dr. and Mrs. Jonathan Davidson Dr. Guy DeLisle Dear Ms. Sabrina S. Deaver Ms. Joanne Doberstein Mr. and Mrs. James H. Doughton Dr. and Mrs. Jeff Drinkard Dr. and Mrs. Peter Dwane Mr. John E. Ellis Mrs. Margaret D. Fikrig Dr. and Mrs. Anthony Fister Dr. Ellen Flanagan Dr. and Mrs. Paolo Flezzani Dr. Cory Furse Dr. Angelo V. Gagliano Dr. Tong Joo Gan Dr. and Mrs. Lynn Darcy George Dr. Mark Allen Gerhardt Dr. Josef P. Grabmayer Dr. William J. Greeley and Ms. Cece M. Fortune Greeley Dr. Alina and Mr. Sorin Grigore Dr. Nicolas Guillard Halifax Anesthesiology Associates Dr. and Mrs. Jon Halling Dr. and Mrs. H. David Hardman Drs. Merel H. Harmel and Ernestine Friedl Ms. Tara L. Harris, Lowenhupt Global Advisors L.L.C. Mr. and Mrs. Peter R. Heath

Dr. and Mrs. Steven Ellis Hill Mr. and Mrs. Eric Hinshaw Dr. Scott Howell and Mrs. D. Ann Taylor Dr. Billy Huh and Dr. Sabina M. Lee Dr. Richard Ing Dr. Paul M. Jaklitsch and Mrs. Aiki N. Burdett Dr. and Mrs. Luke James Dr. Cheryl Jones Dr. and Mrs. David Joseph Dr. and Mrs. John P. Karis Dr. and Mrs. Joannes H. Karis Mr. Timothy L. Kearby Dr. Christopher M. Kerr Dr. and Mrs. Stephen M. Klein Dr. Catherine Kuhn Dr. and Mrs. Stephen Kushins Dr. and Mrs. Michael Henry Lasecki Dr. Labrini C. Liakonis Ms. Shelli P. Lieberman Dr. Steve F. Lipson Mrs. Anne Lloyd Dr. and Mrs. Walker A. Long Dr. Andrew G. Lutz Drs. G. B. Mackensen and Jutta von Stieglitz Dr. and Mrs. Darryl Evan Malak Mr. and Mrs. Kevin Marcilliat Dr. and Mrs. Jonathan B. Mark Mr. Samuel Mathan Dr. and Mrs. Joseph P. Mathew Mr. and Mrs. John P. McConnell Drs. David L. McDonagh and Anne Tuveson Dr. and Mrs. Charles H. McLeskey Mr. and Mrs. Steven K. Miller Dr. and Mrs. Richard Edward Moon Dr. Eugene W. Moretti Dr. and Mrs. Steven Morozowich Dr. Stephen Murphy Dr. and Mrs. Mark Franklin Newman Mrs. Gloria R. Newman Dr. Alina Nicoara Dr. Nathaniel P. Nonoy and Dr. Julie L. Adams Dr. Ronald Osborn Dr. John V. Parham, Jr. Ms. Helen M. Pavilonis Mr. and Mrs. Philip Perez Dr. Ann M. Pflugrath Dr. Keith Norris Phillippi Dr. and Mrs. Mihai Podgoreanu Dr. and Mrs. Anthony Pollizzi Mr. and Mrs. Francis T. Quinn, Jr.

Dr. Nathan Marc Rachman Dr. Atif Raja Mr. and Mrs. Bill Ray Dr. and Mrs. Lloyd F. Redick Dr. and Mrs. Joseph G. Reves Dr. Allison K. Ross Dr. Michael W. Russell Dr. Randall M. Schell Dr. and Mrs. David B. Schinderle Dr. Debra A. Schwinn and Dr. Robert H. M. Gerstmyer Dr. Paul R. Shook Dr. Ralph Snyderman Dr. Donat R. Spahn Dr. Mark Stafford Smith Dr. Thomas E. Stanley III and The Reverend Ashley Ashley Crowder Stanley Mr. and Mrs. Jon Stewart Ms. Sarah L. Stogner Dr. Timothy E. Sweeney Col. and Mrs. James M. Temo Dr. Christopher A. Thunberg Dr. Paul A. Vadnais Dr. and Mrs. Anil M. Vyas Mr. and Mrs. John Wagner Dr. Natalie Wang Dr. and Mrs. David S. Warner Dr. Deryl Hart Warner Dr. Gregory J. Waters Dr. and Mrs. Stanley W. Weitzner Dr. and Mrs. Ian Welsby Dr. and Mrs. Andrew R. Wiksten Dr. McKim Williams Mr. and Mrs. John D. Wolfe Dr. Richard Lee Wolman Dr. David Wright Dr. Daniel Jude Yousif