DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT

DEPARTMENT OF ANESTHESIOLOGY 

Duke University Medical Center 

2000 

ANNUAL 

REPORT


Department of Anesthesiology

This issue is dedicated to the memory of 

WILLIAM JAMES MURRAY,M.D.,PH.D. 

1933 – 2000 

Dr. Murray served on our faculty from 1972, when he was recruited from the University of Michigan, until the morning of his 

death December 6. In fact, Dr. Murray died on his way to attend the Grand Rounds at which Dr. Bruno Urban was honored on 

the occasion of his retirement. This faithful attendance at all Departmental meetings and interest in all Departmental matters 

characterized Dr. Murray. There has never been anyone who paid so much attention to the broad spectrum of activities of our 

department’s many activities and publications as Dr. Murray. During his long academic career at UNC, Michigan, and Duke he 

touched countless numbers of students, medical and anesthesiology residents. All can recall the attention to detail he gave to 

every patient he cared for, to every anesthetic he administered, to every committee he served on and to every task he so willingly 

undertook. The last several years of Dr. Murray’s service were spent representing our department at the various committees 

that make hospitals and medical centers work. His work in these accounted for many of the institutional changes and improvements 

in such areas as Pharmacy, Curriculum and Resuscitation. Despite the heavy committee obligations, he maintained a 

keen interest in patients and patient care at Duke Hospital. These interests inevitably led to improved patient care: this, in fact, 

was the work of his whole life—finding and implementing better ways to care for our patients. Dr. Murray will be greatly 

missed by his family, our department and his church—to whom he was immensely loyal and committed—and all of whom 

benefited immeasurably from this full devotion.

FOREWORD 

Upon reflection, the year 2000 has been much like those of the last ten years for the Department of 

Anesthesiology of Duke University. Everywhere one looks one sees commitment—not self-absorbed 

egomaniacal, but individual work that reaches beyond the corpus of all who learn and labor here— 

there is a more grand aim, a collective spirit of determination to reach goals of excellence in all that 

we do. And we have reached and exceeded even our own expectations—those most high among 

all others. 

How have we done it? We have remarkable people, professionals in the best sense of the word, 

who put their patients and their colleagues first among all priorities. We have created a team named 

the Anesthesiology Department that succeeds in patient care, teaching, research administration and 

tolerance of the many ideas, personalities and diverse interests of our diverse Departmental members. 

We are a mature Department now, secure in the knowledge that we know how to succeed. We have 

learned, we have grown in statue and are a national leader—others follow our example. Lessons we 

have learned are not forgotten they live in us all and we use them every day to continue our quest 

for even greater achievement. 

It has been a privilege to watch this metamorphosis from the sidelines—occasionally entering into 

the fray, but more often consulting, cheering, consoling, and exhorting—always knowing that we would 

exceed our loftiest goals because we had that intangible gift to succeed as a great department, not 

as great individuals. Of course,it takes great individuals to accomplish these things, but it is the teamwork 

that has allowed us to do it all so well. The future is bright and secure as long as this spirit 

is preserved. 

My 17 years at Duke have been gratifying, because of the achievements of everyone. In a recent 

interview I was asked what has been “your most satisfying accomplishment”and the answer came 

reflexly:“My greatest joy has been watching those around me grow and accomplish things they didn't 

think they could do.” As I leave Duke I will always look back on the best group I have ever been 

associated with—you made us all look so good! And I will forever cherish this time together. I’m 

confident that next year’s annual report will contain even better works than all that have gone before. 

This is the progress that Duke Anesthesiology stands for. Congratulations and Godspeed.

DUKE DEPARTMENT OF ANESTHESIOLOGY 

MISSION 

The Mission of this Department is to provide the highest quality patient care and engage 

in superior academic pursuits through excellence in teaching and research. Aspiring to our 

goal is a team of skilled anesthesia professionals with different educational backgrounds and 

unique abilities who embrace collaborative, collegial and complementary relationships. 

Specific Departmental goals are: 

To deliver first rate patient care in operating, labor and delivery rooms, postanesthetic 

and intensive care units, the hyperbaric center and perioperative activities (including surgical 

screening clinic and acute pain management). 

To provide consultant services for preoperative and postoperative care. 

To coordinate a multidisciplinary approach in diagnosis and treatment of acute 

and chronic pain disorders. 

To provide leadership and administrative support in organizing operating rooms, 

intensive care units, ambulatory surgery, transesophageal echocardiography service, 

hyperbaric and heart centers. 

To determine methods to assess quality care assurance, develop programs to facilitate 

cost effectiveness and enhance operating room efficiency. 

To promote an environment supportive of learning and growth,in which each departmental 

member serves as an appropriate professional role model. 

To enlarge knowledge through vigorous investigative laboratory and clinical 

research programs. 

To conduct all professional matters in an ethical manner in order to bring pride and honor 

to the Anesthesia Department and fellow Duke Medical Center colleagues.

Department of Anesthesiology Mission . . . . . . . . . . . . . 4 

Faculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 

Past Anesthesiology Chairs . . . . . . . . . . . . . . . . . . . . . . . 19 

Affiliated Faculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 

Anesthesiology Scholars . . . . . . . . . . . . . . . . . . . . . . . . 24 

Anesthesiology Residents . . . . . . . . . . . . . . . . . . . . . . . 26 

Interns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 

CA-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 

CA-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 

CA-3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 

Anesthesiology Fellows . . . . . . . . . . . . . . . . . . . . . . . 31 

Certified Registered Nurse Anesthesia Staff . . . . . . . . . 32 

Anesthesia Chairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 

Clinical Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 

Ambulatory Anesthesiology . . . . . . . . . . . . . . . . . . . . 41 

Cardiac Anesthesiology . . . . . . . . . . . . . . . . . . . . . . . 44 

Certified Registered Nurse Anesthesia . . . . . . . . . . . 47 

Critical Care Medicine . . . . . . . . . . . . . . . . . . . . . . . . 49 

General, Vascular, Urology and Transplant . . . . . . . 52 

Environmental Physiology 

and Hyperbaric Medicine . . . . . . . . . . . . . . . . . . . . 53 

Orthopaedics, Plastics and Regional 

Anesthesiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 

Otolaryngology, Head, Neck and 

Neuroanesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 

Pain and Pain Management . . . . . . . . . . . . . . . . . . . 62 

Pediatric Anesthesia and 

Pediatric Critical Care Medicine . . . . . . . . . . . . . . 65 

Veterans Affairs Anesthesia 

and Perioperative Medicine . . . . . . . . . . . . . . . . . . 67 

Women’s Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . 70 

Biostatistics and Clinical Outcomes . . . . . . . . . . . . . . . .72 

Divers Alert Network . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 

CONTENTS 

Departmental Committees . . . . . . . . . . . . . . . . . . . . . . . 75 

Division Chiefs and Committee Chairpersons . . . . . . . . 77 

Thirteenth Duke University Medical Center 

Anesthesiology Alumni Reception - 

San Francisco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 

Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 

Lectures, Conferences and Didactics . . . . . . . . . . . . 84 

Eighth Academic Evening . . . . . . . . . . . . . . . . . . . . . 98 

Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 

Support Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 

Clinical Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 

Laboratory Research . . . . . . . . . . . . . . . . . . . . . . . . . . .113 

Research Grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114 

Laboratory Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 

Gerontological Research in Anesthesiology 

and Surgery Program (GRASP) . . . . . . . . . . . . . . . 125 

Research Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 

Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 

Editorial Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 

Anesthesiology in the News . . . . . . . . . . . . . . . . . . . . . 142 

History of Anesthesiology . . . . . . . . . . . . . . . . . . . . . . 144 

GRAPHS 

Cases by Divisions/Sections . . . . . . . . . . . . . . . . . . . . . . 45 

Anesthesiology Research Dollars . . . . . . . . . . . . . . . . 112 

NIH Grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 

Dollar Amounts . . . . . . . . . . . . . . . . . . . . . . . . . . . .116 

Ranking from #1 Position . . . . . . . . . . . . . . . . . . . . 116

FACULTY, RESIDENTS, FELLOWS, AND CRNAS 

DEPARTMENT OF ANESTHESIOLOGY, DUKE UNIVERSITY MEDICAL CENTER, 2000 

(First Row Left to Right) Cathleen L. Peterson-Layne, M.D., Ph.D.; Julie Z.Woosley, M.D.; Russel L. Jacobe, M.D.;Tarsha V. Garvin, M.D.; G. Burkhard Mackensen, M.D.; Robert R. Panten, M.D.; Gayle P.Moyer, 

CRNA, BSN, MS (Second Row Left to Right) Peter S. Baek, M.D.; Christopher M. Kerr, M.D.; David A. Lubarsky, M.D., M.B.A.; J.G. Reves, M.D.; Merel H. Harmel, M.D.; Richard E. Moon, M.D., C.M., M.Sc., 

FRCP(C), FACP, FCCP; William J. Murray, M.D., Ph.D.; Jacques Somma, M.D., FRCP(C); Madan M. Kwatra, Ph.D. (Third Row Left to Right) Ivan T. Demchenko, D.Sc.; Dana N.Wiener, M.D.; John C. Keifer, 

M.D.; Bruno J. Urban, M.D., Dr.med.; Billy K. Huh, M.D., Ph.D.; Karen C. Nielsen, M.D.; Narda D. Croughwell, CRNA; Kerri M. Robertson, M.D., FRCP(C); George N. Djaiani, M.D., D.A., DEAA, FRCA; Lian K.Ti, 

M.B., B.S. (Fourth Row Left to Right) Alina M. Grigore, M.D.; John T. Moloney, M.B., B.S.; Mark Stafford Smith, M.D., C.M., FRCP, DABA; Catherine K. Lineberger, M.D.; Elizabeth A. Bell, M.D., MPH; Kathryn 

P. King, M.D., MSN; Adeyemi J. Olufolabi, M.B., B.S., FRCA; Allison K. Ross, M.D.; David B. MacLeod, M.B., B.S., FRCA; H. David Hardman, M.D., M.B.A.; Janet E. Gorel, CRNA (Fifth Row Left to Right) Allan 

B.Shang,M.D.; Daniel D.DeMeyts,M.D.;Thomas O.Erb,M.D.,F.M.H.; Peter D.Dwane,M.D.,C.M.,FRCP(C); Christopher C.Young,M.D.;Andrew K.Hilton,M.B.,B.S.,FANZCA;Yoazhi Wang,M.D.; Huaxin Sheng, 

M.D.; Mark F. Newman, M.D.; Paula D.Alford, CRNA; Leslie A. Cline, CRNA; Mack E. Haddock, CRNA; Jonathan B. Mark, M.D. (Sixth Row Left to Right) Donald K.Thomas, CRNA; Eugene W. Moretti, M.D.; 

Deborah J.Ferrero-Conover,CRNA,MSN; Holly A.Muir,M.D.,FRCP(C); John R.Schultz,M.D.; David H.Gleason,CRNA; Robert E.Foy,CRNA; David R.Wright,M.B.,Ch.B.; John A.C.Murdoch,M.B.,Ch.B.,B.Sc.; 

John F. Pierce, CRNA;Timothy O. Stanley, M.D.; John B. Eck, M.D.; David B. Schinderle, M.D. (Seventh Row Left to Right) Bo Wu, M.D.; James M.Temo, CRNA, MSN, M.B.A.; Dianne L. Scott, M.D.; David D. 

Lee,CRNA,BSN;Terrence W.Breen,M.D.,FRCPC; Ronald P.Olson,M.D.,CCFP (Eighth Row Left to Right) Ellen M.Lockhart,M.D.; Laura J.Kihlstrom,M.D.; Matthew T.Taylor,M.D.;William P.Norcross,M.D.; 

Garrett W.Scales,M.D.; Donald H.Penning,M.Sc.,M.D.; Laura E.Niklason,M.D.,Ph.D.; B.Will Curtis,M.D.; Scott E.Helsley,M.D.,Ph.D.; Marcella J.Lauzinger,M.D.; Jeffery M.Taekman,M.D.; Kurt J.Knauth,M.D.; 

Randy P. Brewer, M.D.; James R. McCurdey, M.D.; Chiedozie I. Udeh, M.B., B.S.; Thomas E. Buchheit, M.D.; Alison Taylor, P.A.C.; Lisa J. Schwetschenau, CRNA, MNA (Ninth Row Left to Right) John T. Sum 

Ping, M.B., Ch.B., FRCA; Holly A.Williams-Davis, M.D.; Anne Marie Fras, M.D.; Evelyn M. DeRoche, CRNA; Dale Potter; Jason R. Burke, M.D.

Nadia M. Agopyan, Ph.D. 

Assistant Research Professor in 

Anesthesiology 

Elizabeth A. Bell, M.D., M.P.H. 

Assistant Professor of Anesthesiology 

Associate in the Department of Obstetrics 

and Gynecology 

John V. Booth, M.B., Ch.B., FRCA 


FACULTY 

Barry W. Allen, Ph.D. 



Peter B. Bennett, Ph.D., D.Sc. 

Professor of Anesthesiology 

Cecil O. Borel, M.D. 

Associate Professor of Anesthesiology 

Associate Professor in Surgery 

(Neurosurgery) 

Daniel T. Bainbridge, M.D., B.Sc.Med. 

Visiting Associate in the Department of 


Helene D. Benveniste, M.D., Ph.D. 


Assistant Professor of Neurobiology 

Assistant Research Professor of Radiology 

Terrence W. Breen M.D., FRCPC 


FACULTY 5

FACULTY 

Thomas E. Buchheit, M.D. 

Clinical Associate in the Department of 


Robert L. Coleman, M.D. 

Assistant Clinical Professor of 


Francine J. D’Ercole, M.D. 



6 FACULTY 

Alexis C. Carmer, M.D. 

Associate in the Department of 


Guy deLisle Dear, M.B., FRCA 

Associate Clinical Professor of 


Peter D. Dwane, M.D., C.M., FRCP(C) 





Fiona M. Clements, M.D. 

Clinical Professor of Anesthesiology 

Assistant Clinical Professor of Medicine 

Norbert P. DeBruijn, M.D. 

Clinical Professor of Anesthesiology 

Associate Clinical Professor of Surgery 

Assistant Clinical Professor in Medicine 

John B. Eck, M.D. 

Assistant Professor of Anesthesiology

John G. Ellingham, M.B., B.S., FANZCA 



Anne Marie Fras, M.D. 



Charles R. Garcia-Rodriguez, M.B., B.S. 



Thomas O. Erb, M.D., F.M.H. 



Maribel G. Gamoso, M.D. 



Sheila F. Gardner, M.D. 



Jennifer T. Fortney, M.D. 



FACULTY 

T. J. Gan, M.B., B.S., FRCA 


Brian Ginsberg, M.B., Ch.B. 


FACULTY 7

FACULTY 

Joel S. Goldberg, M.D. 


Roy A. Greengrass, M.D., FRCP(C) 



Hilary P. Grocott, M.D., FRCP(C) 


8 FACULTY 

Veerainder Goli, M.D., FAAPM, BCFE 



Assistant Professor of Psychiatry and 

Behavioral Sciences 

Katherine P. Grichnik, M.D., MS 


Ashraf S. Habib, M.B., B.Ch., MSc., 

FRCA 



Stuart Alan Grant, M.B., Ch.B. 



Alina M. Grigore, M.D. 



H. David Hardman, M.D., M.B.A. 


Anesthesiology

Andrew J. Hartle, M.B., Ch.B., FRCA 



Lewis R. Hodgins, M.D. 


Assistant Professor of Surgery 

Brian M. Ilfeld, M.D. 



Steven E. Hill, M.D. 



Billy K. Huh, M.D., Ph.D. 



Richard J. Ing, M.B., Ch.B., FA(SA) 



FACULTY 

Andrew K. Hilton, M.B., B.S., FANZCA 



Peter C. Huttemeier, M.D., Ph.D., M.B.A. 



Assistant Clinical Professor in 

Ophthalmology 

Francis J. Keefe, Ph.D. 

Professor in Anesthesiology 

Professor of Psychiatry and Behavioral 

Sciences 

FACULTY 9

FACULTY 

John C. Keifer, M.D. 



Stephen M. Klein, M.D. 


Madan M. Kwatra, Ph.D. 

Associate Professor in Anesthesiology 

Assistant Professor of Pharmacology and 

Cancer Biology 

10 FACULTY 

Frank H. Kern, M.D., FCCM 


Professor of Pediatrics 

Nancy W. Knudsen, M.D. 



Assistant Clinical Professor in Surgery 

Daniel T. Laskowitz, M.D. 

Assistant Professor in Anesthesiology 

Assistant Professor of Medicine 

Kathryn E. King, M.D., MSN 



Shashidhar H. Kori, M.D. 

Associate Clinical Professor in 


Associate Professor of Medicine 

David R. Lindsay, M.D. 


Anesthesiology

Catherine K. Lineberger, M.D. 


David A. Lubarsky, M.D., M.B.A. 


Raman Madan, M.B., B.S., D.A., FFARCS, 

MRCP(I) 



Lieju Liu, M.D., M.B., MS 



G. Burkhard Mackensen, M.D. 



Jonathan B. Mark, M.D. 


Assistant Professor in Medicine 

Ellen M. Lockhart, M.D. 



FACULTY 

David B. MacLeod, M.B., B.S., FRCA 



Gavin Martin, M.B., Ch.B., FRCA 



FACULTY 11

FACULTY 

Joseph P. Mathew, M.D. 


Andrew F. Meyer, M.D., M.B.A. 



Assistant Clinical Professor of Surgery 

(Urology) 

Eugene W. Moretti, M.D. 



12 FACULTY 

Brian J. McCreath, M.B., Ch.B. 



Gregory A. Michelotti, Ph.D. 

Assistant Research Professor of 


Holly A. Muir, M.D., FRCP(C) 




Jonathan M. Meliones, M.D., FCCM 


Associate Professor of Pediatrics 

Richard E. Moon, M.D., C.M., M.Sc., 

FRCP(C), FACP, FCCP 



John A.C. Murdoch, M.B., Ch.B., B.Sc. 


Anesthesiology

William J. Murray, M.D., Ph.D. 


Laura E. Niklason, M.D., Ph.D. 


Assistant Professor of Biomedical 

Engineering 

Assistant Professor in Surgery 

Robert R. Panten, Jr., M.D. 



Mark F. Newman, M.D. 



Ronald P. Olson, M.D., CCFP 



Assistant Professor of Community and 

Family Medicine 

Stephen J. Parrillo, M.D. 



Karen C. Nielsen, M.D. 



FACULTY 

Adeyemi J. Olufolabi, M.B., B.S., FRCA 



Donald H. Penning, M.Sc., M.D. 


Assistant Professor in Obstetrics and 

Gynecology 

FACULTY 13

FACULTY 

Claude A. Piantadosi, M.D. 


Professor of Medicine 

James D. Reynolds, Ph.D. 


Iain C. Sanderson, B.M., B.Ch., M.A., 

M.Sc., FRCA 



14 FACULTY 

Ziaur Rahman, M.B., B.S. 



Assistant Clinical Professor of Surgery 


Kerri M. Robertson, M.D., FRCP(C) 



Scott R. Schulman, M.D. 


Associate Professor of Pediatrics 

J. G. Reves, M.D. 

Professor and Chairman of Anesthesiology 

Allison K. Ross, M.D. 


John R. Schultz, M.D. 


Anesthesiology

Debra A. Schwinn, M.D. 


Professor in Surgery 

Professor of Pharmacology and Cancer 

Biology 

Peter Sebestyen, D.V.M. 

Associate in Research in Anesthesiology 

Thomas F. Slaughter, M.D. 


Dianne L. Scott, M.D. 



Huaxin Sheng, M.D. 



Jacques Somma, M.D., FRCP(C) 


Mark W. Sebastian, M.D. 



FACULTY 

Sidney A. Simon, Ph.D. 


Professor of Neurobiology 

Guatam M. Sreeram, M.D. 



FACULTY 15

FACULTY 

Mark Stafford-Smith, M.D., C.M., FRCP, 

DABA 


Bryant W. Stolp, M.D., Ph.D. 


Associate in the Department of Cell Biology 

Madhav Swaminathan, M.D. 



16 FACULTY 

Timothy O. Stanley, M.D. 



Hagir B. Suliman, D.V.M., M.V.Sc., Ph.D. 



Jeffrey M. Taekman, M.D. 


Susan M. Steele, M.D. 



John T. Sum Ping, M.B., Ch.B., FRCA 


Barbara E. Tardiff, M.D., MS, M.Phil. 

Assistant Professor of Anesthesiology

Edward D. Thalmann, M.D. 



Assistant Clinical Professor of Community 

and Family Medicine 

Steven N. Vaslef, M.D., Ph.D. 


Assistant Professor of Surgery and 

Biomedical Engineering 

Dana N. Wiener, M.D. 



Bruno J. Urban, M.D., Dr.med. 


Associate Professor in the Department of 

Psychiatry and Behavioral Sciences 

Assistant Professor of Surgery (Neurosurgery) 

David S. Warner, M.D. 


Professor in Neurobiology 

Professor of Surgery 

David R. Wright, B.M., FRCA 



Richard D. Vann, Ph.D. 



FACULTY 

Ian J. Welsby, M.B.B.S., BSc., FRCA 



Bo Wu, M.D. 



FACULTY 17

FACULTY 

Christopher C. Young, M.D., FCCM 



McGovern-Davison Children’s Health Center 

18 FACULTY 

NOT PICTURED 

George N. Djaiani, M.D., FRCA 

Visiting Associate in the Department 

of Anesthesiology 

Adeyemi J. Olufolabi, M.B., B.S., FRCA and 

J. G. Reves, M.D.

DEPARTMENT OF ANESTHESIOLOGY, DUKE UNIVERSITY 

MEDICAL CENTER CHAIRS 

Sara J. Dent, M.D. 

Professor and Chair of Anesthesia, Duke Hospital 

1968-1971 

W. David Watkins, M.D., Ph.D. 

Professor and Chair, Department of Anesthesiology 

1983-1990 

Merel H. Harmel, M.D. 


1971-1983 


Professor and Interim Chair, Department of Anesthesiology 

1990-1991 


1991-2001 

19

20 FACULTY 

DUKE UNIVERSITY HEALTH SYSTEM 

AFFILIATED MEDICAL FACULTY 

Richard L. Jacobs II, M.D. 



Person County Memorial Hospital 

Roxboro, North Carolina 

Person County Memorial Hospital 

Roxboro, North Carolina

David S. Bacon, M.D. 

Consulting Associate in the Department of 


Durham Regional Hospital 

Durham, North Carolina 

Randall L. Carpenter, M.D. 

Adjunct Associate Professor of 


ASTRA USA, Inc. 

Westborough, Massachusetts 

James M. Chimiak, M.D. 



Naval Aerospace, an Operational Institute 

Pensacola, Florida 

AFFILIATED FACULTY 

John D. Buckwalter, M.D. 

Assistant Consulting Professor of 




James L. Caruso, M.D. 



U.S. Naval Hospital 

Pensacola, Florida 

John J. Freiberger, M.D. 



Chapel Hill, North Carolina 

Frederick J. Carpenter, Jr., M.D. 





Kwen-Jen Chang, Ph.D. 

Adjunct Professor in Anesthesiology 

Delta Pharmaceutical, Inc. 

Research Triangle Park, North Carolina 

Wayne A. Gerth, Ph.D. 

US Navy Experimental Diving Unit 

Panama City, Florida 

FACULTY 21


Scott T. Howell, MS, M.D. 

Assisting Consultant Professor of 


Scranton, Pennsylvania 

Fritz F. Klein, Ph.D. 

Adjunct Assistant Professor of 




Gerald A. Maccioli, M.D., FCCM 



Raleigh Community Hospital 

Raleigh, North Carolina 

22 AFFILIATED FACULTY 

James R. Jacobs, M.D., Ph.D. 



Carolinas Medical Center 

Charlotte, North Carolina 

Judith O. Margolis, M.D. 



North Carolina Eye and Ear Institute 


Edward B. McKenzie, Jr., M.D. 





Moyra E. Kileff, M.D. 





Mohammad Maroof, M.B., B.S., FFARCSI 



University of North Carolina, Chapel Hill 

Chapel Hill, North Carolina 

C. P. Reddy Parvata, M.D. 




Durham, North Carolina

Gary L. Pellom, M.D. 





Thomas E. Stanley, III, M.D. 



Memorial Mission Hospital 

Asheville, North Carolina 

Timothy J. H. Webb, M.D., Ph.D. 



University of Cincinnati Medical Center 

Cincinnati, Ohio 

Edward G. Sanders, M.D. 





Cathy W. Thomas, M.D. 






Paul V. Stankus, M.D. 





Rolf B. Wallin, M.D. 



Cape Fear Valley Medical Center 

Fayetteville, North Carolina 

AFFILIATED FACULTY 23

Edmond C. Bloch, M.B., Ch.B. 

Associate Professor Emeritus of 




24 SCHOLARS 

SCHOLARS 

David A. Davis, M.D. 

Professor Emeritus of Anesthesiology 



Elisabeth J. Fox, M.B. 

Associate Clinical Professor Emeritus of 




Merel H. Harmel, M.D. 




Joannes H. Karis, M.D. 



Durham, North Carolina

Lloyd F. Redick, M.D. 




Stanley W. Weitzner, M.D. 




Kenneth Sugioka, M.D. 




Ingeborg H. Talton, M.D. 

Associate Professor Emeritus of 




SCHOLARS 

SCHOLARS 25

INTERNS 

Atilio Barbeito, M.D. 

Abigail H. Melnick, M.D 

26 RESIDENTS 

RESIDENTS 

Aaron A. Ali, M.D. 

Timothy M. Grant, M.D. 

John V. Morreale, M.D. 

Genevieve S. Ali, M.D. 

Christopher G. Gunn, M.D. 

Paul R. Shook, M.D.

CA-1 

Daniel D. DeMeyts, M.D. 

Daphne M. Jones, M.D. 

Shazia M. Choudry, M.D. 

Ellen M. Flanagan, M.D. 

Patricia D. Macha, M.D. 

William B. Corkey, M.D. 

Richard C. Griggs, M.D. 

Eric M. Miller, M.D. 

RESIDENTS 

RESIDENTS 27

RESIDENTS 

John D. Mitchell, M.D. 

CA-2 

Keith D. Hanson, M.D. 

28 RESIDENTS 

Trenton L. Pierce, M.D. 

Peter S. Baek, M.D. 

Scott E. Helsley, M.D., Ph.D. 

Adam J. Schow, M.D. 

Anthony J. Colantonio, M.D. 

Russel L. Jacobe, M.D.

Laura J. Kihlstrom, M.D. 

Matthew T. Taylor, M.D. 

Residents at ASA, San Francisco, CA. 

William P. Norcross, M.D. 

Adrienne J. Wells, M.D. 

RESIDENTS 

Cathleen L. Peterson-Layne, M.D., Ph.D. 

RESIDENTS 29

RESIDENTS 

CA-3 

Tarsha V. Garvin, M.D. 

Marcella J. Lanzinger, M.D. 

30 RESIDENTS 

Jason R. Burke, M.D. 

Jon-Paul Harmer, M.D. 

Graham G. Lashley, M.D. 

Peter DeBalli, III, M.D. 

Kurt J. Knauth, M.D. 

James R. McCurdy, M.D.

David B. Schinderle, M.D. 

FELLOWS 

Mihai V. Podgoreanu, M.D. 

Cardiothoracic 

Holly A. Williams-Davis, M.D. 

Maher J. Albahrani, M.B., Ch.B. 


Lian K. Ti, M.B., B.S. 


Julie Z. Woosley, M.D. 

Adil S. Kamal, M.D. 

Pain Management 

Jay McCurdy, M.D. 

RESIDENTS 

RESIDENTS 31

Paula D. Alford, B.A., CRNA 

Beatrice I. Baldwin, CRNA 

Cynthia R. Black, CRNA 

32 CRNA 

CRNA 

Patricia M. Allushuski, CRNA, MSN 

Maurice L. Begin, CRNA 

Carolyn E. Burgess, CRNA, Ph.D. 

Carleen E. Bagnall, BSN, CRNA 

Sandra L. Bennett, CRNA 

Eleanor W. Carter, CRNA

Debra S. Clements, CRNA,MSN 

Jeanne M. Crabtree, CRNA 

Evelyn M. DeRoche, CRNA 

Leslie A. Cline, CRNA, MSN 

Narda D. Croughwell, CRNA 

Thomas E. Diamond, CRNA 

Ann M. Connell, CRNA, MSN 

E. Susan Crumpler, CRNA 

Terry W. English, CRNA, MS 

CRNA 

CRNA 33

CRNA 

Deborah J. Ferrero-Conover, CRNA, MS, 

MSN 

Julie T. Fritz, CRNA, MSN 

34 CRNA 

Fred Fesel, CRNA 

Daniel J. Geniton, CRNA, MSN 

Russel T. Giesler, BSN, CRNA 

Robert E. Foy, CRNA 

Russell T. Giesler, BSN, CRNA

David H. Gleason, CRNA, BHS 

Mack E. Haddock, CRNA 

Shelley T. Hilliard, BSN, CRNA 

Janet E. Goral, BSN, CRNA 

Janet M. Hall, CRNA 

Donalie P. Guin, CRNA 

Pegge L. Hall, CRNA, MSN 

Ronald C. Iacone, CRNA Sarah O. Jinwright, CRNA 

CRNA 

CRNA 35

CRNA 

Carolyn C. Knoop, CRNA, MSN 

David R. Marion, CRNA 

Meredith L. Muncy, CRNA, MHS 

36 CRNA 

David D. Lee, CRNA, BSN 

Donald R. Moede, CRNA, MSN 

Mary K. Murphy, CRNA 

Janet L. Margeson, CRNA 

Gayle P. Moyer, CRNA, BS, BSN, MS 

Flora C. O’Brien, CRNA

John F. Pierce, CRNA Dale F. Potter, CRNA MaryAnn L. Romero, CRNA 

David B. Salzer, CRNA 

Louis Semrad, CRNA 

Lisa J. Schwetschenau, CRNA, MNA 

Marsha A. Seaton, CRNA 

Bruno J. Urban, M.D., Dr.Med. and Francis R. Smith, CRNA 

CRNA 

CRNA 37

CRNA 

Kena B. Sigman, CRNA, MSN 

Tede E. Spahn, CRNA 

38 CRNA 

Janet E. Goral, CRNA 

Grace A. Simpson, CRNA, MSN 

G. Lynn Stockbridge, CRNA 

Craig E. Shanewise, CRNA, MNA 

Francis R. Smith, CRNA 

James M. Temo, CRNA, MSN, MBA

Donald K. Thomas, CRNA Henry J. Walker, CRNA, M.B.A., MS P. Elaine Wallace, CRNA 

Helen Walston, CRNA Yolanda G. Wright, CRNA Stephen A. Ziegler, CRNA 

E. Susan Crumpler, CRNA Deborah J. Ferrero-Conover, CRNA, MSW 

CRNA 

CRNA 39

40 

DUKE ANESTHESIA FACULTY 

WHO BECAME ANESTHESIOLOGY CHAIRS 

1968 

SARA J. DENT, M.D. 

Duke Hospital 


1981 

PHILIP R. BROMAGE, M.B., B.S., FRCA 

University of Colorado 

Health Sciences Center 

Denver, Colorado 

1983 

JOHN N. MILLER, M.D. 

University of South Alabama 

Mobile,Alabama 

1989 

ENRICO M. CAMPORESI, M.D. 

State University of New York 

Health Science Center at Syracuse 

Syracuse, New York 

1991 

JOSEPH GERALD REVES, M.D. 



1996 

WILLIAM J. GREELEY, M.B.A., M.D. 

The Children’s Hospital 

of Philadelphia 

Philadelphia, Pennsylvania 

1999 

PETER S.A. GLASS, M.B., CH.B., FFA(SA) 

State University of New York 

Stony Brook, New York 

2000 

DONALD H. PENNING, M.SC., M.D. 

University of Toronto 

Sunnybrook and Women’s Health Sciences Center 

Toronto, Canada 

1971 

C. RONALD STEPHENS, M.D. 

Washington University 

School of Medicine 

St. Louis, Missouri 

1983 

LENNART FAGRAEUS, M.D., PH.D. 

University of Oklahoma 

College of Medicine 

Oklahoma City, Oklahoma 

1987 

LENNART FAGRAEUS, M.D., PH.D. 

Christiana Care Health Services 

Newark, Delaware 

1989 

PHILIP D. LUMB, M.B., B.S. 

Albany Medical College 

Albany, New York 

1994 

DAVID H. CHESTNUT, M.D. 

University of Alabama at Birmingham 

Birmingham,Alabama 

1998 

PHILIP D. LUMB, M.B., B.S. 

Penn State University 

College of Medicine 

Hershey, Pennsylvania 

2000 

CARLOS U. ARANCIBIA, M.D. 

Virginia Commonwealth University 

Health System 

Richmond,Virginia

AMBULATORY 

ANESTHESIOLOGY 


Chief, Division of Ambulatory 

Anesthesia 

Medical Director of the 

Ambulatory Surgery Center 

Director of Ambulatory and 

Regional Anesthesia 



MEMBERS 

Roy A. Greengrass, M.D., FRCP(C) 



CRNA COORDINATOR FOR 

AMBULATORY ANESTHESIA 

Paula D. Alford, CRNA 

CRNA STAFF 


Fred Fesel, CRNA 

Robert E. Foy, CRNA 

Ronald C. Iacone, CRNA 

Carolyn C. Knoop, CRNA, MSN 

David D. Lee, CRNA 

Mary K. Murphy, CRNA 

Flora C. O’Brien, CRNA 

Frances R. Smith, CRNA 

CLINICAL ACTIVITIES 

RESEARCH NURSE 

Aliki H. Martin, RN 

SUPPORT STAFF: 

LuAnne C. Latta, Staff Assistant 

Kathy K. Clifton, Administrative 

Secretary 

Linda B. Rocker, Data Entry 

The Division of Ambulatory Anesthesia 

was established on September 1, 1997 

and assumed daily operations at the 

Ambulatory Surgery Center in the North 

Pavilion in May 1998. 

Clinical Service 


is responsible for the delivery of all 

anesthesia services at Ambulatory 

Surgery Center (ASC) which opened 

to patients on July 13, 1998 in the North 

Pavilion. The center has nine operating 

rooms with seven presently functional. 

From July 13, 1998 through December 

2000, our Division provided anesthesia 

coverage to 12,620 patients and postoperative 

acute pain management services 

to 2203 overnight patients in our 

eight bed 23-hour Recovery Care Center 

(RCC). 


offers availability of a wide variety 

of novel regional anesthesia techniques. 

These ambulatory regional anesthesia 

techniques greatly enhance the options 

available to patients for both their intraoperative 

experience and for the management 

of post-operative pain. 

Approximately 56% of our patients 

had surgery under regional anesthesia 

or regional anesthesia/combined technique 

(7074 of 12,620 patients). See 

Table 1 for the description of the wide 

variety of Regional Anesthesia techniques 

done at the ASC. Most notably is 

our emphasis on the predominant use 

of non-central neuraxial regional techniques 

for both extremity and truncal 

surgery when possible. The peripheral 

nerve regional anesthesia techniques 

allow the most flexibility and facilitate 

early, stress free recovery for our ambulatory 

surgery patients. The excellent 

postoperative analgesia afforded by 

the use of single shot and continuous 

catheter peripheral nerve blockade 

is unparalleled. 89.2% of the patient 

population at our Center rate their 

experience with anesthesia and pain 

management as very satisfied 24 hours 

postoperatively and 89.1% 7 days postoperatively. 

See Table 2 for the extraordinary 

patient satisfaction ratings. 

The Duke ASC successfully implemented 

the Saturn Anesthesia Information 

System on September 13, 1999. 

With 28 units in our network covering 

the entire peri-operative event, it is one 

of the largest and most ambitious installations 

of its type in the world. The 

ultimate goal is to create a paperless 

peri-operative record. 

Education 


provides one month rotations at the ASC 

for CA3 and CA2 Residents. Our Division 

offers fellowship in Regional and 

Ambulatory Anesthesia. The fellowship 

involves peri-operative clinical patient 

care: Preoperative Patient Evaluation, 

Operative Ambulatory Regional and 

General Anesthesia and Acute Pain 

Management in the RCC. Upon completion 

of their fellowship training our 

fellows may expect to have a broad 

expertise in regional and ambulatory 

anesthesia. 

Our Division hosts a traineeship in 

Regional Anesthesia that has been very 

successful in establishing Duke Medical 

Center as a forerunner in this science. 

This training involves a one to two-day 

training opportunity in the performance 

of regional anesthesia techniques. This 

training includes OR observation and 

individually designed workshops for 

practicing board certified physicians. 

The response to this educational opportunity 

has been excellent and identifies 

the division as being on the cutting edge 

in offering didactic opportunities in 

regional anesthesia. This training initiative 

has expanded in conjunction with 

an AstraZeneca unrestricted educational 

grant. The Division of Ambulatory 

CLINICAL ACTIVITIES 41


Infraclavicular 15 

Caudal 21 

Wrist 21 

Artificial cervical plexus 24 

Epidural 62 

IV regional 85 

Ankle 240 

Supraclavicular 387 

Axillary 492 

Fem oral 536 

Continuous catheter 807 

Spinal 899 

Anesthesia has been instrumental in our 

center being distinguished as a “Center 

of Excellence” in Regional Anesthesia. 

Our Center is one of five centers across 

the nation with this distinction. 

As the Ambulatory Surgery Center 

continues its recognition as a leader 

in regional anesthesia techniques, the 

Ambulatory Anesthesia division is frequented 

by international physicians who 

come here to study the techniques of 

regional anesthesia as well as the clinical 

operations of an ambulatory surgical 

center. Of special interest to our international 

guests is the outcomes database. 

Educational exchanges have 

been experienced this year with 

Jamaica, Australia and Great Britain. 

This cultural as well as educational 

exchange has provided an exciting 

opportunity for our division. 

The faculty of the Division of 

Ambulatory Anesthesia working collaboratively 

have published in the year 

2000: Interscalene Brachial Plexus 

Block With a Continuous Catheter 

Insertion System and a Disposable 

Infusion Pump. Anesth Analg 2000; 

Thromboelastography as a Perioperative 

Measure Of Anticoagulation Resulting 

From Low Molecular Weight Heparin: A 

Comparison with Anti-Xa Concentrations. 

42 CLINICAL ACTIVITIES 

TABLE 1 

Regional Techniques 


July 13, 1998–December 31, 2000 

Lumbar plexus 982 

Paravertebral 1145 

Interscalene 1567 

Sciatic 1656 

500 1000 1500 2000 

Anesth Analg 2000; Thoracic Paravertebral 

Block for Breast Surgery. Anesth 

Analg 2000; Thoracic Paravertebral 

Block for Breast Surgery. Anesth Analg 

2000; Continuous Interscalene Brachial 

Plexus Blockade at Home After Major 

Shoulder Surgery (abstract) Anesthesiology 

2000; Continuous Peripheral 

Nerve Blocks For Ambulatory Surgery 

(abstract). Anesthesiology 2000; 

Continuous Ambulatory Brachial Plexus 

Block with a New Catheter Insertion 

System and a Disposable Infusions 

Pump (abstract). Anesthesiology 2000; 

Paravertebral Somatic Nerve Block 

Versus Local Infiltration for Outpatient 

Inguinal Herniorrhaphy (abstract). 

Anesthesiology 2000. 

Research 

Marcella J. Lanzinger, M.D., and Karen C. Nielsen, M.D. 

A major project in the Division of 

Ambulatory Anesthesia continues to be 

the Outcomes Database for Ambulatory 

Anesthesia. This database has consistently 

provided us with an excellent 

cross section of information that clearly 

elucidates our accomplishments and 

achievements at the Ambulatory Surgery 

Center as evidenced in the patient satisfaction 

statistics quoted earlier. We 

know from this data that over 96.9% 

of our patients would choose the same 

anesthesia again 24 hours postoperatively 

and 96.3% 7 days postoperatively. 

Our database provides information that 

enables the constant tracking of our 

performance and patient satisfaction. 

We have added technology to enhance 

and improve the collection of our data 

as well as achieve its integration with 

the Saturn Information Systems. This 

improved technology will improve the 

integrity of the data as well as save time 

in processing the information. This 

database is also an integral part of the 

educational opportunities within the 

division as cited above.

Goals for the Future 

The Ambulatory Surgery Center is in 

the third year of operation and we continue 

to have exciting goals for the 

future. Our statistics continue to reveal 

that we are achieving excellent patient 

satisfaction and that remains our first 

and foremost goal. 

We are already delivering regional 

anesthesia to nearly 60% of our patient 

population at the Ambulatory Surgery 

Center. It is our goal to continue to offer 

a wide variety of anesthesia options 

to our patients with special focus on 

Regional Anesthesia. Our status as a 

Center of Excellence in regional and 

ambulatory techniques has allowed us 

to offer training to fellow anesthesiologists 

throughout the country. We will 

continue to develop the Division of 

Ambulatory Anesthesia at Duke as a 

guiding force in education and training 

for Regional Anesthesia both nationally 

and internationally. 

We continue to integrate our outcomes 

data with patient satisfaction 

and are expanding it to look at the cost 

of care delivery. As we broaden and 

hone the outcomes database we are 

establishing a model in the field of outcomes 

for ambulatory surgical centers. 

Our improved technologic enhancement 

to our database systems will improve the 

deliverance of vital information regarding 

ambulatory surgery and patient satisfaction. 


is working to develop a protocol 

for home catheter infusion system for 

the management of post-operative pain. 

Drs. Susan Steele and Karen Nielsen 

have worked collaboratively with this 

protocol and have visited in patient’s 

home after surgery allowing first hand 

investigation of the efficacy of home 

catheter infusion. The results have been 

overwhelming. The patients who have 

participated in this protocol have been 

extremely satisfied with their pain con- 

00 100% 

80 80% 

60 60% 

40 40% 

20 20% 

0% 0 

Very 

Satisfied 

trol and with the convenience of managing 

their pain at home. 

The Ambulatory Surgery Center 

is working with a team of surgeons, 

administrators and other key personnel 

to develop a Breast Care Center of 

Excellence at our facility. This would 

greatly enhance patient convenience 



TABLE 2 

Patient Satisfaction with Anesthesia Techniques 


July 13, 1998–July 13, 2000 

Somewhat 

Satisfied 

Neutral Somewhat 

Dissatisfied 

Very 

Dissatisfied 

24 Hours 

7 Days 

and satisfaction in allowing diagnostic 

procedures of the breast as well as surgical 

procedures to be accomplished 

in one location. This would be a great 

improvement to our present protocol 

for breast procedures. This is certainly 

one of the most promising initiatives 

on our horizon. We remain dedicated 

to providing the highest level of patient 

satisfaction of any ambulatory surgery 

in the nation. 

Our division is initiating an innovative 

pilot study on patients undergoing 

total knee arthroplasty. These procedures 

will be performed under continuous 

peripheral nerve blocks on an ambulatory 

basis. Patients will be discharge 

from our 23 hour recovery care unit to 

a rehabilitation unit. Continuous peripheral 

nerve blockade will be used during 

the first 72 hours allowing excellent 

postoperative analgesia, aggressive 

physical therapy, and early recovery. 



CARDIOTHORACIC 

ANESTHESIA AND 

CRITICAL CARE 

MEDICINE 


Chief, Division of Cardiothoracic 

Anesthesiology and Critical 

Care Medicine 

Director, Neurologic Outcome 

Research Group 

Professor and Vice-Chair of 


Associate Professor in Medicine 

MEMBERS 



Norbert P. deBruijn, M.D. 

Katherine P. Grichnik, M.D., M.S. 



Andrew K. Hilton, M.B., B.S., FANZCA 


J.G. Reves, M.D. 


Mark Stafford Smith, M.D., C.M., FRCP, 

DABA 

Ian J. Welsby, M.B., B.S., B.Sc., FRCA 

FELLOWS 

Maher J. Albhrani, M.B., Ch.B. 

Daniel T. Bainbridge, M.D. 

George N. Djaiani, M.D., DA, DEAA, 

FRCA 

John G. Ellingham, M.D. 





Brian J. McCreath, M.B., Ch.B. 

Madhav Swaminathan, M.B.,B.S. 

Miahi V. Podgoreau, M.D. 

Ajeet Sharma, M.D. 


Lian K. Ti, M.B., B.S. 

Bo Wu, M.D. 

CRNA 


RESEARCH COORDINATORS: 

Aimee M. Butler, B.S. 

Wayne M. Cohen, RN, M.B.A. 

Kelli L. Cozart, RN 

Bonita L. Funk, RN 

Vincent E. Gaver, BA 

Malissa J. Harris, RN 

Jason F. Hawkins, B.S.N 

Jerry L. Kirchner, B.S. 

RESEARCH TECHNICIANS 

Chonna S. Campbell 

Amanda S. Cheek 

Mary H. Currier 

E. D. Derilus 

Tanya R. Kagarise 

Satarah K. Latiker 

Erich M. Lawff 

Kenya S. Lee 

Scott E. Lee 

Colin E. Macdonnell 

Terri C. Moore 

Beverly J. Perry 

Melanie K. Tirronen 

Erin E. Ward 

Jonathan E. Williams 

SUPPORT STAFF 

Cheryle E. Davis 

Marilyn L. Helms 

Teri-Lynne Kulik 

Brenda S. Mickley 

LaTanya M. Rhames 

Nineteen ninety-nine presented an outstanding 

opportunity to the cardiothoracic 

division, with additional continued 

increases in the cardiac and thoracic 

procedures during the year. This 

opportunity further strengthened the 

group's productivity and research 

opportunities. The introduction of minimally 

invasive techniques and “OP- 

CAB” further defined our course. In 

addition, we have expanded to provide 

critical care in the Acute Cardiac Unit 

as an additional resource in the perioperative 

care of patients. 

Clinical Activity 

The practice of cardiothoracic anesthesia 

has broadened markedly at Duke 

and across the nation. The trend continues 

toward less invasive mechanism 

to treat cardiothoracic disease including 

video-assisted thoracoscopic procedures, 

as well as midCAB (coronary 

artery bypass) and OPCAB (off bypass 

coronary artery bypass) beating heart 

revascularization procedures. The 

Cardiothoracic Division led an initiative 

for the development of an interventional 

suite in the operating room to allow 

combined cardiology, cardiac surgery 

and vascular surgery procedures to be 

performed in a cost-effective multidisciplinary 

manner. The Division is at the 

forefront of evaluating these minimally 

invasive technologies, and how they 

affect both short and long-term outcome. 

It remains inherently important 

due to the risk of reoperation that our 

patients receive the best therapy for 

long-term survival and quality of life. 

The Cardiothoracic Division is a 

world leader in the measurement and 

understanding of perioperative complications 

in many organ systems. We are 

now using this evidence to further 

improve the safety for our patients and 

protect their long-term quality of life. 

Research 

Duke Heart Center Division of 

Cardiothoracic Anesthesia is the top 

cardiac anesthesia research division in

the country. The division added two 

active NIH grants during the year, for a 

combined total of 8 NIH grants within 

the division. The research efforts of the 

division are supported by our entire faculty 

and eight full-time research coordinators 

Aimee Butler, Wayne Cohen, 

Kelli Cozart, Bonnie Funk, Vince Gaver, 

Malissa Harris, Jason Hawkins and Jerry 

Kirchner. Additionally, research technicians 

Chonna Campbell, Amanda 

Cheek, Mary Currier, E. D. Derilus, 

Tanya Kagarise, Satarah (Torie) Latiker, 

Erich Lauff, Kenya Lee, Scott Lee, Colin 

Macdonnell, Terri Moore, Beverly Perry, 

Melanie Tirronen, Erin Ward, and 

Jonathan Williams have significantly 

extended the capabilities of divisional 

research. 

Clinical Research 

The Neurologic Outcome Research 

Group added one National Institutes of 

Health grant, for a total of 5 NIH grants 

supporting ongoing work as well as 

receiving the first American Heart 

Association Roundtable grants awarded 

at Duke. Under the direction of Drs. 

Mark Newman, Jerry Reves, and Jim 

Blumenthal, with the assistance of all 

cardiac division members, the division 

is continuing to investigate neurologic 

and neuropsychologic outcome after 

cardiac surgery, as well as interventions 

to improve these perioperative complications. 

The group recently published 

studies in the New England Journal of 

Medicine and Stroke documenting the 

long-term impact of perioperative cognitive 

decline on long-term cognitive 

function. This is a first hopeful step 

in prevention or treatment of these 

untoward events. The group has also 

continued its investigation of the association 

of Apolipoprotein ε4 and cognitive 

dysfunction and stroke after cardiac 

surgery. This research has led to an 

important collaboration with the Department 

of Neurology to further assess 

a patient's genetic predisposition to 

neuronal injury or potential recovery 

from neuronal injury. 

In conjunction with the Department 

of Neurology and Duke Clinical 

Research Institute, the newest focus 

of the neurologic outcomes research 

group is the development of the Multicenter 

"Perioperative Organ Protection 

Consortium." This is a collection of 25 

Academic Sites in the United States and 

Canada. The group is submitting two 

multicenter interventional NIH grants 

in early 2000 evaluating the impact 

of clinical practice on neurocognitive 

outcome. 

Laboratory and 

Translational Research 

The cardiac anesthesiology division has 

spent considerable resources, time, and 

energy over the last 5-10 years developing 

physician scientists and basic 

researchers in areas related to cardiovascular 

medicine. Examples of individuals 

include Debra Schwinn, M.D., 

Hilary Grocott, M.D., FRCP(C) and 

Madan Kwatra, Ph.D. We are now 

pleased to report that basic science 

projects originating from each of these 

investigator's laboratories have resulted 

in publications in major scientific journals 

and national peer reviewed funding 

(NIH, FAER, AHA). 

The Molecular Pharmacology 

Laboratory, under the direction of Dr. 

Debra Schwinn has continued its investigation 

of adrenergic receptors, with an 

additional NIH RO1 grant awarded this 

year. In addition, translational research 

has also begun, with investigators bridging 

clinical and basic science areas 

with new hypothesis-driven research 

projects designed to elucidate mechanisms 

underlying acute myocardial 

beta-adrenergic receptor desensitization, 

G protein-coupling in human 

heart, and mechanisms underlying 

brain injury during cardiopulmonary 

bypass. 

Dr. Debra Schwinn initiated a NIH 

sabbatical in January of 2000 to gather 

additional expertise into genetic and 

genetic translational research. Our goal 

is to develop a perioperative outcome 


and genetics database that will be a 

resource for the entire world. 

A new laboratory initiative was 

begun in 1999 in the Cardiothoracic 

Anesthesia division. A laboratory 

focused on the pathophysiology and 

adverse outcomes (particularly neurologic) 

after cardiopulmonary bypass 

(CPB) was established under the direction 

of Dr. Hilary Grocott. This laboratory, 

The Anesthesiology Cardiopulmonary 

Bypass Laboratory, used a pig CPB 

model to investigate intermediate cerebral 

outcomes (glial and neuronal 

derived proteins released into the CSF 

and serum following brain injury) after 

CPB. In order to make the most of a relatively 

expensive animal preparation as 

well as to capitalize on other expertise 

in the division and department, the 

model was also used to examine issues 

related to myocardial (-adrenergic 

desensitization and renal ultrasound 

imaging employing intravenous contrast. 

Concurrent with the pig CPB 

model, a second, more economical 

CPB model was developed in the rat. 

This work, performed with the collaborative 

support of cardiothoracic anesthesia 

fellow Dr. Burkhard Mackensen, 

took place in the neuroanesthesia laboratory 

with space generously donated 

by Dr. David Warner. This new laboratory 

has been unique, thus far in the 

field, with its ability to successfully perform 

complete CPB in rats with subsequent 

recovery. The coming year’s 

focus will continue with the further 

development of a model of neurocognitive 

impairment after CPB in the rat 

in order to investigate both the mechanisms 

of injury as well as potential pharmacologic 

neuroprotection. In conjunction 

with Dr. Warner, neurology, 

neurosciences and other related fields, 

the Duke Multidisciplinary Neuroprotection 

Laboratory has been developed to 

facilitate these important investigations. 



Goals for 2000 

Enhancing fellow and resident education 

is one of the major goals of the 

division for 2000. The clinical caseload 

has obviously given the division the 

opportunity to do outstanding clinical 

teaching of both residents and fellows. 

The addition of a written examination 

to ongoing oral examination allows residents 

and fellows to assess their ongo- 

Cases by Divisions/Sections 

Ambulatory Surgical Center** 5691 

Cardiothoracic 3099 

Eye Center 3983 

General 5243 

Gynecological 1987 

Hematology/Oncology 32 

Neurosurgical 2452 

Obstetrical 2188 

Orthopaedic 5802 

Otolaryngology, Head, Neck 1567 

Pediatric* 6107 

Plastics 1066 

Urological 1809 

VA Medical Center 3511 

Vascular 1533 

*Includes all patients under the age of 18 


ing learning. We will also take a leadership 

role in the ACU, with Cardiac 

Anesthesiology Intensivist directed by 

Dr. Steve Hill. The goals of this program 

will be improved quality of care, and 

enhanced educational and research 

opportunities. 

The group has developed a national 

continuing medical education presence 

to allow the showcase of ongoing 

clinical and research work within the 

division. The “Fourth Annual Duke 

Cardiothoracic Update” will take place 

in Hilton Head, SC, June 23-26, 2001. 

We continue to appreciate the 

leadership that Dr. Reves provided to 

Duke Heart Center and the division 

over the last ten years and thank him 

for his support, as we try to aggressively 

pursue a leadership role in cardiothoracic 

anesthesia for the next century. 

0 1000 2000 3000 4000 5000 6000 

**Includes Orthopedic, General, Gynecology, Plastics, OHN, Pediatric Urology and Vascular patients previously tabulated within Divisions/Sections

CERTIFIED 

REGISTERED 

NURSE ANESTHETISTS 

Russell T. Giesler, CRNA 

Chair, Clinical Leads 

CLINICAL LEAD COMMITTEE 

Paula D. Alford, BA, CRNA 

Ambulatory Surgical Center 

Patricia M. Allushuski, BSNA, CRNA 

Ortho-plastics 


Cardiac 

Eleanor W. Carter, CRNA 

Eye Center 

Russell T. Giesler, BSN, CRNA 

Chair of Clinical Leads, Neuro-OHN 

Janet M. Hall, CRNA 

Pediatrics Cardiac 

Meredith L. Muncy, CRNA, MHS - 

General, Vascular, Transplant 


Scheduling Coordinator 


Obstetrics 


Pediatrics 

Donald K. Thomas, CRNA 

Urology-Gynecology 

PERIOPERATIVE PEDIATRIC 

COORDINATOR 

Janet E. Goral, BSN, CRNA. 

NEW NURSE ANESTHETISTS 

ARRIVALS 

Dale F. Potter, CRNA 

Wake Forest University Baptist 

Medical Center in Winston-Salem, 

NC 

Daniel J. Geniton, CRNA 

Doctors Hospital of Augusta, GA. 

Steven A. Ziegler, CRNA 

Ronald C. Iacone, CRNA 

The millennium has brought with it a 

continuing evolution by the Duke Nurse 

Anesthetists to the organizational structure 

of Divisions. The apprehension, at 

first, of going to Divisions has melted 

away. Now Certified Registered Nurse 

Anesthetists (CRNA) prefer to be 

assigned within their Divisions. These 

Divisions were established to promote 

an increase in clinician involvement, to 

foster teams and teamwork and to provide 

a high quality of anesthesia care 

efficiently and economically. This environment 

of change will continue for the 

foreseeable future as the Divisions 

evolve and even the physical layout of 

the OR suite is to be altered, which will 

take a few years to complete. 

In June the new automated anesthesia 

record, SATURN, was introduced 

to Duke North Hospital after first being 

applied at the Ambulatory Surgical 

Center and Eye Center. Jeanne M. 

Crabtree, CRNA; Frances R. Smith, 

CRNA and Donald R. Moede, CRNA, 

MSN were responsible for the training 

of anesthesia providers. There is still 

much the SATURN system has to offer 

us and only the future can tell us how 

far we will go with this new system. 

To improve the flow of communication 

among the CRNAs, Anesthesiologists, 

and other disciplines, a Chair 

of the Clinical Leads was established 

in July. Russell T. Giesler, CRNA was 

selected to this position. The Clinical 


Lead Committee was redefined with 

Clinical Leads assuming a more supervisory 

role in assisting in the facilitation 

of the daily OR schedule through the 

CRNA charge responsibilities. Donald K. 

Thomas, CRNA assumed the position of 

Clinical Lead of GYN. This combined 

GYN and GU under one Clinical Lead 

thus helping to redistribute the number 

of CRNAs responsible to any one 

Clinical Lead. Tede E. Spahn, CRNA 

was named Clinical Lead of OB. Paula 

D. Alford, CRNA was chosen Clinical 

Lead of ASC. Finally, with Meredith L. 

Muncy, CRNA assuming her new role in 

the Duke School of Nurse Anesthesia, 

Grace A. Simpson, CRNA has accepted 

the Clinical Lead position for the GVT 

Division. With the Clinical Lead 

Committee established it was able to 

proceed with pending issues. 

September brought the new evaluation 

form for the Performance Partnership 

System as redesigned by the 

Clinical Lead Committee to be used 

beginning July, 2001. It took a great 

deal of energy and time commitment 

to finalize the new form and it is still 

recognized that in the future this evaluation 

form can and will change to meet 

our needs. 

October brought the final accreditation 

of the new Duke School of Nurse 

Anesthesia. The Director of the school 

will be Mary C. Karlet, CRNA, Ph.D. 

with James Temo, CRNA, MSN, M.B.A. 

as Assistant Director. The first class is 

scheduled to begin January 2001. 

With the year drawing to a close, 

the CRNA group completed a survey in 

October with regards to CRNA recruitment 

and retention issues. Committees 

have been established and five areas 

have been identified and are being 

addressed. These committees will complete 

their individual tasks and report 

back to the CRNA group with constructive 

recommendations to move forward. 

We in medicine understand we 

work in a dynamic environment where 

change is always present. I believe 

there are a number of people who have 




worked very hard this last year and are 

still working very hard to accomplish 

tasks at hand that will help us meet the 

challenges of 2001. They should all 

be commended for their efforts. Again 

we end the year with guarded but optimistic 

anticipation of things to come. 

RETIRED 

Louis Semrad, CRNA 

Jeanne M. Crabtree, CRNA 

DEPARTURES 

Terry W. English, CRNA, M.S. 

Flavia P. Blackburn, CRNA 

Mary Ann L. Romero, CRNA 

David B. Salzer, CRNA 


James M. Temo, CRNA, M.S.N., M.B.A. 


Notables 2000 

Cynthia R. Black, CRNA serves on 

the Public Relations Committee and 

Resolutions Committee for the AANA. 


was elected Secretary for the NCANA 

and District 1. 

Donald R. Moede, CRNA, MSN and 

Leslie A. Cline, CRNA, MSN were elected 

as District 1 Educational Directors. 


was elected District 1 Director. 

James M. Temo, CRNA, MSN, 

M.B.A. was named Assistant Director 

of Duke’s School of Nurse Anesthesia 

Program beginning January, 2001. 


was named Clinical Coordinator for 

Duke's School of Nurse Anesthesia 

beginning January, 2001. 

Janet E. Goral, BSN, CRNA is still 

instrumental in the on-going latex safe 

initiative for the Children’s Health 

Center. 

Deborah J. Ferrero, CRNA, MS, 

MSN is working with Dr. T.J. Gan on 

research to determine whether the 

active metabolites of the nondepolorizer 

rapacuronium effect the duration of 

other nondepolorizers. Deborah is also 

our liaison to Abbott Laboratory's preceptor 

program. 

Donald R. Moede, CRNA, MSN, 

Frances R. Smith, CRNA and Jeanne M. 

Crabtree, CRNA were the Consultants/ 

Trainers for the new automated anesthesia 

record, SATURN, and assisted in 

the training of the anesthesia providers 

at Duke. Don also redesigned the manual 

anesthesia record. 

Carleen E. Bagnall, BSN, CRNA 

received the Medical Student Recognition 

Award, Department of 

Anesthesiology. 

Janet M. Hall, CRNA submitted an 

abstract at the academic evening and 

presented a poster on “Forane vs. 

Propofol Anesthesia: Comparison of 

PONV in Pediatric Patients Undergoing 

Radiofrequency Ablation.” 

David H. Gleason, CRNA, BHS presented 

at the Sixth World Congress for 

Nurse Anesthetists in August. His presentations 

were on “PONV Strategies for 

Prevention” and “Physiology of Pain" 

David is also a member of the Abbott 

CRNA advisory board. 

Russell T. Giesler, BSN, CRNA was 

selected Chair of the Clinical Lead 

Committee. 

Maurice L. Begin, CRNA is working 

with ORBIS in China, Burma and India, 

to name a few sites, delivering quality 

anesthesia care to eye patients. 

Henry J. Walker, CRNA, MS, M.B.A. 

served on the Advisory Committee for 

the Duke School of Nurse Anesthesia.

ADULT CRITICAL 

CARE MEDICINE 

Christopher C. Young, M.D. 

FCCM 

Chief, Division of Critical Care 

Medicine 

Associate Clinical Professor 

of Anesthesiology and 

Surgery 

Members 










James A. L. Pittman, M.B., B.S., B.Sc., 

FRCA 


John T. Sum-Ping, M.D., Ch.B., FRCA 


Fellow 

Patrick J. Neligan, M.D. (Anesthesiology) 

Members of the Division of Critical Care 

perform patient care, teaching and 

research in adult critical care in several 

intensive care units: The Surgical Intensive 

Care Unit (SICU) at Duke, the SICU 

at the Veterans Affairs Medical Center 

(VAMC) and the Neuroscience ICU at 

Duke. Divisional faculty also provide 

medical care in the Hyperbaric Center 

and the Pediatric ICU. Reports from the 

Neurosciences ICU, Hyperbaric Center, 

and Pediatric ICU are listed elsewhere 

in this publication. In June of 2000, Dr. 

Reves, at the recommendation of the 

Departmental Executive Committee, 

announced a name change of several 

of the Divisions within the Department 

of Anesthesiology to reflect their 

involvement in Critical Care Medicine. 

This involvement is clinical, educational, 

and investigative. The changed 

names of our divisions are: 

Cardiothoracic Anesthesia and 

Critical Care Medicine 

General, Vascular, Transplant 

Anesthesia and Surgical Critical 

Care Medicine 

Pediatric Anesthesia and Critical 

Care Medicine 

Women’s Anesthesia and Critical 

Care Medicine. 

The matrix Division of Critical Care 

Medicine remains responsible for the 

overall education of fellows in Critical 

Care Medicine and continues to coordinate 

our department's multiple 

specialty-specific critical care programs. 

Surgical Intensive Care 

Units 

Clinical Activities 

Patient care is provided in the Surgical 

Intensive Care Units at Duke and the 

VAMC under the Co-Directorship of faculty 

of the Department of Anesthesiology. 

The Duke University Hospital SICU 

is a 16 bed, Level One trauma unit. In 

addition, it serves as a site for care of 

a variety of postoperative general and 

subspecialty surgical patients. Attending 


staff from the Departments of Medicine, 

Surgery, and Anesthesiology provide 

twenty-four hour a day, seven day per 

week coverage. Dr. William Fulkerson, 

Dr. Joseph Govert (Medicine), Dr. Mark 

Sebastian, Dr. Betsy Tuttle-Newhouse, 

Dr. Steven Vaslef (Surgery), Dr. Nancy 

Knudsen, Dr. Gene Moretti, Dr. Laura 

Niklason and Dr. Christopher Young 

(Anesthesiology) share attending responsibilities. 

The Durham VA Medical 

Center's 12-bed unit emphasizes the 

management of postoperative open 

heart patients, as well as patients from 

general, orthopedic, urologic, plastic, 

and other subspecialty surgical services 

who require critical care. Dr. Lewis 

Hodgins, Dr. John Sum-Ping, Dr. Laura 

Niklason, and Dr. Christopher Young 

share attending responsibilities in this 

unit. 

Attending Staff 

Dr. Eugene Moretti, Dr. Laura Niklason, 

Dr. Nancy Knudsen, and Dr. Christopher 

Young continue to participate in the 

24 hour per day coverage in the Duke 

North Surgical ICU. Dr. James Pittman 

joined the VA faculty this past year as 

a Visiting Associate (from the United 

Kingdom) and shares attending responsibility 

in the VA ICU with Drs. Sum- 

Ping, Hodgins, Niklason, and Young. 

Dr. Frank Kern and Dr. Scott Schulman 

practice in the Pediatric Intensive Care 

Unit. Dr. Cecil Borel serves as the Medical 

Director of the Neurointensive Care 

Unit. Dr. Richard Moon is the Medical 

Director of the Hyperbaric Center and 

is involved in research, teaching, and 

patient care there with Drs. Bret Stolp 

and Guy Dear. During the past year, we 

bid farewell to two esteemed colleagues 

from the Critical Care Division. 

Dr. Andrew Hilton returned home to 

Australia to pursue further training and 

practice opportunities in Critical Care 

Medicine. Andrew and family (Ingrid, 

Max, and Ziggy) are living happily in 

Melbourne and look forward to welcoming 

any visitors to the “land down 

under.” Dr. Charles Garcia-Rodriguez 



returned home this year as well after 

securing a consultant position in the UK. 

Fellows 

2000 is the seventh year the ACGME 

accredited Fellowship in Critical Care 

Medicine has been offered by the 

Department of Anesthesiology. On May 

10, 2000, the ACGME conducted a site 

survey of the fellowship program in 

conjunction with the residency program 

review. Based on the visit, interviews 

with fellows, and review of documents, 

the Residency Review Committee for 

Anesthesiology of the ACGME awarded 

the program continued accreditation. 

The program continues to attract a 

number of applicants despite decreased 

federal support for postgraduate medical 

education. Two fellows have accepted 

positions for academic year 2001 from 

within the residency program in Anesthesiology. 

Previous Anesthesiology/ 

Critical Care fellows continue to be successful. 

Dr. Chiedozie Udeh has spent 

the past six months in locum tenens 

positions in Australia. Dr. Angela 

Joseph has been practicing Anesthesiology 

and Critical Care Medicine in 

Michigan. Both will be taking the ABA 

examination for added qualifications 

in Critical Care Medicine later this year. 

John T. Sum Ping, M.B., Ch.B., FRCA 


Former fellows include: Dr. Albert 

Hasson (South Carolina), Dr. Kevin 

Patrick (Western North Carolina), Dr. 

Eugene Moretti (Duke), Dr. Faisal Masud 

(Houston, TX), Dr. Elliott Bennett- 

Guerrero (New York, NY), Dr. Nancy 

Knudsen (Duke), and Dr. Tony Huggins 

(Raleigh, NC). 

Residents 

CA-1 residents in anesthesiology are 

introduced to Critical Care Medicine 

at the VAMC SICU. In addition, the 

Departments of General Surgery, 

Orthopedic Surgery, and Obstetrics / 

Gynecology require their residents to 

gain critical care experience during residency. 

This requirement is met with 

rotations in the Surgical ICU at the 

Durham VAMC. The residents and 

interns rate this experience highly and 

they regard the VA ICU Anesthesiologists 

/ Intensivists as contributing an 

important component to their training. 

Additional training in Critical Care 

Medicine for senior residents in Anesthesiology 

and Surgery is provided in 

the SICU at Duke University Medical 

Center (2200). Residents gain additional 

proficiency in managing complex patients 

in this busy trauma/post surgical 

unit. The clinical and didactic components 

of this rotation are maintained at 

high levels with the input of the Critical 

Care fellows and attending staff. 

Medical Students 

Instruction to medical students in intensive 

care medicine is offered through 

the Duke University School of Medicine. 

A month long rotation in surgical intensive 

care (Surgical Intensive Care: 

Anesthesiology 241/Surgery 241) has 

continued to be popular with fourth 

year medical students. Students from 

Duke as well as other institutions (both 

national and international) enroll in the 

course to gain valuable experience in 

patient care. Students are assigned to 

the SICU at Duke University Medical 

Center and/or the VA Medical Center. 

They participate in the care of critically 

ill patients, evaluate and present patients 

on SICU rounds, and take inhouse 

call with the residents. The students 

frequently cite the experience in 

managing complex medical problems 

and enthusiastic teaching by residents, 

fellows, and attendings as strong positives 

of this course. 

Accomplishments 

The missions of the Division—excellence 

in patient care, education, and 

research—have been well served this 

past year. The Surgical Intensive Care 

Unit at the VAMC continues to be valued 

as an outstanding educational experience 

in residency training. Attending 

physician coverage at night in the Duke 

Surgical ICU has expanded the missions 

of resident education and excellence 

in patient care. 

The Critical Care Division continues 

to be recognized as a leader in the 

provision of adult Critical Care services 

at both the VA and Duke Medical 

Centers. Drs. Sum-Ping and Knudsen, 

as co-directors of their respective units, 

continue to improve the process of 

healthcare delivery in the ICU setting. 

Other members of the division are to be

commended for their support of these 

processes. Multidisciplinary Critical 

Care Rounds continue biweekly under 

the direction of Dr. Young. These conferences 

provide the opportunity for 

health care professionals from various 

backgrounds to meet and discuss 

Critical Care topics of mutual interest. 

Goals for Critical Care 

at Duke 

The goal of the Division is to build 

upon recent accomplishments and 

continue to improve in all aspects of 

patient care, teaching, and research. 

Patient care continues to be the 

highest priority of the Division. Every 

member of the Division deserves accolades 

for the continued enthusiasm and 

skillful patient care being provided in 

the face of the growing financial constraints 

on the practice of Critical Care 

Medicine. These contributions are recognized 

by hospital administration, our 

patients, and their families. 

All members of the Division are 

involved in the teaching of Critical Care 

Medicine to medical students, residents, 

and others. Biweekly Critical Care Conference 

continues to attract students, 

residents, nurses, and physicians from 

all departments. 

The research potential of the Division 

continues to expand. Dr. Eugene 

Moretti has been extremely successful 

in bringing research protocols to the 

clinical arena and in enrolling patients 

in several important studies. He has protocols 

investigating magnesium flux in 

critically ill patients, infection risk with 

Nancy W. Knudson, M.D. 

a new anti-bacterial bonded central 

venous catheter, and a novel therapy 

for the treatment of sepsis. In addition, 

he is pursuing a Masters Degree in 

Clinical Research and Statstics, and will 

bring these newly developed skills to 

the division’s research efforts. Several 

members of the division (Drs. Moretti, 

Sum-Ping, and Young) work in the 

Human Pharmacology Laboratory 

under the direction of Dr. Jacques 

Somma. Their interests are in investigating 

the pharmacokinetics and pharmacodynamics 

of sedative drugs and Dr. 

Somma has obtained several corporate 


and governmental grants to continue 

this ground-breaking work. In the 

future, the techniques of measurement 

developed in this lab will be brought 

to the patients' bedside in the intensive 

care unit to further delineate the pharmacology 

of these drugs in the critically 

ill. Dr. Niklason continues to gain 

national and international prominence 

for her investigations into engineered 

arterial grafts and the mechanisms of 

vasospasm following subarachnoid 

hemorrhage. Drs. Sum-Ping and Young 

presented the results of their work on 

non-invasive cardiac output measurement 

(LidCO) at the annual meeting 

of the American Society of Anesthesiologists, 

and continue their investigations 

with a newer version of the device 

(PulseCO). Drs. Sum-Ping and Pittman 

continue to be engaged in the study 

of a new sedative agent, dexmedetomidine, 

in the intensive care unit. Additional 

research accomplishments are 

listed in the sections for Pediatrics, 

Neurosciences, and Hyperbaric Medicine. 

Additional protocols and publications 

are anticipated in the areas of 

sedation and evaluation of new, noninvasive 

monitoring devices in the 

intensive care unit. 

The dedication of the Critical Care 

faculty has produced success in our varied 

endeavors—patient care, research, 

and education. In all these missions, 

our goal is continued excellence. 



GENERAL, VASCULAR, 

HIGH-RISK, TRAUMA, 

TRANSPLANT AND 

SURGICAL CRITICAL 

CARE ANESTHESIOLOGY 

David A. Lubarsky, M.D., 

M.B.A. 

Chief, Division of General, 

Vascular, High-Risk, Trauma, 

Transplant and Surgical Critical 

Care Anesthesiology 

Associate Professor and Vice- 

Chair of Anesthesiology 

Adjunct Associate Professor of 

Operations Management at the 

Fuqua School of Business 

FACULTY 

Tong Joo Gan, M.B., B.S., FRCA 







John A.C. Murdoch, M.B., Ch.B., B.Sc. 


Ronald P. Olson, M.D., CCFP 



Iain C. Sanderson, M.B., Ch.B., FRCA 


David R. Wright, M.B., Ch.B. 



CRNA 

Evelyn M. DeRoche, CRNA 

Deborah J. Ferrero-Conover, CRNA, MS, 

MSN 

David R. Marion, CRNA 

Debra S. Clements, CRNA, MSN 

Donald R. Moede, CRNA, MSN 

Gayle P. Moyer, CRNA, BSN, MS 



G. Lynn Stockbridge, CRNA 

Donald K. Thomas, CRNA 

Helen B. Walston, CRNA 

Fellow 

Yung-Wei Hsu, M.D. 

STAFF SUPPORT 

Barbara Blank 

Jennifer K. Fier 

Michelle Harward 

Tonya Meadows 

Thomas Pafford 

Angela Rogers 

Melina Shabani 

Karen Francis-McWhite 

Sharon Skeeter 

Ella Smith 

Regina Williams 

RESEARCH SUPPORT 

Aaron K. Harrison, B.S., Clinical Trial 

Research Associate 

Karen W. Ramsey RN, BSN, M.B.A., 

MHA, Non-Cardiac Clinical Research 

Coordinator 

The GVT and Surgical Critical Care divisions 

were combined in July 2000 to 

form the GVTCCM Division of Anesthesiology 

under the leadership of David 

Lubarsky, M.D., M.B.A. as Chief and 

Associate Directors Kerri M. Robertson, 

M.D., FRCP(C) and Christopher Young, 

M.D., FCCCM. The combination of the 

previously independent sections was 

accomplished in order to bring a full 

perioperative medicine approach to the 

care of our patients. Our responsibilities 

range from directing the preoperative 

screening clinic, to running multiple 

operating rooms for a tertiary care practice, 

to medically supervising the PACU, 

to providing the anesthesia faculty for 

and co-directing the SICU. This allows 

our division to impact the entire perioperative 

experience to maximize 

patient health outcomes and minimize 

procedural imperfections. The division’s 

clinical faculty are a “seasoned” 

and productive group who have a variety 

of clinical and research interests 

which are detailed below. 

David Lubarsky, as Chief of the 

Division, holds an academic rank of 

Associate Professor, is Vice Chairman 

for the department and Adjunct 

Associate Professor in the Health Sector 

Management Program of the Fuqua 

School of Business. He combines a 

high-energy style with his experience 

and expertise in both the world of medicine 

and business to illuminate economic 

concepts and define cost effective 

patient care. He published four articles 

this past year, three related to 

healthcare economics, and one clinical 

study on post-operative ischemia and 

coagulation profiles. His teaching interests 

this year included mentoring medical 

students in their Cost Effective Care 

Clerkship, teaching a full course 

(Informatics, the Internet, and 

Healthcare) at the MBA program 

at Fuqua, writing and editing the 2nd 

Edition of Board Stiff (an oral review 

book that sold 12,000 copies in its first 

edition), and serving as chair of the 

editorial board of AnesthesiaWeb (the 

largest anesthesia e-magazine in the 

world). In the near future, look for the 

first anesthesiology textbook written 

exclusively for the Internet with emedicine.com 

for which Dr. Lubarsky is the 

co-project manager with Dr. Charles 

Cote of Northwestern University and 

one of the editors-in-chief as well. 

Kerri Robertson is a Canadian graduate, 

with two years of fellowship training 

in Liver Transplant Anesthesia, and 

15 years of subsequent clinical and 

research experience in all areas of subspecialty 

anesthesia practice. Following 

an extensive search, due to both her 

clinical and leadership skills, Dr. 

Robertson was selected as the Chief 

of the GVT section of the GVTCCM 

Division in Anesthesiology in July 2000.

Under her leadership, the newly energized 

division has moved forward with 

several initiatives including; the Perioperative 

Outcomes Database, the 

General Surgery Pilot Study (designed 

to allow GVT faculty members to run 

the surgical schedule on a daily basis), 

support and participation in the Human 

Pharmacology Laboratory and development 

of a strategic plan for improving 

the process and patient flow in the 

PACU. The first annual GVTCCM retreat 

was a huge success, and with participation 

from our M.D. and CRNA faculty, 

we gained insight into the various clinical, 

research and teaching initiatives 

administrated by our divisional members. 

Dr. Robertson headed a Taskforce 

on CRNA Recruitment and Retention 

which successfully resolved salary and 

benefits issues that were impeding our 

recruitment of additional CRNA faculty. 

A consistently strong endeavor has 

been the high quality of perioperative 

care that the Liver Transplant Faculty 

have provided to transplant recipients, 

and the enthusiasm with which the residents 

now actively participate in this 

program. As Chief of Transplant 

Services, Dr. Robertson coordinates 

clinical, research and teaching activities 

and provides the necessary liason with 

our surgical colleagues which make this 

a successful cohesive and cooperative 

multidisciplinary effort. 

T.J. Gan is an Associate Professor 

and Director of Clinical Research for 

the department. He also serves as 

Medical Director of the PACU. During 

the 2000 academic year, T.J. coordinated 

the activities of 18 active IRBapproved 

research protocols which 

focused on the use of physiologically 

balanced colloid solutions for fluid 

resuscitation, novel drugs and drug 

delivery systems and improving the 

care of elderly patients undergoing 

surgery. He is an acknowledged world 

expert on antiemetic drug therapies to 

reduce postoperative nausea and vomiting. 

He will soon be expanding his therapeutic 

strategies to include acupuncture 

techniques. T.J. is the driving force 

behind the divisional project of establishing 

a comprehensive postoperative 

database to measure perioperative outcome 

and ultimately establish “best 

practice” for patient care. 

Jacques Somma joined our department 

two years ago with a unique background 

in engineering, medicine and 

two years of fellowship training in Dr. 

Steven Shafer’s Pharmacology Laboratory 

at Stanford University. Dr. Somma 

is director of the Human Pharmacology 

Laboratory (www.pharmacokin.com) 

which is a fully equipped state of the art 

laboratory supported by a comprehensive 

team of Duke faculty who have the 

skills required to efficiently design, perform 

and analyze data for Phase I studies. 

Two protocols are currently active: 

“A Double Blind Randomized Study to 

Compare the Analgesia and Respiratory 

Effect of Dexmedetomidine and 

Remifentanil,” and “Age Effect on the 

Interaction between Propofol and 

Remifentanil.” His support staff includes 

Aaron Harrison (Clinical Trail Research 

Associate), Karen Ramsey (Non-cardiac 

Clinical Research Coordinator) and 

Yung-Wei Hsu, M.D., (Research 

Associate) 

Eugene Moretti is a Duke anesthesia 

graduate, who has subsequently 

completed his board certification in 

anesthesiology and critical care medicine 

and his first of two years towards 

a Master's degree of Health Sciences in 

Clinical Research. Gene’s participation 

in the clinical research training program 

at Duke is intimately tied to the 

Duke Clinical Research Institute (DCRI) 

and meets an existing need for formalized 

academic training in the quantitative 

and methodological principles of 

clinical research. In addition, Dr. 

Moretti’s continuing commitment to 

pursuing excellence in patient care 

finds him in the Duke North OR, as 

an intensivist in the surgical ICU and 

as an active participant on the Liver 

Transplant Team. 

The Laboratory for Tissue 

Engineering under Laura E. Niklason’s 

guidance continues to focus on topics 


related to vascular biology and design 

of vascular replacement tissues. Current 

topics of study include: 

1. Biochemical and theoretical 

modeling approaches to understanding 

and improving the mechanical characteristics 

of engineered tissues. 

2. Life span extension of vascular cells 

via over-expression of the human telomerase 

reverse transcriptase gene. 

3. Utilization of adult human pluripotent 

stem cells as precursor cells for 

engineered cardiovascular tissues. 

4. Effects of controlled mechanical and 

electrical stimuli on vascular cell function 

and phenotype. 

Additionally, the laboratory is 

conducting a collaborative study on a 

possible etiology for delayed vasospasm 

following subarachnoid hemorrhage. 

Funding for these efforts are derived 

from multiple sources, including the 

NIH, private foundations, and private 

corporations. 

Ronald P. Olson, M.D., CCFP, 

Medical Supervisor of the Preoperative 

Screening Unit (POSU) and his team 

continued to serve as the focal point for 

preoperative coordination for most surgical 

patients during the year 2000. 

They strive to offer the most complete 

preoperative service anywhere. 

Their strengths continue to be conducting 

a complete history and physical 

exam which allows accurate risk stratification 

and choosing of appropriate 

investigations. With continual feedback 

from anesthesiologists and surgeons, 

they provide consistency in investigation 

and education of the patients. The 

POSU coordinates appropriate consultation 

and testing and manages minor 

medical conditions. By the morning 

of surgery, the patient has already been 

educated on the perioperative event, 

and the paperwork is organized and 

delivered. Therefore, the POSU minimizes 

morning of surgery surprises. 

Changes during this year have 

been progress with the electronic 

record, use of the POSU for research 

recruitment, and initiation of billing for 



some of the services rendered. They 

continue to seek consensus on appropriate 

education and investigation. 

Example of this are NPO guidelines, 

ASA classification, routine investigations 

ordered by surgeons, and body 

jewelery. 

The coming year will see some 

expansion in the primary care delivered 

in the clinic, billing, POSU services to 

the cardiovascular service, and establishment 

of a different stream for 

healthy patients scheduled for low risk 

surgery. The electronic record will continue 

to evolve. They expect to make 

advances in ease of data entry and 

coordination with the Saturn system. 

There continues to be enormous potential 

for research in the POSU setting, 

and there should be some exciting 

developments in this area. 

The name of our division reflects 

our intimate involvement in Critical 

Care issues, as we treat many of the 

sickest patients who come to Duke for 

surgery. The faculty that provide surgical 

critical care oversight are a uniquely 

qualified subset of our OR group. The 

Duke University Hospital Surgical 

Intensive Care Unit (SICU) is a 16-bed, 

Level One trauma unit. In addition, it 

serves as a site for care of a variety of 

postoperative general and subspecialty 

surgical patients. Attending staff from 

the Departments of Medicine, Surgery, 

and Anesthesiology provide twenty-four 

hour a day, seven day per week coverage. 

The Critical Care Division continues 

to be recognized as a leader in the provision 

of adult Critical Care services at 

Duke Medical Center. Nancy Knudsen, 

M.D. as co-director of the SICU, continues 

to improve the process of healthcare 

delivery in the Intensive Care Unit 

(ICU) setting. Multidisciplinary Critical 

Care Rounds continue biweekly under 

the direction of Christopher Young, 

M.D., FCCM who is the Section Chief 

of Critical Care Medicine within our 

division. 

The goal of the Division is to build 

upon recent accomplishments and 

continue to improve in all aspects of 

patient care, teaching, and research. 


These contributions are recognized by 

hospital administration, our patients, 

and their families. A full description of 

Critical Care Medicine program given 

by Dr. Christopher Young appears separately 

in this annual report. 

LIVER 

TRANSPLANTATION 

Kerri M. Robertson, M.D., 

FRCP(C) 

Chief of Transplant Services 

Chief of GVT Section of GVTCCM 

Division of Anesthesiology 

Associate Director of of GVTCCM 

Division of Anesthesiology 



Members 

T.J. Gan, M.B., B.S., FRCA 




In 1984, Duke University Medical Center 

performed the first liver transplant in 

the Southeast. Program landmarks 

include approval as a Medicare facility 

in 1994, the first center world-wide offering 

an ex-vivo transgenic pig liver perfusion 

system for fulminant hepatic 

failure, initiation of the living-related 

program for children in 1997, and live 

donor right hepatectomy for adult 

recipients in 1999. In January 2001, 

we welcomed a new Surgical Director 

for the Liver Transplant Program, Dr. 

Paul Kuo, from Georgetown University 

in Washington, D.C, who joined Drs. 

Betsy Tuttle-Newhall and Bradley 

Collins. We are also delighted to have 

the experience and expertise of Dr. 

D. Ryan Cook, who has joined our pediatric 

faculty, and is the world’s leading 

expert in pediatric liver transplantation. 

Nationwide there are currently 121 

programs sharing a pool of 4900 cadaveric 

donors per year, with 17,376 patients 

listed as waiting recipients. The 

typical recipient is a male between the 

ages of 35 and 64, with an O or A blood 

type and medical urgency status 2B or 

3. Within our region, the NCNC-OP 1 

Carolina Donor Services recovers between 

80 and 100 cadaveric livers each 

year which are shared by Duke University 

Medical Center and UNC Hospitals. 

The 1-month, 1- and 3-year patient survival 

outcomes for liver transplants performed 

at Duke from January 1997 to 

December 1998 are 94%, 82%, and 

74%, compared to the UNOS-reported 

national averages of 94%, 86% and 81%, 

respectively. 

Anesthesia faculty members provide 

24-hour clinical coverage for 45 

to 50 cases per year, from a waiting list 

exceeding 200 patients. A target of 80 

cases per year has been set, to be 

achieved by 2003. With surgical preservation 

of the inferior vena cava, use of 

antifibrinolytic therapy, lowering cardiac 

filling pressures (low CVP anesthesia) 

and the infusion of octreotide for 

portal hypertension, blood product 

replacement therapy has been significantly 

reduced. Moments of excellence 

in patient care have included requirements 

for no blood products, fast tracking 

with extubation in the operating 

room, survival of massive intraoperative 

pulmonary embolism and discharge 

from hospital on post-operative day two. 

Current research interests include 

pharmacokinetics of muscle relaxants, 

defining optimum perioperative care of 

the living liver donor and determination 

of the clinical efficacy of octreotide.

CENTER FOR 

HYPERBARIC MEDICINE 

AND ENVIRONMENTAL 

PHYSIOLOGY 

Richard E. Moon, M.D., 

C.M., M.Sc., FRCP(C), 

FACP, FCCP 

Medical Director, 

HyperbaricCenter 

Professor of Anesthesiologyr 

of Anesthesiology 


The Center 

The Center for Hyperbaric Medicine 

and Environmental Physiology is a 

multi disciplinary organization involved 

in clinical treatment of patients with 

hyperbaric oxygen, research into oxygen 

biology and environmental physiology 

(especially diving and altitude 

physiology) and provision of information 

and medical services for recreational 

divers through the Divers Alert 

Network. 

The Center for Hyperbaric Medicine 

and Environmental Physiology 

consists of several components. The 

F.G. Hall Environmental Laboratory 

contains a seven-chamber 254 cu m 

complex with a 5,660 cu m compressed 

air storage field, three 3 cu m/min air 

compressors, a 2,633 cu m liquid oxygen 

system, two vacuum pumps, and 

a complete gas mixing facility. These 

chambers were designed to simulate 

environments ranging from an altitude 

of 47,000 m (155,000 feet) to a depth 

of 1,100 msw (3,600 feet of sea water). 

The chambers are outfitted with environmental 

control units, which regulate 

temperature, humidity, and CO 2 accumulation. 

The facility also incorporates 

the capability to conduct studies of 

subjects immersed in water. Electrical 

penetrators are installed, allowing physiological 

monitoring of patients undergoing 

treatment, human subjects and 

experimental animals inside the chambers. 

Studies have been performed in 

humans incorporating invasive measurement 

of arterial and pulmonary 

arterial pressures, transcranial Doppler 

blood velocity, precordial Doppler 

monitoring for vascular bubbles and 

in vivo near infrared spectroscopy of 

tissue oxygenation. In addition to the 

chambers, a human physiology laboratory 

is available for human studies at 

1 ATA. An electronics shop and 

machine shop provide in-house design 

and construction facilities. 

The Oxygen Transport Laboratory 

has facilities for studies of whole animal 

and tissues. It incorporates an operating 

room and facilities capable of maintaining 

anesthetized animals under continuous 

monitoring for several days. 

It is equipped with an environmental 

exposure facility, biochemistry and 

molecular biology laboratories and 

microscopy and darkroom facilities. 

The Divers Alert Network (DAN) is 

an organization devoted to promotion 

of recreational diving safety via accident 

and mortality data collection, research 

and education. In addition DAN 

provides a 24-hour phone consultation 

service for diving accidents (see below). 

Clinical Activities 

Twenty-four hour coverage is provided 

for hyperbaric emergencies and elective 

treatment of patients with hyperbaric 

oxygen. The call team consists of an 

intern, resident or fellow, an attending 

physician, a nurse and a chamber operator. 

The call schedule also includes 

“hotline” coverage of emergency diving 

calls from throughout the world. 


A total of 200 new patients were evaluated 

for hyperbaric therapy in 2000 

(6,721 treatment hours). There were an 

additional 48 patients evaluated but 

who did not receive treatment, including 

fitness-to-dive consults and patients 

with various wounds for whom hyperbaric 

oxygen therapy was not recommended. 

New patients included 28 

patients with decompression sickness, 5 

with air embolism, 29 with carbon 

monoxide poisoning and 18 with necrotizing 

soft tissue infections. There were 

95 emergency hyperbaric treatments. 

In addition, 7 therapeutic lung lavages 

for patients with pulmonary alveolar 

proteinosis were carried out under general 

anesthesia inside “C” chamber to. 

For this procedure hyperbaric oxygen 

provides a convenient mechanism for 

treatment of hypoxemia. Non-emergency 

conditions treated included 

refractory osteomyelitis, threatened 

flaps, radiation necrosis and selected 

ischemic problem wounds. The service 

relies heavily on a computerized database, 

designed and maintained by Dr. 

Guy Dear, accessible from anywhere 

within the Medical Center. All clinical 

notes are computer-generated and 

accessible via the Duke hospital-wide 

computer system. 

The following physicians participated 

in clinical activities in the 

Hyperbaric Center in 2000: 

Martha Sue Carraway, M.D. 

Department of Medicine 


Department of Anesthesiology 



Departments of Anesthesiology and 

Medicine, Medical Director 


Departments of Medicine and 

Anesthesiology, Center Director 





Since 1986 there have been 14 clinical 

fellows in Hyperbaric Medicine. 

The training, which has been up to two 



years, has combined clinical responsibilities 

and research. Fellows for 2000 

have been David Hendricks, M.D. 

(January-June), Charles Gleaton, M.D. 

(January-June) and John Freiberger, 

M.D. (July-December). Klaus Torp, 

M.D., a visiting Fellow from Mayo Clinic 

for three months completed a study of 

the effect of simvastatin on hypoxic 

pulmonary vasoconstriction. 

The full time nursing staff are: 

Kevin L. Kraft, RN 

John H. Rice, RN (Head Nurse) 

Roberta E. Rose, RN 

A number of part time nurses also 

participate in patient care. 

Teaching 

For the second year, a 37-hour course 

in the Physiology of Extreme Environments 

was given (CBI206/ANE245. 

Duke University Graduate and Medical 

School. Fall Semester 2000: Richard D. 

Vann, Ph.D., Course Director). In addition 

to lectures on the physiology of 

high pressure, hyperoxia, hypoxia, 

immersion and hypothermia, the course 

included practical laboratories on diagnosis 

and management of hyperbaric 

and diving related emergencies. The 

course was made available not only for 

the fellows and students working in the 

Center, but also for faculty, residents 

and fellows in the Department. 

The Center also participates in the 

teaching for the Anesthesiology and 

Environmental Physiology section for 

the third year medical student curriculum. 

Two third year medical students 

(Jason Archibald and Heather 

Mummery) are currently working in 

the center on human experiments at 

altitude and during diving. Interns regularly 

rotate onto the Hyperbaric Service, 

as do fellows in critical care and a number 

of medical students. Hyperbaric 

Grand Rounds in 2000 included the 

following lectures: DAN: Beginnings – 

Today – Tomorrow; Australian Experience 

on CO Poisoning; Marine Biotoxins; 

Pulmonary Alveolar Proteinosis; 

Biochemical Markers of Tissue Damage 

in Response to Bubbles and Other 


Injuries; Bubble Trouble: Surface Tension, 

Surfactants and Gas Nuclei; High 

Altitude Expeditions on Mt. Everest. 

A monthly conference on diving medicine 

is held at the DAN building. 

Academic Productivity 

PHOTO BY STEVE BARNETT 

A hyperbaric technician from the 

Center for Hyperbaric Medicine and 

Environmental Physiology uses Doppler 

device on a DAN research volunteer 

after a simulated dive in the chamber. 

The investigators in the Hyperbaric 

Center are pursuing studies on the 

mechanisms by which investigations 

into the effects of altered environmental 

conditions (altitude and diving) affect 

on human physiology, and into the 

biology of oxygen and nitric oxide at 

different gas pressures. Investigators 

in the Center include the following: 

Peter B. Bennett, Ph.D., D.Sc 






Ivan T. Demchenko, D.Sc. 


Petar J. Denoble, M.D., Ph.D. 


Habib El-Moalem, Ph.D. 


Wayne A. Gerth, Ph.D. 


E.N. Grayck, M.D. 

Deptartment of Pediatric Critical 

Care 

Y.C.T. Huang, M.D. 


T. McMahon, M.D. 




Departments of Anesthesiology 

and Medicine 

Carl F. Pieper, D.P.H. 

Deptartment of Biometry 


Departments of Anesthesiology 

and Medicine 

Neal W. Pollock, Ph.D. 


Herbert A. Saltzman, M.D. 




and Cell Biology 

Hagir B. Suliman, D.V.M., Ph.D. 




D.M. Uguccioni, M.Sc. 




K. Welty-Wolfe, M.D. 


The following projects were underway 

in 2000: 

Acute Lung Injury-Mechanisms and 

Therapy (Drs. Piantadosi, Welty-Wolf, 

Carraway) 

Animal models have been developed 

to study acute lung injury due 

to oxygen toxicity and sepsis. Methods 

of assessment include gas exchange 

(blood gases and multiple inert gas 

elimination), mechanics, lung morphometry 

and measures of the pulmonary 

inflammatory response.

Adjuncts to Recompression Therapy for 

Severe Dysbaric Diseases (Dr. 

Thalmann) 

A literature search has been conducted 

to identify pharmacological 

adjuvants, which might be useful in 

treating decompression illness. The 

focus has been on the scenario in 

which there is a long, unavoidable 

delay in obtaining recompression, in 

order to identify pharmacological 

agents that might reduce the negative 

effect of the long pre-treatment surface 

intervals on morbidity. 

Analysis of the Effectiveness of Hyperbaric 

Oxygen Treatment for Radiation 

Cystitis (Drs. Hendricks, Moon, Stolp, 

Dear, Piantadosi) 

Numerous published reports support 

the use of HBO for the treatment 

of radiation-induced cystitis. However, 

neither the optimum treatment pressure 

nor the optimum number of treatments 

are known. To determine these factors, 

a meta-analysis is being performed 

using a database that includes patients 

treated at Duke and published series. 

Biological Effects of Low Frequency 

Sonar Signals on Divers (Drs. 

Thalmann, Gerth) 

Low frequency sonar is a new 

method of communication between 

submarines. Theoretical concerns 

about possible deleterious biological 

effects are being investigated. 

Development of Efficient Oxygen Delivery 

Systems for Field Use (Drs. Vann, 

Pollock) 

Testing of several rebreathing 

circuits to determine the optimum 

design to maximize inspired PO 2 and 

minimize inspired PCO 2 at sea level and 

simulated altitudes of 15,000 and 30,000 

feet, under conditions of rest and 

exercise. 

Effect of Altitude Hypoxia and Hyperbaric 

Oxygenation on S-nitrosohemoglobin 

Concentration and Vascular Tone in 

Humans (Drs. Piantadosi, Moon, 

Stolp, Dear, Carraway, McMahon, 

Mr. Archibald) 

A joint study with members from 

the Department of Medicine (Drs. 

Piantadosi, Carraway, McMahon) has 

been completed to examine the 

hypothesis that PO 2-related changes 

in pulmonary and systemic vascular 

resistance in humans are mediated 

by S-nitrosohemoglobin. This will be 

followed by a study of prolonged exposure 

to 15,000 feet altitude with volunteers 

instrumented with arterial and 

pulmonary artery catheters. 

Effect of Ascent Rate on Venous Gas 

Embolism and Decompression Illness in 

Scuba Divers (Drs. Vann, Denoble) 

With support from the Divers Alert 

Network, a large series of chamber trials 

is underway to study the effect on 

decompression illness and venous gas 

embolism of ascent rates, which have 

in the past been recommended as low 

as 10 ft/min and as high as 60 ft/min. 

Ascent rates of 10 fpm and 60 ft/min 

will be tested in a series of dive profiles 

over a range of no-stop bottom times at 

a depth of 100 fsw. 

Establishing a Multi-Center, Multi- 

Disciplinary Program for Improving Diver 

Thermal Protection Hardware in Warm 

and Cold Water (Drs. Thalmann, Gerth) 

The goal of this project is to establish 

a long range, ongoing, multi-disciplinary 

program to address the thermal 

protection needs of the military diver. 

Current thermal protection methodology 

has several shortcomings; passive 

garments are bulky and provide inadequate 

protection to the hands and feet, 

active systems have yet to be designed, 

which are compatible with current mission 

profiles. In addition, little attention 

has been paid to the thermal problems 

encountered by divers who must dive 

in hot water, such as in the Persian 

Gulf. We will combine literature 

searches with direct contacts of those 

in the field to identify deficiencies and 

possible methods of addressing them. 

The centerpiece of this effort will be 

a symposium where we will invite 

scientists and engineers from various 

disciplines to discuss new cutting edge 


technology that may have current application. 

We will also identify any physiological 

areas which may not have 

been sufficiently investigated and 

which may impact on the design of protective 

garments. One example would 

be the effect or regional heating of the 

hand and forearm on heatflow from the 

rest of the body. Once we have an idea 

of what types of technologies are available, 

and which types of institutions 

may have a role in applying that technology 

to operational problems we 

will develop a BAA, which will solicit 

research proposals targeted at applying 

these technologies to existing problems. 

This BAA will be turned over to the program 

sponsor and form the basis of a 

follow on R&D program. In addition 

we will summarize our finding in a 

report for future reference. 

Field Measurement of Plasma Glucose in 

Insulin-Requiring Diabetics During Scuba 

Diving (Drs. Dear, Moon, Feinglos,* Ms. 

Uguccioni, Mr. Dovenbarger) 

*Division of Endocrinology, Department 

of Medicine 

Insulin-requiring diabetics have 

traditionally been excluded from scuba 

diving because of the risk of severe 

hypoglycemia underwater. Field studies 

in insulin-requiring diabetics are underway 

to determine the probability of 

hypoglycemia during recreational scuba 

diving under tightly controlled circumstances. 

A database of 500 man-dives 

has been established, which includes 

plasma glucose measurements before 

and after each dive. 

Influence of Surfactants on Bubble 

Formation in Gelatin (Drs. Vann, 

Gaskins, Mr. Hobbs) 

The theoretical effects of surfactants 

on bubble formation are widely 

cited with regard to the mechanisms 

of decompression sickness, but no data 

are available to test the theory. We are 

studying the effects of surfactant concentration 

on bubble formation in 

gelatin. 



Molecular Biology of Anti-Oxidant 

Enzymes in the Lung (Drs. Suliman, 

Carraway, Piantadosi) 

The pulmonary response to oxidative 

stress often determines the severity 

of injury following acute insults to the 

lung. These studies are exploring the 

mechanisms of regulation, cellular location 

and effects on injury of altered 

expression of key pulmonary antioxidant 

enzymes on injury during 

exposure to changes in oxygen partial 

pressure across a wide spectrum of 

environments. 

Oxygen Acceleration of Nitrogen-Oxygen 

Decompression in Submarine Rescue 

Scenarios (Drs. Thalmann, Gerth) 

The aim is to develop decompression 

models applicable to submarine 

rescue scenarios in which survivors are 

likely to be saturated on air or air with 

a reduced oxygen content at ambient 

pressures as high as five atmospheres 

absolute. These models should predict 

how oxygen be used to decrease the 

decompression time so rescue is not 

unavoidably delayed. Manned trials 

have been conducted at the Navy 

Experimental Diving Unit in Panama 

City, Florida on several decompression 

schedules and the results suggest 

breathing 100% oxygen before beginning 

ascent is more efficient than 

breathing it at decompression stops. 

In addition, assistance was provided to 

investigators at the Navy Experimental 

Diving Unit in Panama City, Florida 

(NEDU) in developing decompression 

procedures for diving at altitude, helium 

oxygen decompression, and decompression 

table integration. 

Oxygen Delivery During High Altitude 

Moutaineering (Drs. Vann, Pollock, Mr. 

Natoli) 

Oxygen supplies are limited during 

high altitude expeditions. We are testing 

a patented system for efficient oxygen 

delivery during mountaineering 

operations. This system uses CO 2 

rebreathing to compensate for altitudeinduced 

hypocapnia. 


Plasma Glucose Analysis During Hyperbaric 

Oxygen Therapy (Drs. Vote, Moon, 

Freiberger) 

Hyperbaric oxygen therapy has 

been reported to induce hypoglycemia 

in diabetics. A study to establish the 

accuracy of clinical glucometers during 

HBO administration is being followed 

by a QA assessment to determine 

whether hypoglycemia can be precipitated 

by HBO. 

Prevention of Decompression Sickness 

in Space (Drs. Vann, Pollock) 

Efforts will continue with NASA 

support to develop more efficient 

means to prevent DCS in astronauts 

during extravehicular activity (EVA) in 

space flight and during flight in aircraft 

after ground-based training in neutral 

buoyancy pools. Our DCS risk models, 

for example, can now support real-time 

staged decompressions of the EVA suit, 

which could obviate need for lengthy 

and costly pre-EVA oxygen breathing 

without compromising either safety 

or the astronaut. 

Studies 

Project Dive Exploration (Drs. Vann, 

Denoble) 

DAN has worked with the dive 

computer manufacturers to develop 

a prospective observational study 

called Project Dive Exploration (PDE) 

that records depth/time profiles from 

recreational divers who volunteer to 

carry recording dive computers during 

their open-water dives. Additional data 

is collected on demographics, medical 

history, dive conditions, and medical 

outcome of the dives. Over the past 

two years, DAN has collected data on 

14,000 individual dives during which 

four divers were treated for DCI. The 

goal is to collect data on 1,000,000 

recreational dives. The data collected 

will better define the risks associated 

with different diving practices and will 

help establish guidelines for risk 

exposure. 

Prospective Analysis of the Effectiveness 

of Hyperbaric Oxygen Treatment for 

Radiation Necrosis of the CNS (Drs. 

Gleaton, Moon, Stolp, Dear, Piantadosi, 

Thalmann, Carraway, Friedman*, 

Logue‡, Dunn‡) 

* Dept. of Pediatrics; 

‡ Dept. of Psychiatry and Behavioral 

Science. 

Hyperbaric oxygen therapy has 

been shown to be a highly effective 

treatment for radiation necrosis of bone 

and soft tissue. Anecdotal evidence 

supports its efficacy in radiation injury 

to peripheral nerve and the central nervous 

system. Clinical data are being 

collected on a consecutive series of 

patients with radiation-induced CNS 

injury treated with HBO. 

Pulmonary Gas Exchange During Diving 

(Drs. Moon, Stolp, Dear, Ms. Mummery) 

A study to determine the effect 

of age on the increase in respiratory 

dead space during diving is underway. 

Volunteers of two age groups (20 - 40 

and 50 - 70) are being compared. Bohr 

dead space is being measured at rest 

and during two levels of exercise at sea 

level and 60 feet equivalent depth. 

Regulation of Cerebral Blood Flow in 

Hyperoxia, Hypercarbia, Hypoxia, CO 

Hypoxia and Oxygen Convulsions 

(Drs. Demchenko, Allen, Bennett, 

Piantadosi) 

Dr. Ivan Demchenko, visiting scientist 

from the Institute of Evolutionary 

Physiology and Biochemistry, St. 

Petersburg, Russia, performed investigations 

on the role of endogenous nitric 

oxide in the regulation of cerebral 

blood flow in hyperoxia, hypercarbia, 

hypoxia, CO hypoxia and oxygen convulsions. 

These studies have provided 

the first direct evidence that hyperoxic 

vasoconstriction in the brain is a result 

of decreased NO availability due to 

the overproduction of the superoxide 

anion.

Safe Post-Dive Surface Intervals Before 

Military Free-Fall Parachuting (Drs. Vann, 

Pollock, Thalmann) 

Human studies are underway for 

the U.S. Military Special Operations 

Command to determine the minimum 

appropriate interval between diving 

to depths of 60-100 feet and ascent to 

22,500 feet altitude followed by free 

fall/parachute descent to sea level. 

Divers Alert Network (DAN) 

The Divers Alert Network, a recreational 

diving medical safety association, was 

organized in 1980 in order to (1) collect 

data on recreational diving accidents, 

(2) provide 24 hour emergency consultation 

for scuba diving accident management, 

(3) provide consultation for 

physicians and recreational divers on 

medical conditions which pertain to 

scuba diving safety, (4) promote diving 

safety by research. 

In 1991 DAN had grown too large 

to be accommodated within the Hyperbaric 

Center, and new facilities were 

rented in the University Tower. In addition 

to providing office space for 52 

full-time DAN employees, there were 

conference rooms, a classroom and 

a production facility of the bimonthly 

DAN newsletter, Alert Diver. The construction 

of a new 27,000 sq ft DAN 

building was completed and DAN 

moved its now 65 staff to it in July 

of 1997. 

In 1991 DAN became international 

with DAN-Japan, DAN-Europe, DAN- 

South East Asia-Pacific and in 1997 DAN 

Southern Africa were organized in 

order to enlarge the database. During 

2000 DAN answered 11,452 dive medical 

and safety telephone calls, 2,988 

e-mail inquiries and responded to 2,889 

emergency calls. Additional accomplishments 

include collection of data 

on dive fatalities, organization of CME 

dive accident management courses and 

instruction of Medical Technicians 

(EMT's) in O 2 administration. DAN 

supports salaries of Department faculty 

who participate in DAN activities and 

provides funds for research. 

DAN Staff 

Administration: Peter B. Bennett, Ph.D., 

D.Sc., President and CEO, Cindi 

Easterling, M.Ed. Vice President CME 

and Executive Assistant to CEO; Sherry 

Strickland, Staff Assistant; Cindi Duryea, 

Staff Assistant; Operations: Dan Orr, 

MS, Executive Vice President and COO; 

Jeannie Floyd, Staff Specialist; Webb 

Roberts, M.B.A., Vice President Operations; 

Brian Levering, Material Control 

Manager; Doris Lynch, Buyer; James 

Fisher, Ralph Ariail, Tommy Fowler, 

Larry Crabtree, Bill Terry; Shipping, 

James Hallmon, Shirley Fowler, Marge 

Rimmer, Cliff Nutt, Mailroom; Medical: 


FRCP(C), FACP, FCCP, Vice President 

and Medical Director; Bryant W. Stolp, 

M.D., Ph.D., Assistant Medical Director; 

Guy deLisle Dear, M.B., FRCA, Assistant 

Medical Director; Edward D. Thalmann, 

M.D., Assistant Medical Director; Joel 

Dovenbarger, RN, Vice President Medical 

Services; Daniel Nord, Director 

Medical Services; Medics: Celia Evesque, 

Dan Kinkade; Jane Foley, Administrative 

Secretary; Julie Ellis, Research 

Secretary; Finance: Chris Bennett, 

M.B.A., Vice President Finance and 

CFO; Beth Hawkins, CPA, Controller; 

Pam Everline, Allan Krehbiel, Lucy 

Williams; IDAN: Chris Wachholz, RN, 

M.B.A., Vice President IDAN; Elizabeth 

Carrasquillo, Latin America Coordinator; 

Martha Davis; Research: Richard D. 

Vann, Ph.D., Vice President Research; 

Petar Denoble, M.D., D.Sc., Senior 

Research Director; Donna Uguccioni, 

Research Physiologist; Randy Sitzes, 

Research Manager; Lisa Li, Computer 

Programmer; Jamahl Greene, Secretary; 

Training: Bill Clendenen, M.B.A., Vice 

President Training; Denise Haskins, 

Secretary; Eric Douglas, Mark Butler, 

Staff Specialists; Marketing: Barry 

Shuster, M.B.A., Vice President Market- 



DAN research participants undergo a 

series of tests to determine their overall 

fitness to dive, including this neurological 

examination. 

ing; Jim Gaston, Marketing Services 

Manager; Steve Barnett, Sales and 

Promotions Manager; Colin Taylor, 

Field and Services Representative; Rick 

La Reno, Shelby Cutts, Dave Lawler, 

Manager Industry Membership Program; 

Laura Johnson, Eileen Weckerle; 

Information Technology: Donna Heath, 

Vice President Information Technology; 

Panchabi Viethiyanathan, Bryon 

Buesser, Peter Winkler, Kim Walker, 

Bud Elvin; Sponsorship: Cindi Courter, 

M.B.A., Sponsor/Development Chief; 

Michele Harrison, Deb Taft; Renee 

Westerfield, Communications Director; 

Rick Melvin, Steve Mehan, Dan Leigh, 

Wesley Hyatt. 

DAN provides research funding 

(total $400,000) for a number of investigations 

being pursued by Anesthesiology 

faculty. These include Flying after 

Diving, Project Dive Exploration and 

Plasma Glucose Monitoring during Recreational 

Scuba Diving, Doppler Data 

Collection during Open Water Diving 

and Development of a Rebreathing 

Circuit for Emergency Oxygen Delivery. 



ORTHOPAEDICS, 

PLASTICS AND 

REGIONAL 



Division Chief, Orthopaedics, 

Plastics and Regional 




Members: 




H. David Hardman, M.D., M.B.A. 

Andrew J. Hartle, M.B., Ch.B., FRCA 



Stephen J. Parrillo, M.D. 

CRNA Clinical Leads 

Patricia M. Allushuski, CRNA, MSN 


CRNA Members 

Maurice L. Begin, CRNA 

Leslie A. Cline, CRNA, MSN 

Ann M. Connell, CRNA 

E. Susan Crumpler, CRNA 

Terry W. English, CRNA, MS 

David H. Gleason, CRNA, BHS 

Mack E. Haddock, CRNA 


Mary Ann L. Romero, CRNA 

Craig E. Shanewise, CRNA, MNA 

Henry J. Walker, CRNA, MS, M.B.A. 


Research Nurse 

Karen W. Ramsey, RN, M.B.A. 

Support Staff 

Pam Upadhaya 

Intra-Op Autotransfusion 

Coordinator 

Francis Osgood, BS, RCP 

The Division of Orthopedics, Plastics 

and Regional Anesthesiology was 

formed in July, 1998. The Division was 

created to serve the large inpatient 

population requiring total joint replacement, 

spine surgery, advanced plastic 

surgery and associated orthopedic trauma 

surgery. Additionally, the Division 

promotes a consult service for special 

needs patients requiring regional anesthesiology 

techniques. Some surgical 

patients may require regional anesthesia 

for the management of acute and 

chronic pain control. Other patients 

managed with regional anesthesia techniques, 

especially those with co-existing 

disease, may accelerate the patient's 

return-to-function with a subsequent 

earlier hospital discharge. Recently, the 

literature provides evidence regional 

anesthesia reduces postoperative mortality 

and other serious complications 

(1). 


The Regional Anesthesiologist is an 

anesthesiologist and consultant trained 

in the delivery of state-of-the-art regional 

anesthesiology techniques who has 

made a long-term commitment to continue 

learning and teaching to excel the 

specialty. The role as a “Regionalist” is 

the design of a patient-focused anesthetic 

plan and post-operative management 

plan implementing regional anesthesia 

techniques which promote a faster 

recovery and improve outcomes. This 

anesthesiology division is responsible 

for quality patient care in cohesive 

working relationship with Surgery Division 

Chiefs Drs. James Urbanik and 

Scott Levin. Additionally, pediatric 

orthopedic and general surgical 

patients requiring advanced regional 

techniques are managed. 

Education 

The greatest asset fortifying the division 

is the consistent effort made in teaching. 

The investment made in nurturing 

regional anesthesia skills during residency 

training and encouraging a lifetime 

commitment to learning even after 

residency remains the essence for a 

well-trained manpower force. The faculty 

who teach regional techniques 

at Duke remain on a motivated career 

path to enhance skills, including effective 

ways to teach these skills. Dr. David 

MacLeod has developed the Human 

Fresh Tissue Lab which allows gross 

anatomic instruction to enhance the 

understanding of anatomic relationships 

pertinent to peripheral nerve 

blockade and neuraxial blockade (see 

Figure 1). Additionally, Drs. Benveniste 

and MacLeod have utilized the (MRI) 

imaging lab to answer specific questions 

which arise during the clinical 

application of regional anesthesiology 

techniques. Training residents, fellows 

or cross-training faculty continues to be 

enforced in the preoperative regional 

block area which promotes an effective 

learning curve for regional anesthesia 

techniques when compared to other 

teaching modalities at other programs 

(2,3). The Duke regional anesthesiology 

handbook for senior residents and the 

abridged version for CA-1’s residents 

was developed and co-edited by Dr. 

Alexis Carmer. A resident student lecture 

series and the medical student lecture 

series is supported by the division. 

Additionally, guest speakers are invited 

to divisional meetings. This year, Dr. 

James Crews presented the results of 

his clinical trials on the new local anesthetic, 

levo-bupivacaine, now on formulary. 

Fundamental questions pertaining 

to regional anesthesia techniques and 

local anesthetics are acknowledged 

through the AnesthesiaWeb.com by 

Dr. Fran D’Ercole.

Research and 

Developmental Goals 

The focus of research development and 

the selection of clinical trials are based 

on practical needs identified in orthopedic 

and plastic surgery patient care. 

Dr. Alexis Carmer is engaged in a 

prospective study evaluating the delirium 

rate in the elderly requiring orthopedic 

surgery and comparing general 

versus regional anesthesia is an IRB 

approved study. Additionally, the division 

is engaged in outcome studies in 

the geriatric patient population requiring 

major orthopedic surgery in collaboration 

with Madan Kwatra, Ph.D. and 

the VAH. Dr. Gavin Martin has been 

very involved with phase II and III clinical 

trials using slow release epidural 

liposomal morphine and slow release 

hydromorphone for the last two years. 

Other IRB approved funded studies 

include Arrow’s esophageal doppler for 

fluid management during major spine 

surgery. Successfully completed studies 

include the multi-center phase III artificial 

hemoglobin blood substitute investigation 

using allogenic bovine red 

blood cell (HBOC-201) in orthopedic 

patients requiring transfusion. Technical 

support for the HBOC-201 Biopure study 

was coordinated by Karen Ramsey, RN, 

M.B.A. Additionally, Karen Ramsey has 

demonstrated excellent rapport with 

industry including the drafting of financial 

budgets for clinical trials. Clinical 

trials in coordination with Dr. Brian 

Ginsberg have involved several multiphase 

post-op trials for the total hip and 

knee replacement patient population. 

A few of these studies included immediate 

release oxymorphone, sustained 

release hydromorphine, IV acetaminophen 

and COX2 medications. Dr. 


Duke Anesthesiology residents interating with anatomist in the Human Fresh 

Tissue Laboratory. Ths lab was designed by Dr. David MacLeod to enhance 

education in regional anesthesiology. 

Helene Benveniste, former FAER grant 

recipient, orchestrates basic science 

research for the division. Dr. 

Benveniste’s research focuses on the 

development of imaging paradigms to 

detect and follow progression of early 

pathology in Alzheimer's disease. This 

includes creating a high-resolution 3D 

digital C57B16/J mouse brain atlas by 

magnetic resonance imaging to be used 

as a standard reference for all neuroanatomical 

phenotyping of transgenic, 

targeted induced mutations in 

mice. 

Philanthropy 

Congratulations to Maurice Begin, 

CRNA and his successful missionary 

effort with ORBIS. This opportunity has 

provided Mo the experience of delivering 

anesthesia in third world countries 

in an aircraft with a state-of-the-art operating 

room facility designed specifically 

for Eye Surgery. 



OTOLARYNGOLOGY, 

HEAD, NECK/NEURO- 


Cecil O. Borel, M.D., 

Chief, Division of Otolaryngology, 

Head, Neck/Neuroanesthesia 

Medical Director, Neurosciences 

Intensive Care Unit 

Associate Professor of 


Associate Professor of Surgery 


Members 


Kathryn P. King, M.D., MSN 

Ziaur Rahman, M.B., B.S. 


Alan B. Shang, M.D. 

Bryant W. Stolp, Ph.D., M.D. 



Carleen E. Bagnall, CRNA, BSN 

Cythia R. Black, CRNA 

Russell T. Giesler, CRNA, BSN 

Janet L. Margeson, CRNA 

Michele D. Moody, CRNA, BSN, RN, MS 

John F. Pierce, CRNA 

Kena B. Sigman, CRNA, MSN 

James M. Temo, CRNA, MSN, MBA 


The Otolaryngology, Head, Neck/Neuroanesthesia 

Division provides anesthetic 

care for patients undergoing head and 

neck surgery, neurological surgery, 

neuroradiological procedures, aesthetic 

surgery, and electroconvulsive therapy 

(ECT). 

Otolaryngology, Head, 

Neck/Neuroanesthesia/ 

Airway 

Bryant W. Stolp, Ph.D., M.D. 

Section Chief 

The Otolaryngology, Head, Neck/ 

Neuroanesthesia/Airway group provides 

anesthetic care for adults undergoing 

procedures such as: complex head and 

neck surgery, airway laser surgery, and 

translabrynthine acoustic surgery. In 

addition, this group focuses on developing, 

maintaining, and providing equipment 

and expertise for managing difficult 

airways in the OR and hospital 

environment. 

Teaching efforts have included individual 

instruction in use of fiberoptic 

and alternative laryngoscopic techniques. 

Each year the group presents a 

fiberoptic workshop for both residents 

and faculty. This year the workshop 

was expanded to include more hands 

on workstations for the demonstration 

and practice of such emergency airway 

management skills as cricothyrotomy, 

FastTrach LMA, Upshur scope and jet 

ventilation. The usual adult and pediatric 

fiberoptic stations were upgraded 

with the addition of new mannequins 

and videos with good success. Perhaps 

the best improvement was the addition 

of live pig lab stations used to perfect 

fiberoptic intubation techniques under 

conditions simulating those in the OR. 

Future plans include compilation of an 

emergency airway management teaching 

guide to be used in conjunction 

with the manual for resident rotation 

on OHN anesthesia. We are still seeking 

out space to relocate the permanent 

airway management workstation. This 

was an extremely useful site for both 

residents and faculty alike to practice 

intubation skills using a variety of techniques 

immediately prior to induction 

in the OR. (While in existence we had 

no reports of broken fiberoptic scopes!). 

We hope to expand this workstation 

to include interactive computer simulations 

of airway cases. We are actively 

involved in the developing teaching 

scenarios for the new human anesthesia 

simulator. We will be expanding the 

teaching to include faculty, fellows, 

nurses, and residents from other services. 

A final accomplishment this year 

includes the creation of special Anesthesia 

emergency airway packs located 

on all Code carts in the OR and at all 

anesthetizing sites out of the OR. Hopefully, 

this will allow our anesthesia providers 

immediate access to necessary 

equipment before the onset of adverse 

outcomes. 

Neuroanesthesia 


Section Chief 

Group members provide anesthesia 

for adults undergoing brain and spinal 

cord surgery. Anesthesiologists provide 

management for specialized neuroanesthesia 

care such as the following: 

patients in sitting position, cerebral 

John C. Keifer, M.D.

aneurysm clipping, aneurysm clipping 

under circulatory arrest, awake craniotomy, 

seizure surgery, and infratentorial 

surgery. 

An increasing number of patients 

are undergoing “awake” craniotomy. 

This approach to intraoperative functional 

monitoring allows more aggressive 

neurosurgical resection in functionally 

sensitive areas related to speech 

or motor capability. A brief period of 

general anesthesia with an unprotected 

airway is followed by a long period of 

functional testing during which the 

patient must be capable of full alertness 

and cooperation. This awake period 

is followed by a final period of general 

anesthesia for craniotomy closure. 

The group has undertaken a clinical research 

project to prospectively evaluate 

anesthetic techniques for managing 

these patients. 

ECT, Radiology, and Off-Site 

Anesthesia 


Section Chief. 

Anesthesia is provided in a variety of 

“off-site” locations by members of the 

group. Services provided in these areas 

are more difficult because of their 

remote locations and access to emergency 

support. These services are highly 

valued by patients and referring 

physicians. The anesthesiologist often 

performs vital consultative and supportive 

measures in addition to routine 

anesthetic care in these locations. 

With the appointment of Michael 

J. Alexander, M.D. to the neurosurgical 

and neuroradiological faculty, the use 

of coiling and embolization procedures 

to coagulate intracerebral aneuysms following 

subarachnoid hemmorrhage has 

increased dramatically. These procedures 

require general anesthesia, hemo- 

Dianne l. Scott, M.D. 

dynamic monitoring, and the potential 

need for acute lowering or raising 

blood pressure. Anesthesia support 

from within the division has been called 

on to develop emergency staffing and 

management protocols for this challenging 

group of patients. 

Aesthetic Anesthesia 


Section Chief 

The Duke Center for Aesthetic Services 

functions as a part of the Otolaryngology, 

Head And Neck Division. Dr. 

Dianne Scott provides general and 

sedation anesthesia for ambulatory 

patients undergoing cosmetic surgery. 

The full service center opened its doors 

in October 1997. Anesthesia service is 

currently provided for three days per 

week with the target goal of five days 

per week. There are two fully equipped 

operating rooms and a postanesthesia 

care unit on site. The medical specialties 

involved include otolaryngology, 

plastic surgery, oculoplastic surgery and 

dermatology. The surgical procedures 

involve rhinoplasties, breast augmentation, 

breast reduction, face and neck 

lifts, body sculpting, liposuctions, brow 


lifts, laser resurfacing and blephroplasties. 

The facility provides cosmetic services 

for the private, self-pay population. 

All surgical and anesthesia service 

is provided by attending physicians. 

There have been 591 anesthetics provided 

since 1997. Resident training 

rotations began in 2000. Office based 

anesthesia is the current trend in anesthesia 

and is certainly an aspect of 

training that should be incorporated 

into the residency program. 

Neurointensive Care 


Cecil Borel serves as the Medical 

Director of the NICU. One of the goals 

of this duty is to provide a seamless 

integration between OR anesthetic care 

and postoperative care. The Unit serves 

as the most advanced treatment neurointensive 

care unit in the area for the 

care of patients with life-threatening 

neurological illness. 

The NICU facility has undergone 

complete renovation in the last year. 

The bed capacity has increased from 

10 to 14 over the last year in a state-ofthe-art 

facility. Five Critical Care Nurse 

Practitioners, 5 faculty intensivists, and 

three fellows compose the multidisciplinary 

critical care team. Multiple clinical 

research projects are underway in a 

variety of areas including: the role of 

vascular growth factors in cerebral 

vasospasm, hypothermia for stroke 

patients, radiolabeled antibodies for 

brain tumor patients, the effect of magnesium 

infusion on cerebral vasospasm, 

and sleep-wake cycles in neurologically 

critically ill patients. 

The goal of the Division over the 

next several years will be the development 

of collaborative clinical and basic 

neuroscience research involving Divisions 

of Neurology and Neurosurgery. 



PAIN MANAGEMENT 


Co-Chief, Division of Pain 

Management 

Clinical Associate in the 


PAIN MANAGEMENT 


Co-Chief, Division of Pain 

Management 




Members 

Billy K. Huh, M.D., Ph.D. 


Brain Ginsberg, M.B., Ch.B., Acute Pain 

Service 

Joel S. Goldberg, M.D., Director Pain 

Management, Durham VAMC 

David Lindsey, M.D., VAMC 

Allison Taylor. P.A.-C 

Fellow: 


The year 2000 brought many changes to 

the Division of Pain Management in the 

Department of Anesthesiology. After 28 

years of distinguished service at Duke 

University Medical Center, Bruno J. 

Urban, M.D, Dr.med stepped down 

from clinical practice. It was also the 

year that the leadership in the division 

was passed to co-directors, Anne Marie 

Fras, M.D. and Thomas E. Buchheit, 

M.D. In November of 2000 the completion 

of the Morreene Road Clinic 

allowed the move of the Anesthesiology 

pain clinic to a newly constructed 

multidisciplinary clinic facility. 

In 1974, Dr. Bruno J. Urban, along 

with Dr. Blaine Nashold of Neurosurgery 

and Dr. Bill Wilson of Psychiatry, 

founded the Duke Pain Clinic to provide 

treatment to patients with chronic 

pain using a multidisciplinary approach. 

This was one of the first clinics established 

in the United States to offer this 

approach to the evaluation and treatment 

of patients with chronic pain 

syndromes. Unfortunately, economic 

pressures led to the separation of these 

specialists into parallel clinics in 1998. 

During the 26 years that Dr. Urban practiced 

pain management, he stressed 

a comprehensive approach to patient 

evaluation and treatment to the residents 

and fellows who learned pain 

management under his tutelage. 

One of these former fellows, Dr. 

Fras, succeeded Dr. Urban in a leadership 

position within the Division. The 

future of the division was assured with 

naming of Co-Division Chiefs, Dr. Fras 

and Dr. Buchheit. Dr. Fras will supervise 

clinical matters and Dr. Buchheit 

will supervise resident and fellow education 

and research. The year 2000 saw 

the Anesthesiology Pain Clinic move 

from its home of 26 years in Duke South 

to join the multidisciplinary clinic 

housed in the Morreene Road Clinic 

Building. The participation of the 

Anesthesiology Pain Management 

Division as part of this multi-specialty 

clinic will facilitate the cooperation of 

clinicians from the specialties of 

Anesthesiology, Psychiatry, Psychology, 

Neurology, and Neurosurgery. One of 

innovative ideas for the new clinic is a 

single point of telephone access for 

patients and referring physicians. The 

proximity of the clinicians from varying 

backgrounds with a common interest in 

pain management will encourage collaboration 

in clinical care, research, 

and teaching. 

Anesthesiologists in the pain clinic 

evaluate and treat all types of chronic 

pain syndromes including neuropathic 

pain, musculoskeletal pain, headaches, 

cancer pain, as well as sympathetic and 

visceral pain syndromes. The comprehensive 

evaluation in the clinic includes 

a detailed pain history, physical 

examination, and laboratory assessments 

as indicated. Patients seen in 

the multidisciplinary clinic complete a 

comprehensive Pain Perception Profile 

to evaluate the multiple factors involved 

in the generation of chronic 

pain syndromes. The emphasis on the 

multi-dimensional aspect of pain evaluation 

and treatment is in accordance 

with the original mission of the pain 

clinic. The patients may receive a 

variety of interventions in the clinic including 

standardization of medications, 

diagnostic and therapeutic injections, 

including discography, neurostimulatory 

and infusion procedures, and 

neuro-ablative procedures. The location 

of the Anesthesiology pain clinic 

within multidisciplinary clinic facilitates 

referral for physical therapy interventions 

as well as instruction in biofeedback 

and relaxation techniques. 

The outpatient clinic meets five 

days per week at Morreene Road. The 

expansion of clinic staff in March of

2000 when Dr. Buchheit began seeing 

pain patients has allowed the continued 

accommodation of urgent pain evaluations 

of cancer patients and patients for 

injections. The clinic has continued the 

recent trend of increasing patient volumes 

for clinic visits and injections 

while maintaining the comprehensive, 

thorough patient evaluations on which 

the attending staff pride themselves 

(see pain statistics). Drs. Fras, Huh, 

Buchheit, and Scott evaluate patients in 

the pain clinic. Allison Taylor. P.A.-C 

assists in patient evaluation and continuity 

of care. 

The inpatient Acute Pain Service 

(APS) continues to provide patient care 

1999 

Nerve Blocks/other procedures 

Differential Spinal 2 

Epidural 664 

Paravertebral/facet 127 

Lumbar Sympathetic 40 

Stellate 21 

Celiac plexus 1 

Peripheral nerve 44 

Brachial Plexus 2 

Trigger injection 131 

IV lidocaine, bretyliium 30 

Neurolytic/cryo 5 

Interpleural – 

SCS 6 

Other 9 

TOTAL 1082 

Patient Visits 

New 1024 

Return 2762 

TOTAL 3786 


Inpatient Service 14 

PAIN CLINIC STATISTICS 

on a 24 hours/day, seven days/week 

basis. This coverage is provided by Dr. 

Ginsberg (two weeks/month), Dr. Huh 

(one week/month), and Dr. Fras (one 

week/month). The APS establishes 

continuous catheters and maintains 

those established in the operating room 

for post-operative pain control. In addition, 

consultations are provided for difficult 

post-operative patients without 

catheters and for inpatients with chronic 

pain syndromes. This year, the complete 

statistics of the APS are available 

for the first time. During the year 2000, 

close to 1500 patients were followed on 

the APS; 1165 of the patients had continuous 

epidural catheters. Five special- 

2000 

Nerve Blocks/other procedures 

Differential Spinal 1 

Epidural 593 

Paravertebral/facet 150 

Lumbar Sympathetic 26 

Stellate 23 

Celiac plexus 5 

Peripheral nerve 48 

Brachial Plexus 2 

Trigger injection 192 

IV lidocaine, bretyliium 10 

Neurolytic/cryo 0 

Interpleural 0 

SCS 4 

Accupuncture 19 

Blood patch 5 

TOTAL 1081 

Patient Visits 

New 1021 

Return 2875 

TOTAL 3896 


Inpatient Service 6 


ly trained nurses assist the attending 

physicians in providing patient care on 

the APS. 

The Durham VA Medical Center 

has seen expansion in the pain clinic as 

well. Dr. Goldberg continues to provide 

the leadership for that clinic. The Anesthesiology 

pain management program 

of Drs. Buchheit and Goldberg was augmented 

by the return of Dr. David 

Lindsay to Duke. In addition, the clinic 

staff includes one psychiatrist and one 

nurse practitioner. The clinical activity 

of the VAMC included 2550 patient visits 

in 2000. The clinic meets three 

days/week with one additional day of 

invasive procedures and inpatient consultations 

are provided five days/week. 

Dr. Goldberg has expanded clinical 

teaching by offering a training course 

for Fayetteville VAMC physicians. Dr. 

Goldberg transferred the mantle of 

Director of the Fellowship Program to 

Dr. Buchheit. The Pain Fellow splits 

time between the VAMC, the Morreene 

Road Clinic, and the APS. 

In addition to providing excellent 

patient care in the inpatient and outpatient 

settings, the goal of excellence in 

education and research is emphasized 

within the division. The CA-1 residents 

each spend one month with the pain 

service. The residents participate in the 

evaluation and treatment of chronic 

pain patients in the Duke Pain Clinic 

and the VA Pain clinic over three weeks. 

In addition they spend one week rounding 

with the Acute Pain Service, learning 

strategies for post-operative pain 

management, 

The pain management fellowship 

has undergone several changes during 

the year 2000. In September, Dr. 

Thomas Buchheit assumed direction of 

the fellowship. In November, the new 

Morreene Road Pain Clinic became the 

primary teaching site. At the new pain 

management center, the fellow has not 

only had the opportunity to learn from 

anesthesiology pain management specialists, 

but also from pain specialists in 

the fields of neurology, psychiatry, psychology, 

neurosurgery, and physical 



therapy. This year’s fellow, Dr. Adil 

Kamal, has learned techniques in fluoroscopically 

guided injections, neurolytic 

procedures, implantation therapies, 

diagnostic discography, and radiofrequency 

lesioning. Clinical and 

teaching activities have also continued 

at the VA pain clinic, directed by Dr. 

Joel Goldberg. 

Additionally, the year 2000 has 

been an active time for establishment 

and improvement of educational policies 

as guided by the ACGME. We are 

working toward our ultimate goal of 

making the Duke Anesthesiology Pain 

Management Fellowship a model program 

in the United States. 

Outside interest in the pain fellowship 

has also increased, and a total 

of 35 completed applications were received 

for the 2001 position. The position 

has been filled, and applications 

have already arrived for the academic 

year 2002. The division looks forward 


2000 

ACUTE PAIN SERVICE STATISTICS 

Axillary 29 

Caudal 4 

Consults: 148 

Epidural: 1165 

Femoral 3 

Interscalene 3 

PCA 67 

Sciatic 12 

Superclavicular 4 

Tibial 9 

Unspecified 37 

to a growing and increasingly successful 

fellowship in the years to come 

Research has continued in the 

division as Dr. Huh is investigating 

yohimibine infusion as a diagnostic test 

for the presence of Complex Regional 

Pain Syndrome. In addition, he is looking 

into the effects of high concentration 

local anesthetics in facet joint injections. 

Dr. Fras has a protocol for the 

examination of various neurotransmitters 

in the CSF of patients with chronic 

pain syndromes. Dr. Ginsberg continues 

his investigation into new agents for the 

medication management of acute pain. 

Dr. Urban with Dr. Carlos Nebreda 

published a textbook on chronic pain 

treatments in Spanish. 

Bruno J. Urban Honored at Grand Rounds December 6, 2000 

Bruno J. Urban, M.D., Dr.med. came to Duke 28 years ago and continuously served 

on our clinical faculty until December 31, 2000. That is more than a quarter of a 

century of dedication to Duke University and this Department—a loyalty for which 

we are most grateful. 

Careers often have beginnings and ends that make sense. Bruno and Dr. Blaine 

Nashold established the first pain clinic in Duke South in 1974. They were codirectors 

of this clinic which has remained in service at Duke South for 26 years. 

We have a new pain clinic and it is co-directed by one of Dr. Urban’s protégées, 

Dr. Anne Marie Fras. This new Pain Clinic and new co-directors bring a new beginning 

as we celebrate both the beginning and the end of Dr. Urban's active faculty 

status. 

Dr. Urban was granted the title of Professor Emeritus of Anesthesiology and 

was also honored by Dr. Ralph Snyderman. We wish to honor Bruno and his wife, 

Ingeborg, for the many patients that have benefited from his dedication, for the 

countless resident and fellows who have learned the art and science of pain 

management from Dr. Urban. We are hopeful that Dr. Urban will join our “front 

row Emeriti Professors” when time permits and that he will have a long and healthy 

retirement. We will all miss his no-nonsense approach and dedication to excellent 

care.

PEDIATRIC 

ANESTHESIA AND 

CRITICAL CARE 

MEDICINE 


Chief, Division of Pediatric 

Anesthesia 

Associate Director, Pediatric 

Critical Care Medicine 



Pediatric Anesthesia 


Chief, Division of Pediatric Anesthesia 

Associate Director, Pediatric Critical 

Care Medicine 




Section Chief, General Pediatric 

Anesthesia 


Members: 

Robert L. Coleman, M.D. 



Thomas O. Erb, M.D., F.M.H. 

Brian Ginsberg, M.B., B.Ch. 


Clinical responsibilities of the faculty 

and staff are to provide comprehensive 

care for the pediatric patient. 

In 2000 we have been involved 

in providing comprehensive pediatric 

anesthesia services both in the OR and 

at multiple remote anesthetizing sites, 

including a regular bone marrow clinic, 

endoscopy/bronchoscopy suite and 

cardiac catheterization suite. Members 

of our division have been actively 

involved in planning the Duke Children’s 

Hospital which broke ground in March 

of 1998 and opened in the spring of 

2000. Children specific OR’s, intake 

and PACU areas for children have 

become an important part of pediatric 

anesthetic care at Duke. The pediatric 

division has continued to grow in the 

services which are provided to children 

at Duke and in pediatric anesthesia 

research. 

Research 

Our research efforts have been devoted 

to physiology, pharmacokinetics/ 

dynamics and regional anesthesia. 

Physiologic research: Includes cerebral 

blood flow, cerebral metabolism 

and inflammatory effects of cardiopulmonary 

bypass, and cardiorespiratory 

interactions. 

In the recent past, our section has 

described the effects of deep hypothermic 

circulatory arrest on cerebral blood 

flow and metabolism. Publications 

have demonstrated marked differences 

in brain blood flow and metabolism between 

children undergoing continuous 

flow deep hypothermic cardiopulmonary 

bypass and children undergoing 

deep hypothermic circulatory arrest 

and the importance of PaO 2 on cerebral 

oxygen utilization during profound 

hypothermia. We have also observed 

that cerebral blood flow falls linearly 

with temperature reduction whereas 

metabolism falls exponentially using 

alpha stat blood gas regulation. We 

have defined a metabolic index for predicting 

safe circulatory arrest times 


based on metabolic reduction due 

to hypothermia. Our group has also 

described the effects of CO 2 on cerebral 

blood flow during deep hypothermia 

in children and we have pioneered the 

use of jugular venous saturation as a 

monitor for effective cooling of the 

brain prior to the institution of circulatory 

arrest. In addition, we have 

defined the detrimental effects of CPB 

and circulatory arrest on respiratory 

and myocardial function. While inflammatory 

modification of CPB remains the 

holy grail in congenital heart surgery, 

our efforts at modifying the inflammatory 

response through circuit miniaturization, 

high dose steroids, inhibition of 

inflammatory mediator release are 

ongoing projects. 

Pharmacokinetics: Our group has 

been involved in numerous clinical 

research projects involving the pharmacokinetic 

and pharmacodynamic 

aspects of drugs in children. We have 

been involved in Phase 2 and Phase 3 

studies of investigational agents. Included 

in this list of agents are an intravenous 

induction agent, muscle relaxants 

and ultrashort acting opioids. 




Regional Anesthesia: Regional anesthesia 

has proven to lessen pain, facilitate 

early discharge from the PACU and 

minimize the deleterious effects of general 

anesthesia in high risk patients. 

Examples of the latter include, newborns, 

ex-premature infants with respiratory 

insufficiency and children with 

abnormal respiratory function due to 

CNS injury, myopathies, neuropathies 

and lung disease. Regional anesthesia 

continues to be a fertile area of research 

for our group and an important 

area for the control of pain in children 

undergoing surgery and children with 

complex medical problems. 

The Pediatric Anesthesia group 

has taken part in the International 

Cochrane Collaboration in evidencebased 

medicine. Our section had been 

designated as the section to review 

meta-analyses of national clinical trials 

in children. 

Resident education continues to be 

an important aspect of teaching in the 

department. In addition to hands on 

training and didactic lectures, pediatric 

anesthesia has a six-month subspecialty 

experience for CA-3 residents and a 

one year postgraduate fellowship in 

Pediatric Anesthesia that includes experience 

in pediatric general, cardiac and 

critical care medicine. We have also 

established an inter-departmental conference 

program dedicated to pediatric 

anesthesia and perioperative care of 

children. Fellow education, research 

and participation in national organizations 

remain important goals for the 

Pediatric Anesthesia group. 


PEDIATRIC CRITICAL 

CARE MEDICINE 

John N. Meliones, M.D., FCCM 

Chief, Pediatric Critical Care 

Medicine 

Medical Director, Pediatric 

Intensive Care Unit 




Members: 

Ira M. Cheifetz, M.D. 

Eva N. Grayck, M.D. 



The Pediatric Intensive Care Unit is a 

multi-disciplinary intensive care unit 

which includes two pediatric anesthesiologists 

and three pediatric trained critical 

care physicians who jointly share 

responsibility for the care of medical 

and surgical postoperative patients in 

the PICU and transitional care unit. The 

faculty are responsible for all medical 

and surgical admissions into Intensive 

Care. Medical patients are admitted 

directly to the critical care service. All 

surgical patients are admitted to the primary 

surgical service with a mandatory 

consultation from the pediatric critical 

care service. An ongoing fellowship 

program is maintained at two fellows 

per year. 

Research 

Research in the Pediatric Intensive Care 

Unit has been robust. Areas of investigation 

include: Partial liquid ventilation 

in ARDS, effects of Nitric Oxide and 

varying modes of ventilation on right 

ventilation function, cerebral blood 

flow, metabolism and near infrared 

spectroscopic measurements of cerebral 

oxygenation in critically ill newborns 

undergoing extracorporeal membrane 

oxygenation, pharmacokinetic 

research on long term infusions of sedatives 

such as midazolam and propofol 

for continuous sedation of critically ill 

children in the pediatric intensive care 

unit. Exciting new areas of research 

include the use of liquid ventilation during 

CPB to decrease systemic and pulmonary 

inflammatory responses. This 

investigation is occurring in swine and 

clinical arms are under investigation. 

The effect of nitric oxide as a putative 

mediator of lung injury is under investigation 

in a rabbit model in our basic 

science laboratory. 

Teaching 

Training of physicians at the resident 

and fellowship level is a very important 

part of the pediatric division. We currently 

train two fellows per year in 

critical care medicine. Three medical 

residents receive clinical and didactic 

teaching in pediatric intensive care per 

month, and fellows and residents in 

medicine, anesthesia, surgery frequently 

rotate through the PICU. The PICU 

rotation remains a favorite rotation for 

Duke medical students.

VETERANS AFFAIRS 


SERVICE 


Chief, Anesthesiology Service 

Veterans Affairs Medical Center 



Associate Professor in Medicine 

Members: 

Jonathan B. Mark, M.D., Chief 


Joel S. Goldberg, M.D. 





Gautam M. Sreeram, M.D. 

John (Sam) Thio Sum Ping, M.B., Ch.B., 

FRCA 

Dana N. Wiener, M.D 


Pain Clinic: 

Joel S. Goldberg, M.D., Director 



Surgical Intensive Care Unit: 

John (Sam) Thio Sum Ping, M.B., Ch.B., 

FRCA, Director 




CRNA: 

Linda W. Skinner, CRNA, Chief CRNA 

Pauline F. Brault, CRNA, BSN 

Hazel Kerry, CRNA, MSN 

Li-Yuan M. Lo, CRNA, BSN 

James M. Neblett III, CRNA, MSN 

George W. Tennis, CRNA 

Robin W. Westbrook, CRNA, BSN 

Physician Assistant: 

Delmer L. Shelton, PA 

Valerie Forbes, PA, BS 

David W. Lewis, PA 

Research Assistant: 

Cynthia H. Cassell, BA, MA 

The Durham Veterans Affairs (VA) 

Medical Center is conveniently located 

across the street from Duke University 

Medical Center. Our VA anesthesia faculty 

provide comprehensive clinical 

anesthesiology services for the veteran 

population at this institution, including 

patients undergoing cardiac surgery, 

orthopedic joint replacement, major 

vascular, thoracic, neurosurgical, plastic, 

ENT, urologic, and ophthalmologic 

operations. Outside the operating 

rooms, our staff care for patients undergoing 

electroconvulsive therapy and 

those requiring painful diagnostic and 

therapeutic procedures in the cardiac 

catheterization laboratory, gastrointestinal, 

and radiology suites. Our service 

provides primary coverage for all 

patients in surgical intensive care, short 

stay unit, acute and chronic pain management 

services, diagnostic transesophageal 

echocardiography, and 

emergency airway management. 

The staff bring special expertise 

and interests to all of these clinical arenas. 

Faculty with subspecialty board 

certification work in intensive care and 

pain management, and contribute to 

accredited Duke departmental fellowship 

training programs in both of these 

areas. Other faculty members have 

advanced training and interests in cardiac 

anesthesia, regional anesthesia, 

geriatric anesthesia, fiberoptic techniques 

for airway management, and 


transesophageal echocardiography. 

The expansion and renovation of 

the VA operating rooms and recovery 

room continued during the past 12 

months. In addition to a new heart 

room and major orthopedic room, both 

of which opened in late 1999, two more 

large operating rooms and a minor procedure 

room are complete and will be 

ready for clinical use after January 

2001. At the same time, we will move 

into a new post anesthesia care unit 

(PACU), located adjacent to the new 

operating rooms. The new PACU will 

have updated monitoring capabilities, 

with the bedside displays supported 

from ceiling-mounted articulating 

booms. Other features include a new 

isolation room and extra bed spaces 

to accommodate preoperative patients, 

thereby allowing the PACU to serve 

both a pre- and postoperative function. 

The final phase of this extensive operating 

room project will begin this winter, 

when the entire original operating room 

suite will be closed for renovation. At 

the conclusion of this final phase, we 

will have three more renovated operating 

rooms, a new cystoscopy room, a 

new anesthesia workroom and anesthesia 

lab-office, and centrally located support 

and storage space for operating 

room and anesthesia functions. This 

project, once completed, should help 

the VA provide surgical services in a 

modern environment well into the next 

century. 

The VAMC Pain Clinic, directed by 

Dr. Joel Goldberg, is a busy multidisciplinary 

unit. In addition to sympathetic, 

neurolytic, and other major conduction 

blocks, diagnostic thermography is used 

regularly in the evaluation of clinic patients. 

The Pain Clinic serves as a training 

site for the departmental Fellowship 

in Pain Management. Residents and fellows 

in anesthesia and primary care 

rotate through the pain clinic as part 

of their training. Over the past year, 

our pain management physicians have 

accepted important new administrative 

roles. Dr. Goldberg was asked to participate 

on the American Board of Anes- 



thesiology Pain Management Examination 

Committee, and Dr. Tom 

Buchheit was appointed as Co-Director 

of the Duke Anesthesia Division of Pain 

Management and as Pain Management 

Fellowship Director. Dr. Buchheit has 

also been very active clinically, both at 

Duke and at the VA and has expanded 

pain services by offering a variety of 

invasive techniques for patients who fail 

to respond to more conservative treatments. 

These procedures include 

radiofrequency nerve root ablation and 

implantation of spinal cord stimulators. 

Pain management services continue to 

grow at the VA, in concert with the VA 

national initiative to make pain the “5th 

vital sign.” During the past 12 months, 

the recruitment of two additional outstanding 

practitioners has helped our 

pain service continue to grow and serve 

as the leading VA pain referral center in 

the southeastern United States. Dr. 

David Lindsay, former chief resident 

and fellow in our department, returned 

to join the VA faculty December, 2000. 

His background in pain management 

and his interests in palliative care will 

lend additional experience and breadth 

to our pain service. We were fortunate 

as well in being able to recruit Marty 

Larson, Nurse Practitioner, to join the 

pain management team. Marty has 

already been active seeing patients in 

the clinic, assisting Dr. Buchheit in the 

operating room, and serving as co-chair 

of the hospital-wide pain initiative committee. 

In the latter role, she provides 

a unique opportunity for our service to 

have a close working relationship with 

hospital nursing staff, who carry out 

front-line management of pain in our 

veteran patients. 

The Surgical Intensive Care Unit 

(SICU) is an important responsibility of 

the Anesthesiology Service. Our faculty 

provide perioperative care for all surgical 

patients at the VAMC. Dr. John Sum 

Ping is the Medical Director of the unit, 

a new responsibility that he accepted 

this past year. Three other faculty share 

attending responsibilities: Drs. Lewis 

Hodgins, Laura Niklason, and 


Christopher Young. Residents from the 

Duke Departments of Anesthesiology, 

Surgery, Family Medicine, and Obstetrics 

and Gynecology provide house staff 

coverage for this unit. This heterogeneous 

group of trainees provides a 

unique collaborative learning environment. 

As described below, the SICU 

also has been an active site for clinical 

research this past year, and a number of 

abstracts and manuscripts, focused on 

ICU sedation and hemodynamic monitoring 

have resulted from these efforts. 

Of note, Dr. Christopher Young was 

honored this year as a Fellow in the 

College of Critical Care Medicine and 

will be serving on the American Board 

of Anesthesiology Critical Care 

Examination Committee. 

Our 23-Hour Short Stay Unit (SSU) 

continues to grow and serve as the hub 

of perioperative patient preparation. It 

is conveniently located on the 4th floor 

adjacent to our operating rooms and 

new recovery room. Renovated just a 

year ago, the SSU provides additional 

space that allows more private examination 

rooms and improved patient 

waiting areas. Dr. Dana Wiener continues 

her effective leadership as the 

Medical Director of the SSU, and along 

with other staff anesthesiologists, she 

provides consultative medical direction 

to the three physician assistants who 

perform most of the patient evaluations 

on this unit. Mr. Bud Shelton, PA-C, has 

worked closely since 1995 to plan the 

SSU operations, guide its growth, and 

assure its success. Two other physician 

assistants, Ms. Susie Forbes, PA, and Mr. 

David Lewis, PA, complete the team on 

this unit. Each month, more than 300 

patients receive care in the SSU, resulting 

in a marked reduction in average 

hospital length of stay for surgical and 

medical patients. Care maps for coronary 

artery bypass grafting and knee 

and hip joint replacement have originated 

in this unit and have been models 

for care throughout the VAMC. The 

unit has expanded to include medical 

patients who require a brief hospital 

stay for a variety of diagnostic or thera- 

peutic procedures. In fact, nearly 25 

percent of the patients seen in this unit 

are non-surgical patients, truly making 

this a multidisciplinary patient care 

service. 

The Transesophageal Echocardiography 

Service acquired new equipment 

this year for digital acquisition and storage 

of both intraoperative and other 

diagnostic echocardiograms. This is a 

very unique, state of the art imaging system, 

which allows rapid retrieval and 

review of any echocardiogram performed 

at the VA or at Duke. Its role 

in clinical care is already evident, and 

it will offer unique opportunities for 

clinical research in the future. 

The clinical success of the VA 

Anesthesia Service would be impossible 

without the ongoing contributions of an 

outstanding group of certified registered 

nurse anesthetists. Ms. Linda Skinner 

has provided superb leadership in her 

role as acting Chief CRNA and agreed 

to serve in this capacity on a more permanent 

basis this year. In 2000, we 

were fortunate to recruit two capable 

anesthetists, James Neblett and Robin 

Westbrook, to join our other experienced 

CRNAs, Pauline Brault, Hazel 

Kerry, Mary Lo, and George Tennis. 

Our CRNAs not only provide clinical 

care, but they also support the educational 

efforts of the faculty and serve 

the VA on a variety of committees. 

Members of the faculty also are 

active in hospital affairs and provide 

leadership in a variety of areas outside 

the operating rooms. Dr. Joel Goldberg 

chairs the Pharmacy and Therapeutics 

Committee, Dr. Thomas Slaughter 

chairs the Transfusion Committee, and 

Dr. Lewis Hodgins co-chairs the Ethics 

Committee. 

Research and Publication 

Year 2000 was a productive one for divisional 

research. Dr. Thomas Slaughter 

continues to work closely with Dr. 

Gautam Sreeram in the area of perioperative 

disorders of hemostasis. Both 

remain supported by NIH grants and 

commercial awards. Dr. Slaughter’s

success as a physician-investigator was 

recognized at the end of this year when 

he was promoted to Associate Professor 

of Anesthesiology. A number of other 

clinical investigators have been active 

this year. Dr. Sum Ping has been evaluating 

the efficacy of dexmedetomidine 

as a sedative-antihypertensive for 

patients following cardiac surgery, and 

he and Dr. Christopher Young are 

actively pursuing other clinical trials 

using this unique sedative, both in 

intensive care patients as well as in the 

departmental human pharmacology 

laboratory. Technology assessment 

remains another focus of the VA group. 

Drs. Slaughter and Sreeram continue to 

explore improved methods for bedside 

evaluation of the coagulation system 

and platelet function, and both have 

published widely on hemostasis and 

transfusion practice. In addition, Drs. 

Chris Young and Jonathan Mark have 

been evaluating a new method of cardiac 

output measurement that does not 

require pulmonary artery catheterization 

and is based on ion-selective sensor 

technology. Our research assistant, 

Ms. Cynthia Cassell, has been instrumental 

in providing support for all of 

these clinical investigations. The VA 

faculty continued to contribute to the 

medical literature in 2000 by authoring 

numerous chapters and reviews in the 

fields of cardiovascular physiology, critical 

care, cardiovascular monitoring, 

and coagulation pathophysiology. 

Teaching 

Resident, fellow, and medical student 

education are top priorities for the 

entire faculty at the VA, as evidenced 

by the fact that our clinicians are consistently 

rated highly as effective teach- 

ers in the department. In recognition of 

this tradition that emphasizes resident 

education, a VA Teaching Award was 

established in 1996 by the Duke Department 

of Anesthesiology and was awarded 

to Dr. Tom Buchheit this past June. 

Daily didactic conferences at the 

VA supplement bedside SICU and operating 

room training. Each morning, 

from 7:00 - 7:45 a.m., a general departmental 

teaching conference starts the 

educational day, followed by didactic 

SICU teaching rounds at 10:00 a.m. 

Finally, a departmental Friday morning 

Echocardiography and Cardiac Physiology 

Conference is attended by faculty 

and residents at the VA, Duke cardiac 

anesthesia fellows, and fellows and residents 

from cardiology and cardiac 

surgery. 

Medical students from Duke and 

other institutions rotate through our 

operating rooms and SICU at the VA. 

All of our faculty are involved in teaching 

students at the bedside and in small 

group conferences, and several faculty 

contribute to the first year medical 

school curriculum in pharmacology 

and physiology. 

Goals for 2001 

Operating Room Renovation. A major 

renovation of the entire 40-year-old VA 

operating rooms is currently in progress. 

The final phase of this multi-year project 

will begin in 2001. During this year, we 

will modify our daily operating room 

schedule to attempt to maintain workload 

and clinical productivity. 

Short Stay Unit. Work to make preoperative 

assessment available electronically 

through the VA computer system. 

Intensive Care and Monitoring 

Units. Promote development of multi- 


disciplinary care of the critically ill 

patient, training housestaff from Anesthesiology, 

Surgery, Family Medicine, 

and Obstetrics and Gynecology. Work 

more closely with the medical intensive 

care unit team to develop further collaborative 

efforts in intensive care medicine 

and training at the VA and at Duke. 

Pain Management Services. Support 

pain services to meet the growing clinical 

demand, including cancer pain 

management and palliative care. The 

greatest challenge for the upcoming year 

will be to arrange expanded clinic 

space and hours to accommodate our 

growing pain team and patient load. 

Fellowship Training. Continue 

board-certified training programs in 

Pain Management and Critical Care 

with our faculty at Duke. Continue 

to develop collaborative subspecialty 

training for our cardiac anesthesia fellows, 

particularly in transesophageal 

echocardiography. 

Clinical Research. Support Dr. 

Slaughter’s research program in perioperative 

hemostasis and thrombosis, linking 

both clinical and laboratory investigations, 

with a long term goal of establishing 

a Laboratory for the Investigation 

of Perioperative Hemostasis and Thrombosis 

at the Durham VAMC. Continue 

and expand SICU research in clinical 

pharmacology (sedation) and hemodynamic 

monitoring. Aid fellows in 

clinical research, particularly in the 

areas of transesophageal echocardiography, 

cardiac physiology, clinical 

monitoring, and perioperative coagulation 

disorders. 

Digital Echocardiography. Work to 

expand the application of digital echocardiography 

from clinical service to 

clinical research. 



WOMEN’S ANESTHESIA 

AND CRITICAL CARE 

MEDICINE 

Holly A Muir, M.D., FRCP(C) 

Chief, Division of Women's 

Anesthesia (DWA) 

Assistant Professor of Anesthesia 

Associate of Obstetrics and 

Gynecology 

Members 

Elizabeth A. Bell, M.D., M.P.H., 

Terrance W. Breen, M.D. 

Peter D. Dwane, M.D., C.M., FRCP(C), 

Clinical Director 



James D. Reynolds, Ph.D. 


CRNA Staff 

Carolyn E. Burgess, CRNA, Ph.D. 

Julie T. Fritz, CRNA, MSN 

Sarah O. Jinwright, CRNA 


Yolanda G. Wright, CRNA 



The Division of Women's Anesthesia 

(DWA) is responsible for obstetric and 

gynecologic anesthesia and provides 

continuous in-house faculty coverage 

of obstetrics. There were over 3,200 

deliveries in 2000. Anesthesia was 

involved with over 75% of these patients 

at some point in their care. The DWA 

provides all major modalities of labor 

analgesia including neuraxial narcotics, 

combined spinal-epidural analgesia 

(CSE), and patient-controlled epidural 

analgesia (PCEA). 

Over the past year, we have settled 

in to the newly constructed Duke 

Birthing Center. As a result of a significant 

change in our physical layout we 

needed to update departmental procedures 

and policies to meet the clinical 

demands of our service. Residents and 

faculty have had to endure almost daily 

changes in the way we do business. 

Efforts to improve our clinical service 

have included the introduction of new 

PACU and post-op pain orders, a new 

anesthesia record, and access to PCEA 

for all patients on labor and delivery. 

Unfortunately the year 2000 also resulted 

in the loss of the computerized record 

keeping system in the OR, (Arkive) with 

a delay in its replacement, SATURN. On 

the obstetric side we welcomed a new 

medical director for labor and delivery, 

Dr. Philip Heine. We are looking forward 

to a renewed collaborative relationship 

with our obstetric colleagues. 

The gynecology service saw significant 

renovation in OR’s 19 and 20 to allow 

for the construction of a high radiation 

therapy unit. This project, with direction 

from Dr. Peter Dwane, proceeded very 

smoothly. This unit allows an expansion 

of therapeutic modalities for our 

gyn-oncology patients, as well as adding 

some challenging anesthetic issues. 

Education 

Resident education is a major mission 

of the Division of Women’s Anesthesia. 

We have two residents rotating on 

obstetrical anesthesia at all times. 

Under the guidance of Dr. Holly Muir, 

the DWA Residency Director, we have 

reexamined and renewed our commitment 

to format education in obstetric 

anesthesia. In our continuum of 

change, the Divisional meeting was 

changed to Thursday afternoons at 5:00 

p.m. to avoid conflict with the GVLT 

and Cardiac meetings. Here faculty 

and fellows review important developments 

in the field and discuss research 

progress. Residents are encouraged 

to attend and contribute. With a good 

balance of high-risk and normal pregnancies, 

we are confident that our residents 

get an education in obstetrical 

and gynecological anesthesia that is 

second to none. In this new academic 

year, we have seen an increased interest 

in CA-3 and advanced clinical track 

rotations on the obstetric service. 

We offer 1-2 fellowship positions 

per year in obstetrical anesthesia. These 

fellows undertake clinical care and 

teaching as well as participate in clinical 

and laboratory research. This year 

saw a change in our Fellowship Director 

from Dr. Elizabeth Bell to Dr. Yemi 

Olufolabi. Under his leadership the program 

has flourished. This years fellows 

included Dr. Sheila Gardner, Dr. John 

Schultz and Dr. Ashraf Habib. Our fellowship 

program has recently introduced 

a new option of combining the 

OB experience with Cardiac Anesthesia 

and Echo Experience in collaboration 

with Dr. Mark Stafford-Smith. Interest is 

strong and we are seeing many superb 

applicants. 

Dr. Peter Dwane, in his capacity as 

coordinator of the fourth year clinical 

elective, facilitates the introduction of 

numerous medical students to the field 

of anesthesia, including our own service, 

women’s and obstetric anesthesia. 

Research 

Elizabeth A. Bell, M.D., M.P.H. continues 

to coordinate the Combined Obstetric 

Research Database (CORD). Using data 

obtained from the database, Dr. John 

Schultz, under the guidance of Drs. Bell

and Muir, produced an abstract for presentation 

at SOAP 2000 comparing the 

anesthesia manpower required for patients 

using patient controlled epidural 

pumps versus continuous infusion 

pumps. This retrospective look at our 

data lends support to a prospective 

study comparing PCEA modalities 

under the supervision of Dr. Terry 

Breen. Dr. Bell presented the results 

of a prospective analysis of anesthesia 

time requirements for management of 

a labor service at the ASA as a follow 

up to her retrospective study published 

in 1999. 

John R. Schultz, M.D. the most 

recent addition to the divisional roster, 

is continuing a study to evaluates the 

addition of IHIL blocks to neuraxial 

narcotics after cesarean section can 

reduce the dosage of narcotics and 

unwanted side effects. This industrious 

young man is also directing a study 

evaluating a new simpler form of EKG 

monitoring, working on collaborative 

projects with Dr. T.J. Gan, and exploring 

laboratory research with Dr. James 

Reynolds. 

Adeyemi J. Olufolabi, M.B., B.S., 

FRCA continues to spearhead an investigation 

of TEG and bleeding tendencies 

Departmental Support Staff 

in severe pre-eclampsia. He is also conducting 

a study looking at BIS levels and 

suggestion under anesthesia. In 2001, 

he hopes to conduct a study using near 

infrared spectrometry (NIRS) to evaluate 

placental blood flow. 

Terrance W. Breen, M.D., FRCP(C) 

is organizing a multi-center study to 

look at ED-95 doses of local anesthetic 

for induction of labor analgesia. He 

as well, will be starting a collaborative 

study with obstetrics to look at PCEA 

modalities and obstetric outcomes. He 

has recently been named as the QI 

Director for our Department and has 

taken this job on with vigor. 

Ellen M. Lockhart, M.D. continues 

to work on her laboratory based investigations 

of progesterone and brain protection. 

Scott E. Helsly, M.D., Ph.D., one 

of our up and coming Residents, under 

the tutelage of Dr. Terrance Breen, presented 

a retrospective evaluation of the 

risk of total spinal when spinal anesthesia 

is administered after failed epidural, 

both at the departmental research day 

and at the ASA this year. 

James D. Reynolds, Ph.D. moved 

to the position of the Director of the 

Obstetric Anesthesia Research Labora- 


tory and has developed collaborative 

relationships in his laboratory research 

with the Department of Surgery. 

Personnel 

In the year 2000, the Division saw major 

changes in personnel and administrative 

structure. Early in the year we were 

saddened by the departure but delighted 

by the promotion for Mary Carnell to 

the office of Grants and Contracts. This 

was followed by a move by Dr. John 

Booth to the Cardiac Division. John 

will be missed on the clinical service, 

however, he will continue to explore 

his research interests on the genetics 

of preterm labor. This year we also saw 

changes in our CRNA membership with 

the departure of Robert Foy and Mary 

Murphy, both to positions at the Ambulatory 

Surgery Center. They are both 

missed by their colleagues. In July we 

saw the departure of our leader, Dr. 

Donald Penning to an exiting administrative 

position in Toronto, Canada. 

He was replaced by Dr. Holly Muir, who 

will move the interests of the Division 

in new directions. 

Barbara Blank Patsy Clifton Vicki Jackson 


BIOSTATISTICS AND 

CLINICAL OUTCOME 

William D. White, M.P.H. 

Chief, Division of Biostatistics 

and Clinical Outcomes 

MEMBERS: 


Barbara Phillips-Bute, Ph.D. 

Regina deLacy, B.A. 

BIOSTATISTICS AND CLINICAL OUTCOMES 

One of the primary commitments and 

achievements of the Department of 

Anesthesia is research, evidenced by 

increasing numbers of publications, 

funded research studies, and most 

important, improvements in patient 

care. Since its organization in 1997, the 

Division of Biostatistics and Clinical 

Outcomes has been committed to 

providing the necessary statistical 

resources and support to promote and 

enhance these efforts. Working in productive 

collaboration with clinicians 

and other research faculty and staff, 

division members provide statistical 

leadership and guidance in the areas of 

study design, information management, 

and analysis and interpretation of data. 

Our mission within the Department is 

two-fold: to encourage and promote 

research of the highest quality, and to 

teach sound principles and interpretation 

of statistical research techniques 

and results. 

Research 

74 BIOSTATISTICS AND CLINICAL OUTCOMES.. 

Two purposes shape the Division's work 

with respect to research. First, we support 

investigators in the department by 

collaborating on both clinical and laboratory 

studies. This involves help with 

preparing grant proposals, defining 

hypotheses, designing studies and calculating 

sample sizes, collecting and 

managing data, analyzing the data, and 

interpreting and reporting results. In 

this role we are involved with investigators 

at all levels and virtually all divisions 

in the department. 

Examples of recent projects include 

interventions to reduce cognitive 

deficits following CABG; effectiveness 

of continuous interscalene brachial 

plexus block for ambulatory surgery; a 

grant to support identification of genes 

associated with postoperative delirium 

using DNA microarrays; effectiveness 

of analgesia after cesarean delivery; 

a genetic association with 4 cytokine 

inflammatory markers; and correlation 

of BIS index with sedation in the ICU. 

In the past year the division’s three biostatisticians 

provided sample size estimates 

for over 150 studies and worked 

with over 650 sets of data. Two large 

research databases we administer contain 

data on nearly 10,000 admissions 

for 19 study protocols. 

The second area of our research 

is within biostatistics. To stay at the 

leading edge of our field requires 

methodological research and development, 

both theoretical and applied. 

Areas of current research include factor 

analysis of cognitive outcomes data, 

statistical methods for genetic and 

microarray data, methods for analysis 

of continuous-monitor output, variance 

components, validation methods, and 

incorporation of surrogate variables 

in clinical trials. 

Teaching 

It is the nature of our work and part of 

our mission to promote a sound understanding 

of statistical principles and to 

help clients interpret and evaluate their 

own results and those of others. To this 

end, members of the division are actively 

involved in educational activities 

within the department. A vital and rewarding 

part of every analysis is the oneon-one 

interaction with clients exploring 

questions and explaining methods, 

results, and appropriate interpretation. 

Fellows are mentored in the statistical 

part of their projects by statisticians. 

The group participates in weekly conferences 

and seminars with faculty, 

fellows, and medical students. Additionally, 

Dr. Habib El-Moalem teaches 

in the curriculum of the Department 

of Bioinformatics and Biostatistics. 

Regina DeLacey, B.S., Habib El-Moalem, Ph.D., Barbara 

Phillips-Bute, Ph.D, William Whitey, M.S.

DIVERS ALERT 

NETWORK 


Founder, President and CEO, 

Divers Alert Network 

Senior Director, Hyperbaric 

Center 


Vice Presidents 

Christopher C. Bennett, M.B.A. 

Vice President of Finance and CFO 

William H. Clendenen, M.B.A. 

Vice President of Training 

Joel A. Dovenbarger, RN 

Vice President of Medical Services 

Cindi C. Easterling, M.Ed. 

Vice President of Continuing Medical 

Education 

Donna Heath, B.S., M.S. 

Vice President of Information 

Technology 



Vice President and Medical Director 

Daniel L. Orr, B.S., M.S. 

Executive Vice President and COO 

Webb L. Roberts, M.B.A. 

Vice President of Operations 

Barry K. Shuster, M.B.A. 

Vice President of Marketing 


Vice President of Research 

Christopher J. Wachholz, M.B.A. 

Vice President of International DAN 

DIVERS ALERT NETWORK 

Directors 

Cindi M. Courter, B.F.A., M.A. 

Chief Development Officer 


Assistant Medical Director 

Petar J. Denoble, M.D., D.Sc. 

Senior Research Director 

Deborah A. Williams 

Membership Director 





Renee D. Westerfield, B.A. 

Communications Director 

The Divers Alert Network (DAN) is 

an international 501(c)3 non profit 

diving safety association affiliated with 

the Department of Anesthesiology 

and Duke Medical Center. Dr. Peter 

Bennett, President and CEO, initiated 

DAN in 1980 as a 24-hour emergency 

hotline for recreational diving accidents 

in the United States and the Caribbean 

with grants from NOAA and NIOSH. In 

1983 as grants decreased, membership 

support was instituted. Today DAN is 

supported by 200,000 members and 

is growing steadily with a present support 

staff of 70 and a budget of over 

$13 million. The hotline in 2000, as of 

September, received 2,312 emergency 

calls, 9,551 information calls and 2,382 

e-mails. 

DAN exists to provide expert medical 

information and advice for the benefit 

of the diving public. Its historical 

and primary function is to provide 

emergency medical information and 

assistance for underwater diving accidents, 

prevent accidents and promote 

diving safety. DAN promotes and supports 

underwater diving research and 

education particularly as it relates to the 

improvement of diving safety, medical 

treatment and first aid. DAN strives to 

provide the most accurate, up to date 

and unbiased information on issues of 

common concern to the diving public, 

primarily, but not exclusively, for diving 

safety. 

DAN publishes a bimonthly magazine, 

Alert Diver, which updates 

research and specialized information to 

improve diver safety. From January 

2001 it will be published monthly. 

Other publications include the DAN 

Sponsorship News, membership services 

brochures, a DAN Pocket Guide 

to First Aid for Scuba Diving and a new 

Annual Report. 

In 1991, DAN initiated its Oxygen 

Program with specialized courses and 

developed its own emergency oxygen 

equipment vital for delivering oxygen to 

a diving accident victim. As of October 

1, 2000 over 9,443 qualified Oxygen 

Instructors can be found in 88 countries 

with 85,623 oxygen providers trained. 

DAN Research is supported at a 

level of $500,000 with projects carried 

out at the Hyperbaric Center. Projects 

in analysis or reporting include studies 

of: (a) the effects of time to flying after 

diving on the risk of decompression 

illness; (b) the probability of Dopplerdetected 

venous gas bubbles during 

real dives to assess the effects of age, 

gender, and maximum dive depths; and 

(c) the risks of diving with diabetes by 

insulin-dependent diabetics. Active 

data collection is in progress for: (1) 

evaluating ascent rates after diving 

at the hyperbaric chamber of Duke 

Medical Center; and (2) Project Dive 

Exploration (PDE), a long range epidemiology 

study with the goal of collecting 

computer recorded dive profiles 

and injury information from open water 

divers. A Dive Computer Identification 

Program has been established to single 

out dive computer manufacturers 

whose instruments are compatible with 

PDE. Project Dive Exploration is particularly 

interested in attracting older 

divers for a study of the Aging Diver. 

Volunteer divers can be trained as Field 

Research Coordinators (FRC) to collect 

data for PDE. In 2000, a summer internship 

program began during which four 

students were trained as FRCs and provided 

experience in diving research. 

The internship is presently being 

DIVERS ALERT NETWORK..75

DIVERS ALERT NETWORK 

extended to Cozumel, Mexico. Over 

20,000 dive profiles have been collected 

in Project Dive Exploration to date. 

Membership dollars also supported 

a DAN Recompression Chamber 

Assistance Program which provided 

education and technical support to 

recompression chambers in the Caribbean. 

Safety seminars and clinics were 

held at all major dive shows in North 

America and two very successful CME 

courses for physicians on diving medicine 

were held in the Caribbean. 

DAN has grown internationally 

since 1991 and active programs are 

available through DAN Europe, DAN 

Japan, DAN SE Asia/Pacific and DAN 

Southern Africa with a further 60,000 

members. 

DAN has an active industry 

Sponsor Program through resorts and 

stores (861), corporations (130), clubs 

(130), Friends of DAN (474), and Dive 

Instructors (4,056). 

In July 1997 DAN moved into its 

own 27,000 sq. ft. offices and headquarters 

at Colony Road in Durham, North 

Carolina. The Peter B. Bennett Center 

was named by the DAN Board in honor 

of the founder of DAN. 

76 DIVERS ALERT NETWORK 

When a dive injury is suspected, especially decompression sickness, a physician 

can administer a series of tests to check for neurological deficits by observing 

strength and reflexes. 

Finally, DAN initiated a for profit 

subsidiary, DAN Services, Inc., in 1998. 

It is wholly owned by DAN and its 

mission is: 

1. Support DAN in its ability to 

improve recreational diving safety and 

water related activities. 

2 Provide DAN and its members 

with services and business opportunities 

best provided by a tax-paying, 

for-profit corporation. 


3. Investigate and develop new 

services and business opportunities 

to benefit DAN and its members. 

One of its projects is to develop 

the REM O 2—an oxygen rebreather to 

enable the DAN standard oxygen emergency 

delivery equipment to be expanded 

from 30 minutes to up to six 

hours from the same oxygen cylinder. 

A second is to develop the DAN oxygen 

program for aquatics, i.e. use for swimming 

pools, emergencies, ocean lifeguards, 

etc.

Appointments, 

Promotions and Tenure 


Chairperson 

Members 






J.G. Reves, M.D. (ex officio) 


Bruno J. Urban, M.D., Dr.med. 


Computer 


Chairperson 

Members 

Richard J. Adrian 

Edward F. Cousineau, M.A., M.B.A. 

Larry A. Dowell, A.A.S. 

Andrew F. Meyer, M.D., M.B.A. 


Kisan P. Uphadaya, A.A.S. 

Christopher A. Wester 


Education Executive 


Chairperson 

Members 

Patsy E. Clifton 

Anthony J. Colantonio, M.D. 


Daniel D. DeMeyts, M.D. 



Katherine P. Grichnik, M.D. 


Kathryn P. King, M.D., M.S.N. 

Kurt J. Knauth, M.D. 


James R. McCurdy, II, M.D. 


Patti L. Myers 

DEPARTMENTAL COMMITTEES 

Cathleen L. Peterson-Layne, M.D., Ph.D. 






Emergency Airway Service 


Chairperson 

Members 




John (Sam) Thio Sum Ping, M.B., 

Ch.B., FRCA 


Equipment, Supplies and 

Products Committee 


Chairperson 


Acting Chairperson 

Members 

Steven E. Guerrant, Clinical Engineering 

Brooke L. Berson, Procurement Services 

Cynthia H. Robertson, Corporate 

Assistance Associate, Perioperative 

Services 



Janet E. Goral, BSN, CRNA 




Stanley W. Weitzner, M.D. 


Larry A. Dowell, A.A.S. 



Finance Committee 


Chairperson 

Members 






Charlene D. Hundley, B.B.A. 






Natalie J. Schneider, B.B.A. 


Steven M. Williams, B.B.A. 


Operations and Safety F.G. 

Hall Hyperbaric Center 


Chairperson 

Members 

Michael J. Natoli, B.S., M.S. 

Pelzer Owen Doar, B.S. 

Thomas L. Edwards 

John H. Rice, R.N. 

Albert E. Boso, B.S., P.T. 

Quality Improvement 

Terrance W. Breen, M.D., FRCPC 

Chairperson 

Members 

Patricia M. Allushuski, CRNA, M.S.N. 









James M. Temo, CRNA, M.S.N., M.B.A. 


DEPARTMENTAL COMMITTEES 77

DEPARTMENTAL COMMITTEES 


Diane L. Scott, M.D. 


Patricia S. Tucker, R.N.C., B.S.N., 

QI Coordinator 

Research Committee 


Chairperson 

Members 

General 


Patricia A. Cruse, A.A.S. 

Tong J. Gan, M.B., B.S., FRCA 


Madan M. Kwatra, Ph.D. 

Richard E. Moon, M.D., C.M., M.Sc. 



Donald H. Penning, M.Sc., M.D. 

Karen W. Ramsey, R.N., M.B.A. 




DABA 


Executive 

Patricia A. Cruse, A.A.S. 

Tong J. Gan, M.B., B.S., FRCA 




Resident Advisory 

Committee 


Chairperson 

Members 

Terrance W. Breen, M.D., FRCP(C) 









78 DEPARTMENTAL COMMITTEES 











Resident Evaluation 

Committee 


Chairperson 

Members 









John C. Kiefer, M.D. 









DABA 

John T. Sum-Ping, M.B., Ch.B., FRCA 

Resident Selection 

Committee 

Catherine K. Lineberger,M.D. 

Chairperson 

Members 



Terrance W. Breen, M.D., FRCPC 










Brian Grinsberg, M.B., Ch.B. 























Mark Stafford-Smith, M.D., C.M., FRCP, 

DABA 





Christopher C. Young, M.D., FCCM

DIVISION CHIEFS AND COMMITTEE CHAIRPERSONS 

Departmental Executive Committee 

J.G. Reves, M.D., Chairperson 

Members 


Terrance W. Breen, M.D. 






Russell T. Giesler, CRNA 





Richard E. Moon, M.D. C.M., M.Sc., FRCP(C), FACP, FCCP 





Alison K. Ross, M.D. 

Debra A. Schwinn, M.D 





DIVISION CHIEFS AND COMMITTEE CHAIRPERSONS 79

80 

Thirteenth Annual ASA Duke Anesthesiology Alumni Reception 

SAN FRANCISCO, CALIFORNIA • OCTOBER 15, 2000

EDUCATION 


Residency Program Director 



It is a pleasure to once again summarize 

the many contributions our faculty 

and residents and fellows contribute in 

the arena of education. One of the 

three major charges of any academic 

Department, our educational mission 

has thrived in 2000. 

Graduate Medical Education 

Internship 

In the year 2000 match we matched our 

third group of interns. The internship 

was established in the 1998-1999 academic 

year to meet the needs of applicants 

to our program that wished to 

pursue the entire postgraduate education 

curriculum in one location. Each 

year we have enrolled eight interns, 

and the program continues under the 

capable leadership of the Assistant 

Program Director, John B. Eck, M.D. 

The internship is a rotating internship 

designed to meet the educational 

needs of future anesthesiologists. It is a 

unique program at Duke, and unlike 

many transitional internships, is limited 

to interns who plan anesthesia careers 

at Duke. The internship emphasizes 

general medicine, surgery and pedi- 

82 EDUCATION.. 

EDUCATION 

atrics, with a particular emphasis on 

critical care medicine. Interns rotate 

through nine mandatory rotations and 

have elective opportunities as well. 

Notable events regarding the 

internship include the addition of an 

anesthesiology rotation as a required 

rotation. The interns, in conjunction 

with Dr. Eck, decide what aspects of 

our Department they would like to feature, 

and the rotation is constructed 

accordingly. Some of the interns have 

opted to spend valuable time on the 

acute pain service, or have gained 

experience with starting IVs, basic intubation 

and airway skills, etc. The 

hyperbaric medicine elective continues 

to be popular, and gives the interns an 

exposure to one of the unique aspects 

of the Department. 

The faculty have now had the 

opportunity to work with two classes 

of graduates from our internship. These 

interns have had the benefit of knowledge 

of the institution and colleagues 

from other departments, and have the 

appropriate medical knowledge for the 

specialty of anesthesiology. In addition, 

our interns' performance on the medicine, 

surgery, emergency medicine and 

pediatric services has been evaluated 

quite favorably. This was evidenced in 

2000 when the Department of Medicine 

looked to our Department for intern 

support of its plan to add a team on the 

General Medicine Service at Durham 

Regional Hospital. 

Residency 

In May of 2000 the anesthesiology 

residency, critical care fellowship and 

pain fellowship underwent their respective 

reviews by the Anesthesiology 

Residency Review Committee of the 

Accreditation Council for Graduate 

Medical Education. The quality of all 

three programs was affirmed by the 

ACGME's decision to accord continued 

full accreditation status to the three programs. 

Preparation for these reviews is 

a time-consuming process and the contributions 

of Christopher C. Young, 

M.D., FCCM, Joel S. Goldberg, M.D., 

John B. Eck, M.D., Catherine K. 

Lineberger, M.D., Ms. Patsy Clifton, 

Ms. Laraine Tuck, and Mr. Edward 

Cousineau were critically important to 

the successful outcome. The reviewer 

met with many of the interns, residents 

and faculty from the Department and 

their time and effort is also appreciated. 

The American Board of Anesthesiology 

released figures from 1995-1999 

and demonstrated that the Duke Anesthesiology 

residency graduates have a 

collective board certification rate of 

97% in that time interval, compared 

with 81% nationally. This includes the 

period of time when interest in anesthesiology 

as a career dropped precipitously. 

These data support the outstanding 

efforts of our faculty and residents in 

the development of one of the country's 

best residency programs. 

For the 2000 Match we received 

980 applications, and interviewed 

88 medical students. We ranked 75 students 

and once again, filled all of our 

requested positions in the match. The 

overall quality of the applicant pool 

increased this year, as did the size of 

the pool. Our graduating class of residents 

pursued fellowships in cardiac 

anesthesia, pain management, and private 

practice opportunities in locations 

across the country. 

2000 Graduate Residents 

Randy P. Brewer, M.D. 

Pain Fellowship, Mayo Jacksonville, 

FL 

Andrea L. Crawford, M.D. 

Private Practice, Los Angeles, CA 

B. Will Curtis, M.D. 

Private Practice, Austin TX 

Adil J. Kamal, M.D. 

Pain Fellowship, Duke 

Christopher M. Kerr, M.D. 

Private Practice, Salinas, KS 


Cardiac Fellowship, Duke 

Garrett W. Scales, M.D. 

Private Practice, Austin TX 

Bo Wu, M.D. 

Cardiac Fellowship, Duke

Several advances in the residency 

curriculum and management deserve 

mention. 

Jeffrey M. Taekman, M.D. developed 

a new, web-based resident evaluation 

system for the Department. Holly 

A. Muir, M.D., FRCP(C) and Catherine 

K. Lineberger, M.D. assisted him with 

the development of the new evaluation 

criteria. This system is accessible via 

any internet service and is intended 

to facilitate the evaluation process and 

provide more feedback to the residents. 

Dr. Taekman is quite interested in incorporating 

computer-based and webbased 

items into educational curricula, 

and organized sessions for the residents 

to learn about internet-based resources 

for reviewing the literature. 

Two years ago, the chief residents 

developed an Advanced Resident Lecture 

Series. This is a series of biweekly 

lectures, with faculty and topics selected 

by the chief residents. Drs. Bo Wu and 

Garrett Scales continued to organize the 

series through the 1999-2000 academic 

year, and David B. Schinderle, M.D. and 

James R. McCurdy, II, M.D. are handling 

the duties in the 2000-2001 year. These 

lectures are intended to supplement the 

residency curriculum lectures, which 

are held on Wednesday mornings. 

Duke is fortunate to have a human 

fresh tissue laboratory under the supervision 

of Scott L. Levin, M.D., Chief of 

the Division of Plastic Surgery. This 

year, David B. MacLeod, M.B., B.S., 

FRCA organized the first of several 

planned anatomy dissections for the 

residents. The first session concentrated 

on brachial plexus anatomy. Each resident 

attended one of two sessions 

which featured a review lecture and 

an opportunity to review the brachial 

plexus anatomy using demonstrations 

with a dissected cadaver. The Department 

is supporting Dr. MacLeod’s plans 

for additional sessions focusing on 

other aspects of anatomy that are relevant 

to anesthesia practice and regional 

anesthesia in particular. 

The Department explored the new 

expanding technology of human simulation 

this year. As plans for the purchase 

of a simulator at Duke developed, 

the Department of Anesthesiology 

decided to provide each senior resident 

with the opportunity to spend a day in a 

simulator session. The first group of residents 

spent a day in December at the 

simulation laboratory at Wake Forest 

University (WFU) with Dr. Michael 

Olympio. The residents found this valuable, 

and the Department plans to send 

the remainder of the senior class to 

WFU later this year. We anticipate the 

arrival of a simulator, which will be 

used by the schools of medicine and 

nursing in addition to our Department. 

Fellowships 

As mentioned above, our ACGMEaccredited 

fellowships in critical care 

medicine and pain management received 

full continued accreditation in 

2000. More detailed descriptions of 

these and other fellowships (cardiothoracic 

anesthesia, obstetric anesthesia, 

regional anesthesia, hyperbaric medicine, 

human pharmacology, and neuroanesthesia) 

can be found in the appropriate 

clinical sections of this report. 

All of the Duke fellowships provide 

excellent opportunities for the development 

of outstanding academic careers 

and enhancement of clinical skills. 

Fellows in all of the fellowships have 

a long history of productivity regarding 

publications, meaningful research and 

acquiring funding. Of particular note 

this year, one of our cardiac fellows, 

G. Burkhard Mackensen, M.D. won first 

prize in the national ASA Resident 

Research Essay contest for his abstract 

and paper entitled, “Neuroprotection 

from Delayed Post-Ischemic Administration 

of a Metalloporphyrin Catalytic 

Antioxidant in the Rat.” This work was 

accomplished with David S. Warner, 

M.D. and has been a springboard for 

Dr. Mackensen's career, which now 

includes several additional papers and 

grants. 

EDUCATION 

Undergraduate Medical 

Education 

Medical Student Education 

The Department of Anesthesiology is 

fortunate to have established significant 

amounts of participation in all four 

years of the medical school curriculum. 

Many of our faculty influence the makeup 

of the medical school classes by 

serving on the Medical School Admissions 

Committee. These include 

Kathryn E. King, M.D., John B. Eck, 

M.D., Christopher C. Young, M.D., 

FCCM, Bryant W., Stolp, M.D., Ph.D., 

Laura E. Niklason, M.D., Ph.D., Richard 

E. Moon, M.D., C.M., M.Sc., FRCP(C), 

FACP, FCCP, Adeyemi John Olufolabi, 

M.B., B.S., DCH, FRCA, John C. Keifer, 

M.D., Mark Stafford Smith, M.D., C.M., 

FRCP, DABA, and J.G. Reves, M.D. In 

addition, Drs. King and Young are 

members of the Executive Admissions 

Committee for the medical school. 

First Year Curriculum 

Several departmental faculty continue 

to serve as mentors in the PRACTICE 

(Progressive Responsibilities and 

Competencies Through an Integrated 

Clinical and Curricular Experience) 

course, including Edmond C. Bloch, 

M.B., Ch.B., Merel H. Harmel, M.D. and 

Kathryn E. King, M.D. This longitudinal 

course represents a significant commitment 

of faculty time for the course, 

which runs for a two-year cycle. The 

course consists of small group discussions 

and sessions on interviewing, 

physical diagnosis, ethics and other topics 

and prepares students to assume the 

professional responsibilities of a physician. 

It is as rewarding for the faculty 

as it is valuable for the students. 

Dr. Bret Stolp continues to be the 

course director for the first year physiology 

course. In addition, Drs. Richard 

Moon, Jonathan Mark, and Chris Young 

also participate as faculty in the course. 

Dr. Lewis Hodgins continues to participate 

as a lecturer in the first year pharmacology 

course. 

EDUCATION 83

EDUCATION 

Second Year Curriculum 

Many of the Department of Anesthesiology 

faculty participate in the second 

year of the medical school curriculum, 

either as clinical supervisors or participating 

in the lecture series associated 

with the core clinical courses. Elizabeth 

A. Bell, M.D. lectures in the obstetrics 

and gynecology core course. Dr. 

Kathryn King continues to organize 

the anesthesiology component of the 

surgery core course. Many departmental 

faculty, including Drs. King, Gavin 

Martin, David MacLeod, Peter Dwane, 

Elizabeth Bell, Brian Ginsberg, Lewis 

Hodgins, Catherine Lineberger, Jerry 

Reves, Iain Sanderson, and Mark 

Stafford-Smith give lectures to the students 

in the introductory portion of the 

course. Nearly every department member, 

including faculty, residents and 

nurse anesthetists, helps provide meaningful 

clinical exposure to the specialty 

during the three daylong introductory 

series to the surgery core course. 

Third Year Curriculum 

The Department has sponsored one of 

the third year study tracks, Anesthesia, 

Surgery and Environmental Physiology, 

for six years. Dr. Kathryn King is the 

Administrative Director for the study 

track, and the steering committee 

includes Drs. Richard Moon, David 

Warner, James Reynolds, Bret Stolp and 

Steve Vaslef. Currently nine students 

are studying in the track, doing scientific 

projects under the supervision and 

mentorship of one of the faculty in the 

study track. These faculty include Drs. 

David Warner, Laura Niklason, and 

Richard Moon from the Department 

of Anesthesiology, and Drs. Steve 

Eubanks, Jeff Lawson, and Steve Vaslef 

in the Department of Surgery. 

Most of the students in the track 

produce at least one research paper, 

and some win awards, such as Brian 

Kaminski, who won the top prize out 

of 180 papers presented at the Southeastern 

Trauma Conference Fall 2000 

meeting. Mr. Kaminski’s work was in 

Dr. Steve Vaslef's laboratory. 

84 EDUCATION.. 

Fourth Year Curriculum 

The Department offers a research elective, 

a critical care elective and a clinical 

elective in the fourth year. While the 

faculty involved in the research elective 

can vary from year to year, many 

department members have participated 

in the lecture series for the clinical elective 

for several years. These faculty 

include the course director, Dr. Peter 

Dwane, as well as Drs. Bret Stolp, Iain 

Sanderson, Jonathan Mark, Dana 

Wiener, Lewis Hodgins, Kathy Grichnik, 

Brian Ginsberg, Jerry Reves, John Eck, 

Allison Ross, and Guy Dear. This year 

Drs. Merel Harmel and Eugene Moretti 

have started to lecture in the course. 

Dr. Chris Young continues to serve as 

the course director for the critical care 

elective. 

The contributions of many faculty 

and resident clinical mentors to the 

fourth year medical students cannot be 

overstated. Similarly, the Departmental 

Teaching Scholars provide organization 

of the clinical preceptors and organize 

the students’ clinical case conferences 

each year. Last year Drs. Will Curtis 

and Chris Kerr filled this role admirably, 

and Drs. Jon-Paul Harmer and Peter 

DeBalli are our current Teaching 

Scholars. 

Lastly, during the year 2000, a 

medical school curriculum review was 

accomplished by the Task Force on 

Curriculum Structure and Organization, 

which was led by Anesthesiology Chair, 

J.G. Reves, M.D. and Dale Purves, M.D., 

Chair of the Neurobiology Department. 

It is expected that the task force recommendations 

will be developed further 

in 2001 and implemented in 2002. 

Events 

The Eighth Departmental Academic 

Evening was held on May 2, 2000 at the 

Durham Hilton Hotel. Several residents 

and fellows submitted abstracts for the 

event, which is described in greater 

detail in another section of this report. 

Alina M. Grigore, M.D. won the Dick 

Smith Award, and Timothy O. Stanley, 

M.D., Maribel G. Gamoso, M.D., and 

Karen C. Neilsen, M.D. were runners-up 

for the award. Dr. Adil Kamal won first 

prize in the new case report category, 

and Dr. Peter DeBalli was the runner 

up. The evening was well-attended and 

is an opportunity for the Department to 

showcase the research and other academic 

efforts of its non-faculty members. 

Resident and Fellow Participants, 

2000 Academic Evening 

Randy P. Brewer, M.D. 


George N. Djaiani, M.D., FRCA 


Sheila F. Gardner, M.D. 

Charles H. Gleaton, M.D. 


Scott E. Helsley, M.D., Ph.D. 

David M. Hendricks, M.D. 


Marcella J. Lanzinger, M.D. 


Karen C. Neilsen, M.D. 




Lian Kah Ti, M.B., B.S. 

The Department of Anesthesiology 

at the University of North Carolina at 

Chapel Hill sponsored the 2000 Gulf 

Atlantic Residents’ Research Conference 

(GAARC). Several residents and fellows 

from our Department presented abstracts, 

and Dr. Robert Panten was the 

recipient of the third place award for 

case reports. Dr. Peter DeBalli won the 

third place award in the literature review 

category. Drs. John Eck, John Keifer, 

and Jerry Reves attended the meeting 

and served as faculty moderators. 

Resident and Fellow Participants, 

2000 GAARC 


James R. McCurdy, M.D. 


John Moloney, M.D. 




Lian Kah Ti, M.B., B.S. 

Chiedozie Udeh, M.B., B.S.

The Annual Resident Graduation 

and Awards Banquet was held on June 

17, 2000 at the Hope Valley Country 

Club. Over 150 Department members 

and families attended the event, our 

opportunity to celebrate the accomplishments 

of the graduating resident 

class. Many awards were given to faculty 

and residents. Dr. Reves presented 

the Robert N. Sladen Teacher of the 

Year award to John C. Keifer, M.D. and 

Dr. Lineberger presented the VA 

Teaching award to Thomas E. Buchheit, 

M.D. Several medical student teaching 

awards were presented by Dr. Kathryn 

King, including awards to Kurt J. 

Knauth, M.D. and Julie Z. Woosley, 

M.D. as Resident Teachers of the Year, 

and B. Will Curtis, M.D. for the Outstanding 

Resident Contribution to Medical 

Student Education. Carleen E. 

Bagnall, CRNA was the recipient of the 

Medical Student CRNA Recognition 

award, and Bryant Stolp, M.D., Ph.D. 

received the Medical Student Faculty 

Recognition Award. 

Dr. John Eck presented certificates 

to each of the interns as they completed 

the internship year, and our Departmental 

fellows were acknowledged 

by their program directors. 

Christopher M. Kerr, M.D. received 

the award for Outstanding Graduate 

Resident in Anesthesiology. Drs. Garrett 

Scales and Bo Wu were recognized for 

their contributions as Chief Residents, 

and Drs. Will Curtis and Christopher 

Kerr were acknowledged for their work 

as Teaching Scholars. Drs. Will Curtis, 

Adil Kamal, and Garrett Scales were 

recognized with certificates acknowledging 

completion of ten liver transplants. 

Andrew J. Hartle, M.B., Ch.B., 

FRCA presented Dr. Laura Kihlstrom 

with the Golden Tuohy Award, resulting 

from a particularly difficult call night on 

the obstetric service. 

In October Dr. Peter DeBalli represented 

the Department as our resident 

representative for the ASA resident 

section meeting in San Francisco, CA. 

Similarly, Dr. Cathleen Peterson-Layne 

was sponsored as our FAER scholar 

at the same meeting. 

The sixth annual Alumni Evening 

was held on November 3 at the Siena 

Hotel in Chapel Hill, and was organized 

by Katherine P. Grichnik, M.D., MS and 

Peter D. Dwane, M.D., C.M., FRCP(C). 

Residents and their guests were treated 

to a nice dinner and then were addressed 

by Drs. Charlene Elliott, Scott 

Howell, Steve Rogers and Joshua 

Schwartz who provided them with 

advice and insight into various practice 

situations. It is always nice to hear from 

our alumni and see their post-Duke 

accomplishments. 

Summary 

Duke Anesthesiology is fortunate to 

have the resources of talented faculty, 

residents and fellows, in addition to a 

rich clinical environment in which to 

work. We look forward to another year 

of learning and professional growth. 

EDUCATION 

EDUCATION 85

EDUCATION 

Lectures, Conferences and Didactics 

Date Title Speaker Position 

ANESTHESIOLOGY AND ENVIRONMENTAL PHYSIOLOGY 

May 1 Academic Evening David Warner, M.D. Faculty 

Kathryn King, M.D., MSN Faculty 

September 11 Coagulation Jeff Lawson, M.D., Ph.D. Duke Staff 

Vascular Biology Jeff Lawson, M.D., Ph.D. Duke Staff 

Blood Substitutes Steve Vaslef, M.D., Ph.D. Faculty 

Tissue Engineering Laura Niklason, M.D., Ph.D. Faculty 

12 Fetal Brain Injury James Reynolds, Ph.D. Faculty 

The Grant Process Madan Kwatra, Ph.D. Faculty 

IRB/Human Studies T.J. Gan, M.B., B.S., FRCA Faculty 

Ethics of Animal Research Lee Tyrey, Ph.D. Duke Staff 

12 What Does a Journal Editor Look For? J. G. Reves, M.D. Faculty 

David Warner, M.D. Faculty 

13 CRP 240: Statistics Bill Wilkinson, Ph.D. Duke Staff 

14 Ischemic Brain Injury David Warner, M.D. Faculty 

Hilary Grocott, M.D., FRCP(C) Faculty 

Brain Imaging Helene Benveniste, M.D., Ph.D. Faculty 

14 Hyperbaric Medicine Richard Moon, M.D., C.M., M.Sc., Faculty 


Bryant Stolp, M.D., Ph.D. Faculty 

Richard Vann, Ph.D. Faculty 

15 Molecular Pharmacology Madan Kwatra, Ph.D. Faculty 

Gregory Michelotti, Ph.D. Faculty 

October 3 Minimally Invasive Surgery Steve Eubanks, M.D. Duke Staff 

CARDIAC LECTURES 

January 4 Cognition and Cardiac Anesthesia Mark Newman, M.D. Faculty 

11 Rationale of CPB Temperatures Hilary Grocott, M.D., FRCP(C) Faculty 

25 Thoracic Anesthesia Katherine Grichnik, M.D., MS Faculty 

February 1 Paravertebral Block Steven Hill, M.D. Faculty 

8 Post CPB Vasodilatation, Impressions of Vasopressin Andrew Hilton, M.B., B.S., FANZCA Faculty 

15 Research Update Joseph Mathew, M.D. Faculty 

22 Neurocognition Update Mark Newman, M.D. Faculty 

29 Right Ventricular Function Jonathan Mark, M.D. Faculty 

March 7 Sympathectomy for the Treatment of Refractory Sunil Panchal, M.D. Guest 

Angina 

14 Perioperative Renal Function Mark Stafford Smith, M.D., C.M., Faculty 

FRCP, DABA 

21 Common Postoperative Problems in the Cardiac ICU Andrew Hilton, M.B., B.S., FANZCA Faculty 

28 Air Emboli and Hyperbaric Medicine Bryant Stolp, M.D., Ph.D. Faculty 

86 EDUCATION..


EDUCATION 


April 4 The Digital Echo Lab John Toptine, RRT Duke Staff 

11 Cognition and Paravertebral Block in Thoracic Patients Katherine Grichnik, M.D., MS Faculty 

18 Postoperative Pain Management in Thoracic Patients Brian Ginsberg, M.B., Ch.B. Faculty 

25 Research Update Madan Kwatra, Ph.D. Faculty 

May 2 SCA Poster Presentations The Cardiac Fellows Resident Faculty 

16 Pulmonary Hypertension in Pediatric Cardiac Surgery Frank Kern, M.D., FCCM Faculty 

30 Lung Cancer and Thoracic Surgery Thomas D'Amico, M.D. Duke Staff 

June 6 Adult Congential Heart Surgery Hilary Grocott, M.D., FRCP(C) Faculty 

13 Does Anything Reduce Cardiac Morbidity? Lee Fleisher, M.D. Guest 

20 Nitric Oxide in Cardiac Surgery Stan Shernan, M.D. Guest 

27 Evaluation of a Novel Neuroprotectant G. Burkhard Mackensen, M.D. Faculty 

July 11 “CT State of the Union Address” Mark Newman,M.D. Faculty 

18 Novel Antiplatelet Therapy Gautham Sreeram, M.D. Faculty 

25 Palm Pilot Use Joseph Mathew, M.D. Faculty 

August 1 Divisional Research Interests The Cardiac Faculty Faculty 

8 Divisional Research Interests The Cardiac Faculty Faculty 

15 Intraoperative Thoracic Surgery Emergencies Katherine Grichnik, M.D., MS Faculty 

September 5 Patterns of Postoperative Renal Dysfunction Mark Stafford Smith, M.D., C.M., Faculty 

FRCP, DABA 

19 Are All Beta-Blockers the Same? John Booth, M.B., Ch.B., FRCA Faculty 

26 Research Update Laura Niklason, M.D., Ph.D. Faculty 

October 3 Echo Case Reviews Daniel Bainbridge, M.D. Faculty 

10 History of Cardiac Anesthesia J.G. Reves, M.D. Faculty 

24 Synthetic Oxygen Carriers Steven Hill, M.D. Faculty 

November 14 Diastolic Dysfunction and Echocardiography Joseph Mathew, M.D. Faculty 

21 TEE Considerations for the Ross Procedure Daniel Thys, M.D. Guest 

December 5 Anesthesia and Space Physiology Richard Moon, M.D., C.M., M.Sc., Faculty 


12 Left Ventricular Assist Devices Carmello Milano, M.D. Duke Staff 

19 TEE Considerations Roman Kluger, M.D. Guest 

CRITICAL CARE CONFERENCES 

January 27 Ethical Issues in the ICU Lewis Hodgins, M.D. Faculty 

February 10 Medical Management of Subarchnoid Hemorrhage Cecil Borel, M.D. Faculty 

24 Ethical Issues in ICU Lewis Hodgins, M.D. Faculty 

March 23 Hypobaric Physiology Richard Moon, M.D., C.M., M.Sc., 

FRCP(C), FACP, FCCP Faculty 

EDUCATION 87

EDUCATION 



April 6 Clinical Effects of Altitude David Murdoch, M.D. Duke Staff 

20 Methemoglodinemia-Case Report and Review John Sum Ping, M.B., Ch.B., FRCA Faculty 

of Literature 

May 18 Current Status of Blood Substitutes Steven Vaslef, M.D., Ph.D. Faculty 

August 10 Complications of Invasive Hemodynamic Monitoring David Schinderle, M.D. Resident 

24 Tissue Engineering and You Laura Niklason, M.D., Ph.D. Faculty 

September 7 ICU Sedation Kurt Knauth, M.D. Resident 

21 Candidemia Gary Cox, M.D. Duke Staff 

GERONTOLOGICAL RESEARCH IN ANESTHESIA AND SURGERY PROGRAM (GRASP) 

January 10 Strategy to Analyze the Effect of Aging on Jacques Somma, M.D., FRCP(C) Faculty 

Pharmacokinetics and Dynamics 

February 7 Spinal Opioids in the Elderly Thomas Buchheit, M.D. Faculty 

April 10 Physical Fitness and Postoperative Complications Miriam Morey, Ph.D. Duke Staff 

A Review of the Currently Used Instruments to Detect Madan Kwatra, Ph.D. Faculty 

Postoperative Delerium 

May 22 Impact of Anesthesia; Problems in Analysis of Gerda Fillenbaum, Ph.D. Duke Staff 

Secondary Data from a Representative Older 

Community Sample 

June 12 Delirium Jack Twersky, M.D. Duke Staff 

August 7 Predicting Adverse Postoperative Outcomes in Richard Moon, M.D., C.M., M.Sc., Faculty 

Patients Aged 80 Years or Older FRCP(C), FACP, FCCP 

September 11 Delirium in Orthopedic Patients William Richardson, M.D. Duke Staff 

November 6 Mental Status Screening Katherine Welsh-Bohmer, Ph.D. Duke Staff 

GRAND ROUNDS 

January 5 The Relationship of Addiction to the Treatment Charles O’Brien, M.D., Ph.D. Guest 

of Chronic Pain 

12 Should We Use Local Anesthetic in Thoracic Epidural Oscar DeLeon Casasola, M.D. Guest 

Anesthesia and Analgesia? 

19 Preemptive Analgesia: Fact or Fiction Tarsha Garvin, M.D. Resident 

February 2 Sex, Lies and Anesthesia Peter DeBalli, III, M.D. Resident 

9 Success With Heart Failure: Recent Advances Michael Cuffe, M.D. Duke Staff 

88 EDUCATION..


EDUCATION 


February 16 Preemptive Analgesia: Fact or Fiction? Tarsha Garvin, M.D. Resident 

23 Pre and Postoperative Management of the Geriatric David Lipschitz, M.D., Ph.D. Guest 

Patient 

March 1 Unrelated Umbilical Cord Blood Transplant Joanne Kurtzberg, M.D. Duke Staff 

8 Clinical Case Conference John Eck, M.D. Faculty 

15 Waiting to Inhale: Post Anesthetic Apnea . . . Jay McCurdy, M.D. Resident 

22 Genetic Approach to Understanding and Treating Jeffrey Leiden, M.D., Ph.D. Guest 

Cardiovascular Disease 

29 Anesthesia Related Cardiac Arrest in Children-Lessons Jeffrey Morray, M.D. Guest 

Learned From the Closed Claims Project and the 

POCA Registry 

April 5 New Concepts in Neuroanesthesia William Kofke, M.D, FCCM Guest 

12 Awake Craniotomy: Seizure vs. Tumor Surgery John Keifer, M.D. Faculty 

19 Seizures and Anesthesia Julie Woosley, M.D. Resident 

26 State-Dependent Respiratory Control; Clinical 

Relevance and Basic Mechanisms Ralph Lydic, Ph.D. Guest 

May 3 Sedating the ICU Patient- Challenges, Old and New Kurt Knauth, M.D. Resident 

10 Case Presentation--Methemoglobinemia and its John Sum-Ping, M.B., Ch.B., FRCA Faculty 

Clinical Implication 

17 Ethics Lewis Hodgins, M.D. Faculty 

24 On Traumatologic Resuscitation in the Twentieth Peter Safar, M.D., Dr.h.c., FCCM, FCCP Guest 

Century 

31 Management of the Septic Patient Christopher Young, M.D., FCCCM Faculty 

June 7 Perioperative Organ Protection Eugene Moretti, M.D. Faculty 

14 Cost Containment and Perioperative Care; Fact Lee Fleischer, M.D. Guest 

or Fiction 

21 Morbidity and Mortality Rounds: Management Kerri Robertson, M.D., FRCP(C) Faculty 

Strategies for Intraoperative Pulmonary Embolism Peter DeBalli, III, M.D. Resident 

28 Post Dural Puncture Headache Holly Williams-Davis, M.D. Resident 

July 5 Professionalism Catherine Lineberger, M.D. Faculty 

12 Office-Based Anesthesia--Adventures in Anesthesia Jason Burke, M.D. Resident 

19 Chemical Dependence Catherine Lineberger, M.D. Faculty 

26 Hyperbaric Oxygen in the 21st Century Richard Moon, M.D., C.M., M.Sc., 


August 2 Complementary and Alternative Medicine Martin Sullivan, M.D. Duke Staff 

9 Current State of Transfusion Services at Duke Steven J. Bredehoeft, M.D. Duke Staff 

16 Preoperative Screening at Duke - Recurrent State Ron Olson, M.D., CCEP Faculty 

of an Ever-Changing Census 

23 State of the Department J. G Reves, M.D. Faculty 

30 State of Saturn Iain Sanderson, M.B., Ch.B., FRCA Faculty 

September 6 Dialysis Patients and Surgery: What Anesthesiologists Steve Schwab, M.D. Duke Staff 

Need to Know But Are Too Busy to Ask. 

13 Origins and Interpreting Hemodynamics Joannes Karis, M.D. Faculty 

20 Magnesium: Elixir Vitae? Marcella Lanzinger, M.D. Resident 

27 Ventilator Induced Lung Injury Neil Macintyre, M.D. Duke Staff 

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October 4 Unintentional Total Spinals After Failed Labor Scott Helsley, M.D., Ph.D. Resident 

Epidurals in Parturients 

11 HIPAA Concepts, Background, Impact for Physician David Kirby Duke Staff 

Researchers 

25 Computers and Medical Practice James Morris, Jr., M.D. Duke Staff 

November 1 Insights Into Pharmacologic Neuroprotection for Hilary Grocott, M.D., FRCP(C) Faculty 

Cardiac Surgery 

8 JCHO Required Safety Update Training Course Debra Hunt, Ph.D. Duke Staff 

15 Thoracic Epidural Anesthesia and Cardiac Ischemia Matthew Taylor, M.D. Resident 

22 Perioperative Echocardiography: A Challenge for Daniel Thys, M.D. Guest 


29 How Research in Cardiac Anesthesia has Changed Fiona Clements, M.D. Faculty 

our Clinical Practice 

December 6 Christmas Quiz Elizabeth Bell, M.D. Faculty 

13 Hypertrophic Cardiomyopathy and Pregnancy Bill Norcross, M.D. Resident 

20 Quality Improvement Terrance Breen, M.D., FRCPC Faculty 

HYPERBARIC LECTURES 

March 16 DAN: Beginnings - Today - Tomorrow Peter Bennett, Ph.D., D.Sc. Faculty 

April 12 The Australian Experience on CO Poisoning Ian Miller, M.B. Guest 

20 Marine Biotoxins David Hendricks, M.D. Duke Staff 

July 20 Pulmonary Alveolar Proteinosis Claude Piantadosi, M.D. Faculty 

August 31 Biochemical Markers of Tissue Damage in Response Kathy Coulombe Duke Staff 

to Bubbles and Other Injuries 

September 6 Physical, Physical Chemical, and Biophysical Richard Vann, Ph.D. Faculty 

Concepts/Bubbles and Decompression Physiology 

8 Decompression History, Haldane, and Bubbles/ Richard Vann, Ph.D. Faculty 

Decompression Safety and Operational Methods 

14 DCI: Pathophysiology Richard Vann, Ph.D. Faculty 

Richard Moon, M.D., C.M., M.Sc., 


15 Decompression Illness: Therapy Richard Moon, M.D., C.M., M.Sc., 


19 Decompression Illness: Clinical Presentation and Wayne Massey, M.D. Duke Staff 

Diagnosis 

20 Exercise and Cardiorespiratory Physiology: Normal Bryant Stolp, M.D., Ph.D. Faculty 

Function and Measurements 

21 Decompression Illness: Epidemiology Guy deLisle Dear, M.B., FRCA Faculty 

Bubble Trouble: Surface Tension, Surfactants, and David Needham, Ph.D. Duke Staff 

Gas Nuclei Sung Hee Lee, Ph.D. Duke Staff 

Dennis Kim, Ph.D. Duke Staff 

27 Exercise and Cardiorespiratory Physiology: Richard Vann, Ph.D. Faculty 

Effects of Breathing Apparatus 

29 Sinus and Pulmonary Barotrauma Cameron Gillespie, M.D. Guest 

90 EDUCATION..


October 2 Barotrauma and Dysbaric Diseases of the Hearing Cameron Gillespie, M.D. Guest 

and Vestibular System 

4 High Altitude Expeditions on Mt. Everest Eric Simonson Guest 

5 Inert Gas Narcosis Peter Bennett, Ph.D., D.Sc. Faculty 

6 Direct Effects of Pressure: High Pressure Nervous 

Syndrome Peter Bennett, Ph.D., D.Sc. Faculty 

9 Drowning Guy deLisle Dear, M.B, FRCA Faculty 

12 Altitude Illness: Pathophysiology, Prevention, Richard Moon, M.D., C.M., M.Sc., Faculty 

Treatment of AMS, HAPE, HACE FRCP(C), FACP, FCCP 

18 Altitude, Aviation, and Space Physiology Neal Pollock, Ph.D. Faculty 

19 Exercise and Cardiorespiratory Physiology: Gravity Richard Moon, M.D., C.M., M.Sc., Faculty 


20 Altitude Decompression Richard Vann, Ph.D. Faculty 

23 Biochemistry and Physiology of Inhaled O2 and CO2 Claude Piantadosi, M.D. Faculty 

27 CNS Oxygen Toxicity (Hyperoxia and Post Hypoxia) Claude Piantadosi, M.D. Faculty 

30 Hyperbaric Oxygen Therapy: Poisoning Claude Piantadosi, M.D. Faculty 

November 1 Thermal Physiology: Protection from Extremes Edward Thalmann, M.D. Faculty 

of Heat and Cold 

6 Hyperbaric Oxygen Therapy: Wound Healing Bryant Stolp, M.D., Ph.D. Faculty 

8 Hyperbaric Oxygen Therapy: Infection Richard Moon, M.D., C.M., M.Sc., Faculty 


10 Investigational and Other HBO Indications Guy deLisle Dear, M.B., FRCA Faculty 

13 Commercial Diving Operations Gary Beyerstein Guest 

15 Effects of Immersion on Vision, Hearing, Movement, Loring Crepeau, Ph.D 

and Locomotion . 

16 Breath Hold Diving Richard Vann, Ph.D. Faculty 

17 Human Engineering in Life Support Equipment 

Design Lew Nuckols, Ph.D. Guest 

20 Vibration, Radiation, and Underwater Sound and Ed Cudahy, Ph.D. Guest 

Explosion Hazards 

21 Making Diving Safer Richard Vann, Ph.D. Faculty 

27 Fitness to Dive: Physical Standards and Return to Richard Moon, M.D., C.M., M.Sc., Faculty 

Diving FRCP(C), FACP, FCCP 

29 Shellfish and Seafood Poisoning David Hendricks, M.D. Duke Staff 

PAIN CONFERENCES 

EDUCATION 


January 5 Pain Pathway Billy Huh, M.D., Ph.D. Faculty 

Addiction and Pain Management Charles O'brien, M.D., Ph.D. Guest 

12 Should We Use Local Anesthetics in Thoracic Oscar DeLeon Casasola, M.D. Guest 

Epidurals? 

February 2 Three-In-One Fascia Iliaca Block Bruno Urban, M.D., Dr.med. Faculty 

Treatment of Vertebral Compression Bruno Urban, M.D., Dr.med. Faculty 

Fractures with Calcitonin And Risedronate 

Guidelines for Narcotic Maintenance Therapy for Bruno Urban, M.D., Dr.med. Faculty 

Non-Cancer Patients 

3 Critical Appraisal of Electromedicine: Cranial Bruno Urban, M.D., Dr.med. Faculty 

Electrostimulation and TENS 

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March 29 Case Report: Calcitonin/ Elavil for Metastatic Bruno Urban, M.D., Dr.med. Faculty 

Breast Cancer Pain 

Interthecal Steroids For Post-Herpetic Neuralgia Bruno Urban, M.D., Dr.med. Faculty 

April 26 Review of Interventional Techniques of Chronic Bruno Urban, M.D., Dr.med. Faculty 

Spine Pain Management 

June 7 Treatment of Spinal Pain by Lumbar RF Procedures Bruno Urban, M.D., Dr.med. Faculty 

July 31 CRPS, New Nomenclature and Treatments Thomas Buchheit, M.D. Faculty 

August 7 A Guestial Low Back Pain Thomas Buchheit, M.D. Faculty 

15 Functional Anatomy of the Spine Joel Goldberg, M.D. Faculty 

28 Neural Blockade for Pain Management Thomas Buchheit, M.D. Faculty 

September 12 Mechanisms of Pain Transmission I Thomas Buchheit, M.D. Faculty 

19 Pain Management Case Studies Joel Goldberg, M.D. Faculty 

28 Spinal Infusion for Cancer Pain Thomas Buchheit, M.D. Faculty 

October 2 Invasive Therapies for CRPS Thomas Buchheit, M.D. Faculty 

November 21 Spinal Opioids Thomas Buchheit, M.D. Faculty 

RESEARCH CONFERENCES 

March 6 Platelet Function Testing in Cardiac Surgery Gautam Sreeram, M.D. Faculty 

April 3 The Association of Rewarming Rate and 

Neurocognitive Dysfunction After Cardiac Surgery Alina Grigore, M.D. Faculty 

3 Effects of Allopregnanolone on Induced Cellular Ellen Lockhart, M.D. Faculty 

Injury in Human NT2 Cells 

June 5 Neuroprotection from Delayed Post-Schemic 

Adminsistration of a Metalloporphyrin Catalytic 

Anti-Oxidant in the Rat G. Burkhard Mackensen, M.D. Faculty 

July 24 Desensitization of the Substance P Receptor: 

a Mechanistic Approach Mark Richardson, Ph.D. Duke Staff 

August 14 Progress in Engineered Arteries Tracy DuLaney, Ph.D. Duke Staff 

September 25 Continuous Catheter Anesthesia in the Outpatient Steve Klein, M.D. Faculty 

Environment 

October 30 Bispectral Index for Electroconvulsive Therapy John Keifer, M.D. Faculty 

November 27 Pulmonary Physiology in Environmental Extremes Richard Moon, M.D., C.M., M.Sc., Faculty 


92 EDUCATION..


December 11 Use and Validation of Near Infrared Spectroscopy James Reynolds, Ph.D. Faculty 

to Measure Fetal Cerebral Oxygenation In Utero: 

Studies Using Nearterm Fetal Sheep 

RESIDENT LECTURES 

EDUCATION 


January 12 Chronic Pelvic/Abdominal Pain in Women Carlos Nebreda, M.D. Faculty 

19 Complex Regional Pain Syndrome Thomas Buchheit, M.D. Faculty 

26 Myofascial Pain Syndrome Dianne Scott, M.D. Faculty 

February 2 Cognitive Dysfunction in the Post-Operative Period Kathy Grichnik, M.D., MS Faculty 

9 Air, Air, Everywhere Edith Marom, M.D. Duke Staff 

16 Geriatric Clinical Pharmacology Madan Kwatra, Ph.D. Faculty 

23 Ophthalmic Anesthesia Charles Garcia-Rodriguez, M.B., B.S. Faculty 

March 1 Pediatric Head Trauma Allison Ross, M.D. Faculty 

8 Pediatric Syndromes and Their Implications Guy deLisle Dear, M.B., FRCA Faculty 

15 Pediatric Ventilators: Modes, Methods... Frank Kern, M.D., FCCM Faculty 

22 Anesthesia for Airway Surgery in Children John Eck, M.D., F.M.H. Faculty 

29 Sedation of Off-Site Pediatric Anesthesia Robert Coleman, M.D. Faculty 

April 5 Airway Management for the Neurosurgical Patient Randall Brewer, M.D. Resident 

12 Positioning the Neurosurgical Patient John Keifer, M.D. Faculty 

19 Neural Monitoring Jeffrey Taekman, M.D. Faculty 

26 Management of Head Trauma David Warner, M.D. Faculty 

May 3 Acid Base Balance Andrew Hilton, M.B., B.S, FANZCA Faculty 

10 What Nutrition and When Should it be Given? John Sum Ping, M.B., Ch.B., FRCA Faculty 

17 Mechanical Ventilation Laura Niklason, M.D., Ph.D. Faculty 

24 Blood Transfusion Thomas Slaughter, M.D. Faculty 

31 Antibiotic Choices for Hospital Infection Deborah Friedman, M.D. Duke Staff 

June 7 Pheochromocytoma Eugene Moretti, M.D. Faculty 

14 Airway Management and Cervical Spine Injury Randall Brewer, M.D. Resident 

21 Pharmacokinetics and Dynamics for Dummies Jacques Somma, M.D., FRCP(C) Faculty 

28 Liver Boarded Kerri Robertson, M.D., FRCP(C) Faculty 

July 5 Nuts and Bolts Catherine Lineberger, M.D. Faculty 

12 Clinical Case Conference Catherine Lineberger, M.D. Faculty 

19 Substance Abuse Video Catherine Lineberger, M.D. Faculty 

26 Internet-Based Learning Jeffrey Taekman, M.D. Faculty 

September 6 ABG Interpretation: The Respiratory Gases Richard Moon, M.D., C.M., M.Sc., Faculty 


13 ABG Interpretation: Acid-Base Pathology Richard Moon, M.D., C.M., M.Sc., Faculty 


20 Understanding and Interpreting Hemodynamics Laura Niklason, M.D., Ph.D Faculty 

27 Infusing Narcotics: the Context-Sensitive Half-Time Jacques Somma Faculty 

to the Rescue, M.D., FRCP(C) 

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October 4 Introduction to Informatics Jeffrey Taekman, M.D. Faculty 

11 Assessing the Quality of Online Medical Information Jeffrey Taekman, M.D. Faculty 

25 Information Systems and Their Application in Clinical Iain Sanderson, M.B.,Ch.B., FRCA Faculty 

Medicine 

November 1 Most Missed 2000 Cardiac Key Words Steven Hill, M.D. Faculty 

8 Most Missed 2000 Thoracic Key Words Katherine Grichnik, M.D., MS Faculty 

15 Regional Anesthesia for Thoracic Surgery Mark Stafford Smith, M.D., CM, Faculty 

FRCP, DABA 

22 Post Anesthesia ICU Problems John Booth, M.B., Ch.B., FRCA Faculty 

29 Controversies PA Catheter Use David Lubarsky, M.D., M.B.A. Faculty 

December 6 Fetal Monitoring Ellen Lockhart, M.D. Faculty 

13 OB Emergencies Asraf Habib, M.B., B.Ch., M.Sc., FRCA Faculty 

20 Complications of OB Anesthesia Adeyemi Olufolabi, M.B., B.S., FRCA Faculty 

VETERANS AFFAIRS MEDICAL CENTER LECTURES 

January 3 Thoracic Aneurysm Anesthesia/Management Gautam Sreeram, M.D. Faculty 

4 Pulse oximetry Christopher Young, M.D., FCCM Faculty 

6 Aging—Keywords Dana Wiener, M.D. Faculty 

7 Case Studies John Sum Ping, M.B., Ch.B., FRCA Faculty 

10 High Altitude Medicine Charles Garcia-Rodriguez, M.B., B.S. Faculty 

11 Acute Pain Thomas Buchheit, M.D. Faculty 

13 Preop Evaluation of Bleeding Risk Thomas Slaughter, M.D. Faculty 

14 Preop Evaluation Dana Wiener, M.D. Faculty 

18 LVH - Strain or Ischemia Mathew Taylor, M.D. Resident 

20 Gas Exchange Lewis Hodgins, M.D. Faculty 

21 Morbidity and Mortality Conference—CVP Jonathan Mark, M.D. Faculty 

Placement Method 

24 Acute Poisoning Charles Garcia-Rodriguez, M.B., B.S. Faculty 

31 Cardiac Pacemakers Keith Hanson, M.D. Resident 

August 2 Preoperative Assessment of Endocrine Disease Catherine Lineberger, M.D. Faculty 

9 Preoperative Testing--How Much, How Little? Ronald Olson, M.D., CCFP Faculty 

16 Neuromuscular Disorders Cecil Borel, M.D. Faculty 

23 Evaluating the Clotting Cascade for Anesthesiologists John Schultz, M.D. Faculty 

30 Risk Assessment Iain Sanderson, M.B.,Ch.B., FRCA Faculty 

February 1 Morbidity and Mortality - Septic Shock Christopher Young, M.D., FCCM Faculty 

3 Morbidity and Mortality Conference - Total Spinal Lewis Hodgins, M.D. Faculty 

3 Physiology in the Elderly Dana Wiener, M.D. Faculty 

4 Opioid Analgesia Thomas Buchheit, M.D. Faculty 

7 Carotid Endarterectomy Garrett Scales, M.D. Resident 

8 Autononic Pain Joel Goldberg, M.D Faculty 

11 Bleeding and CPB Thomas Slaughter, M.D. Faculty 

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February 14 Anticoagulants, New Antiplatelet Agents and Gautam Sreeram, M.D. Faculty 

Regional Anesthesia 

15 Poisoning Charles Garcia-Rodriguez, M.B., B.S. Faculty 

17 Adult Resipratory Disease Syndrome William Norcross, M.D. Resident 

18 Sevoforane in Heart Surgery Lewis Hodgins, M.D. Faculty 

24 Adult Resipratory Disease Syndrome Timothy Hayward, M.D. Resident 

25 Morbidity and Mortality Conference - AVP Use Andrew Hilton, M.B., B.S., FANZCA Faculty 

28 Protection from Respiratory Contamination— Rebecca Bateman, Industrial Hygienist Guest 

PAPR Respirator 

March 2 Case Conference Dana Wiener, M.D. Faculty 

6 Morbidity and Mortality Conference John Sum Ping, M.B., Ch.B., FRCA Faculty 

7 Thermoregulation; Temperature and Heat Charles Garcia-Rodriguez, M.B., B.S. Faculty 

9 HTT Gautam Sreeram, M.D. Faculty 

10 Esophagogastrectomy Lewis Hodgins, M.D. Faculty 

13 Airway Garrett Scales, M.D. Resident 

16 Peripheral Nerve Blocks Joel Goldberg, M.D. Faculty 

17 Pharmacology to Reduce Blood Lose Thomas Slaughter, M.D. Faculty 

21 Adult Respiratory Disease Syndrome Chad Grotecut, M.D. Resident 

23 Malignant Hyperthermia Elayne Schweikert, CRNA Duke Staff 

24 Peripheral Nerve Catheters Stuart Grant, M.B., Ch.B. Faculty 

27 Ewings Sarcoma Mark Albritton, M.D. Resident 

28 IARS Abstracts Marcella Lanzinger, M.D. Resident 

30 Perioperative Neural Injuries Thomas Buchheit, M.D. Faculty 

31 Chartery Morbidity and Mortality Jonathan Mark, M.D. Faculty 

April 3 Perioperative Risk Assessment / Abdominal Aortic Christopher Young, M.D., FCCCM Faculty 

Aneurysm 

4 Bi Spectral Index Scott Helsley, M.D. Resident 

6 Herbs and Anesthesia Dana Wiener, M.D. Faculty 

7 Infection Control Mary Moorefield, RN Guest 

10 Oxygen Physiology Lewis Hodgins, M.D. Faculty 

11 Pain Clinic Complications Joel Goldberg, M.D. Faculty 

13 Tricuspid Regulation John Sum Ping, M.B., Ch.B., FRCA Faculty 

14 Case Presentation—AAA with Pacemaker Gautam Sreeram, M.D. Faculty 

17 Cardiac Pressures Jonathan Mark, M.D. Faculty 

18 Medical Error Charles Garcia-Rodriguez, M.B., B.S. Faculty 

20 Muscle Relaxants David Schinderle, M.D. Resident 

21 IR Ventilation Andrew Hilton, M.B., B.S., FANZCA Faculty 

24 Case Presentation - Coagulation Disorder Laura Kihlstrom, M.D. Resident 

25 Remifonlonyl William Norcross, M.D. Resident 

28 Morbidity and Mortality Jonathan Mark, M.D. Faculty 

May 1 Management of Hyperdynamic States Lewis Hodgins, M.D. Faculty 

2 Upper Extremity Nerve Blocks Thomas Buchheit, M.D. Faculty 

4 Popular Use of Herbs Dana Wiener, M.D. Faculty 

5 Morbidity and Mortality John Sum Ping, M.B., Ch.B., FRCA Faculty 

9 Intra Uterine Growth Retardation Krystle Pham, M.D. Resident 

11 Transducers Peter Baek, M.D. Resident 

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May 12 Porphyria Gautam Sreeram, M.D. Faculty 

15 Aortic Aneurysms Thomas Slaughter, M.D. Faculty 

15 AAA Thomas Slaughter, M.D. Faculty 

16 Ventilation Andrew Hilton, M.B., B.S., FANZCA Faculty 

18 Gem Premier Jim Ellefson Guest 

19 Morbidity and Mortality Christopher Young, M.D., FCCM Faculty 

22 Regional Anesthesia and the Neurologic Exam Thomas Buchheit, M.D. Faculty 

23 Blood Transfusion Laura Khilstrom, M.D. Resident 

25 Post op Pain Management in the Opicod Tolerant Thomas Buchheit, M.D. Faculty 

Patient 

26 Respiratory—Circulatory Interactions Jonathan Mark, M.D. Faculty 

30 Innnervation of Larynx John Sum Ping, M.B., Ch.B., FRCA Faculty 

June 2 Keyword Review Dana Wiener, M.D. Faculty 

5 Case Study Christopher Kerr, M.D. Resident 

6 Case Study John Sum Ping, M.B., Ch.B., FRCA Faculty 

8 Case Study Graham Lashley, M.D. Resident 

9 Anesthesia for Repair of Thoracic Aneurysm Thomas Slaughter, M.D. Faculty 

12 Oxygenaration During Mechanical Ventilation Andrew Hilton, M.B., B.S., FANZCA Faculty 

13 Evaluation of Abdominal Pain in ICU Fernando Delvecchio, M.D. Resident 

15 Pain Medications Joel Goldberg, M.D. Faculty 

16 Clinical Studies Jonathan Mark, M.D. Faculty 

John Sum Ping, M.B., Ch.B., FRCA Faculty 

19 Pulse Oximetry Christopher Young, M.D.. FCCM Faculty 

20 Hemolytic and Researchers Daphne Jones, M.D. Resident 

22 Carotid Disease Paul Chai, M.D. Resident 

29 Muscle Relaxants Cathleen Peterson-Layne, M.D., Ph.D. Resident 

30 Morbidity and Mortality Jonathan Mark, M.D. Faculty 

July 6 Anatomy Key Words Dana Wiener, M.D. Faculty 

7 Pharmacologic Approaches to Hemostasis Thomas Slaughter, M.D. Faculty 

10 Micrologic Evaluation of High Extremity Thomas Buchheit, M.D. Faculty 

11 Inhaled Agents Lewis Hodgins, M.D. Faculty 

13 Amniotic Fluid Embolism Leigh Elmore, M.D. Resident 

17 LMA Tarsha Garvin, M.D. Resident 

18 Poppy Joel Goldberg, M.D. Faculty 

20 Optimal Preload Jonathan Mark, M.D. Faculty 

21 Awareness during Anesthesia Jonathan Mark, M.D. Faculty 

24 Anesthesia Machine Laura Kihlstrom, M.D. Resident 

25 High Altitude Oxygenation Lewis Hodgins, M.D. Faculty 

26 Fire Safety Clorine Chasteen Guest 

27 Ethics Lewis Hodgins, M.D. Faculty 

28 Obstructive Sleep Apnea and Awake Case Presentation Christopher Young, M.D., FCCM Faculty 

31 Neuropathic Pain Thomas Buchheit, M.D. Faculty 

96 EDUCATION..


EDUCATION 


August 1 Heparin Induced Thrombocytopenia Ryan Simovitch, M.D. Resident 

3 Stress Ulceration with Acquired Pneumonia Allen Cheng, M.D. Fellow 

4 Morbidity and Mortality Lewis Hodgins, M.D. Faculty 

8 VA Trivia Kurt Knauth, M.D. Resident 

10 ECG Monitoring Jonathan Mark, M.D. Faculty 

11 Neuromuscular Blockade - Prolonged Gautam Sreeram, M.D. Faculty 

14 Transfusion Thomas Slaughter, M.D. Faculty 

15 Low Back Pain Joel Goldberg, M.D. Faculty 

17 I-Stat Ed Cole, Specialist Guest 

18 Morbidity and Mortality Dana Wiener, M.D. Faculty 

21 Diabetes Mellites - Perioperative Management Cathleen Peterson-Layne, M.D., Ph.D. Resident 

22 Anesthetic Considerations in Renal Disease Eric Miller, M.D. Resident 

25 Morbidity and Mortality - TURP Syndrome Christopher Young, M.D., FCCM Faculty 

28 Aspiration Pnermonitis Patricia Macha, M.D. Resident 

29 Case Report Jeffrey Yergler, M.D. Resident 

31 Complications following Vascular Surgery Shanka Biswas, M.D. Resident 

September 1 Morbidity and Mortality - Hyperthyroidism John Sum Ping, M.B., Ch.B., FRCA Faculty 

5 Renal Physiology Lewis Hodgins, M.D. Faculty 

7 Epidural Anesthesia in Labor Cescili Drake, M.D. Resident 

8 Preop Coagulation Testing Thomas Slaughter, M.D. Faculty 

11 Neuroanatomy of Pain Thomas Buchheit, M.D. Faculty 

12 Case Discussion John Sum Ping, M.B., Ch.B., FRCA Faculty 

14 Latex Dana Wiener, M.D. Faculty 

15 Anesthesiologist Role Antibiotic Administrate to Ellen Flanagan, M.D. Resident 

Prevent Postop Infection 

18 Desflurane Barbara McDermott, CRNA Duke Staff 

19 Cases in Pain Management Joel Goldberg, M.D. Faculty 

21 Cholinesterase's Deficiency Keith Hanson, M.D. Resident 

22 Controversial Issues in ICU Laura Niklason, M.D., Ph.D. Faculty 

25 LMA William Corkey, M.D. Resident 

26 Hypoalbuminemia Abigail Melnick, M.D. Resident 

28 Sepsis from Invasive Lines Allen Cheng, M.D. Resident 

October 9 Oxygen Delivery Lewis Hodgins, M.D. Faculty 

5 High Altitude Physiology Dana Wiener, M.D. Faculty 

6 Leave Forms Jonathan Mark, M.D. Faculty 

10 Local Anesthetic John Mitchell, M.D. Resident 

12 Coexisting Disease Gautam Sreeram, M.D. Faculty 

13 Research Variables Thomas Slaughter, M.D. Faculty 

17 Hemodynamic Monitoring in Preclampsia Connette McMahon, M.D. Resident 

20 BP Lewis Hodgins, M.D. Faculty 

26 Surgical Management of Pancreatitis Michael Davidson, M.D. Resident 

27 Morbidity and Mortality Joel Goldberg, M.D. Faculty 

30 Liuev Reaction—Post op Consideration Lewis Hodgins, M.D. Faculty 

31 Kidney Lewis Hodgins, M.D. Faculty 

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November 2 Pharmaco Kinetics Ronald Logan Duke Staff 

3 ECG's John Sum Ping, M.B., Ch.B., FRCA Faculty 

6 Depression and Anesthesia Holly Davis, M.D. Resident 

7 Cardiac Tamporade Gautam Sreeram, M.D. Faculty 

9 Peripheral Nerve Injuries - Preop Dana Wiener, M.D. Faculty 

13 Pacemakers Jonathan Mark, M.D. Faculty 

14 Airway Management in Patients with Goiter (Thyroid) John Sum Ping, M.B., Ch.B., FRCA Faculty 

16 Case Presentation “Problems with BP” Adam Schow, M.D. Resident 

17 Automatic Defibrillator Within the OR Virginia Kent, RN Guest 

20 Waste Anesthetic Gases Will Corkey, M.D. Resident 

21 Spinal Opiods Thomas Buchheit, M.D. Faculty 

28 Nerve Physiology and Anatomy Joel Goldberg, M.D. Faculty 

December 1 Inhalation Anesthetics Lewis Hodgins, M.D. Faculty 

4 Cancer Pain Paula Lee, M.D. Resident 

5 Heparin Administration Gautam Sreeram, M.D. Resident 

7 Cardiac Output Laura Niklason, M.D., Ph.D. Faculty 

8 Dexmedetomidine Christopher Young, M.D., FCCM Faculty 

11 Anesthesia Gas Machine, Gas Supplies, Scavengers John Sum Ping, M.B., Ch.B., FRCA Faculty 

12 Hypertrophic Cardiomyopathy William Norcross,M.D. Resident 

14 Pulse Oximetry David Lindsay, M.D. Faculty 

15 Hip Replacement in the Elderly Dana Wiener, M.D. Faculty 

19 Pacemakers Daniel DeMeyts, M.D. Resident 

21 Review of Hemostasis, Coagulation and Associated Paul Shook, M.D. Resident 

Blood Products 

22 Physiology of the Elderly Daphne Jones, M.D. Resident 

WOMEN'S ANESTHESIA 

January 11 ....and by a sleep to say we end the heartache John Booth, M.B., Ch.B., FRCA Faculty 

heartache and the thousand natural shocks 

the flesh is heir to; tis a consummation devoutly 

to be wished 

February 1 Morbidity and Mortality Conference Adeyemi Olufolabi, M.B., B.S., FRCA Faculty 

15 Business Donald Penning, M.Sc., M.D. Faculty 

22 The Use of Caffeine for PDPH Peter Dwane, M.D., C.M., FRCP(C) Faculty 

29 Was Gertie Marx off the Marx? Hypotension After John Schultz, M.D. Faculty 

Spinal. 

March 7 How Much Labor in a Labor Epidural? Elizabeth Bell, M.D., M.P.H. Faculty 

21 Risk Management in OB Anesthesia Barbara Hendrix Duke Staff 

28 How Anesthesiologists Practice Obstetric Anesthesia Terrance Breen, M.D., FRCPC Faculty 

98 EDUCATION..


EDUCATION 


April 4 Spinal Anesthesia for Labor Epidural Ellen Lockhart, M.D. Faculty 

11 Fellows Conference Ellen Lockhart, M.D. Faculty 

Sheila Gardner, M.D. Faculty 

18 Perioperative Use of Local Anesthetics Jim Crews, M.D. Guest 

25 Morbidity and Mortality Conference Adeyemi Olufolabi, M.B., B.S., FRCA Faculty 

May 9 Morbidity and Mortality Conference Adeyemi Olufolabi, M.B., B.S., FRCA Faculty 

16 Business Meeting J.G. Reves, M.D. Faculty 

23 Prelude to SOAP Ellen Lockhart, M.D. Faculty 

June 13 How Does Blood Clot? John Schultz, M.D. Faculty 

20 Business Meeting Holly Muir, M.D., FRCP(C) Faculty 

17 QI Issues Terrance Breen, M.D., FRCP Faculty 

July 4 Business Meeting Holly Muir, M.D., FRCP(C) Faculty 


August 3 Business Meeting Holly Muir, M.D., FRCP(C) Faculty 



31 Research Meeting James Reynolds, Ph.D. Faculty 

September 7 Business Meeting Holly Muir, M.D., FRCP(C) Faculty 

21 Difficult Airway Management “New Toys” and Ideas Bryant Stolp, M.D., Ph.D. Faculty 

for Helping to Set Up Our New ORs 

28 Journal Club Terrance Breen, M.D., FRCPC Faculty 

October 5 Psychosocial Aspects of Acute Pain David Sheffield, Ph.D. Guest 


26 CORD Elizabeth Bell, M.D., M.P.H. Faculty 

November 2 Hematology Thomas Ortel, M.D., Ph.D. Guest 

9 Research Meeting James Reynolds, Ph.D. Faculty 


30 Journal Club Adeyemi Olufolabi, M.B., B.S., FRCA Faculty 

December 7 Divisional Policy and Procedure Meeting Peter Dwane, M.D., C.M., FRCP(C) Faculty 


EDUCATION 99

EDUCATION 


Program Co-Chair and Moderator 

Kathryn E. King, M.D., MSN 

Program Co-Chair 

100 EDUCATION 

Eighth Academic Evening 

The Annual Academic Evening was 

established in 1993 as a forum for the 

display and celebration of ongoing 

research and academic activity by 

fellows, residents, graduate students, 

medical students, undergraduates, and 

nurse anesthetists working in the research 

groups within the Department 

of Anesthesiology. Submitted abstracts 

are initially scored by a committee of 

faculty members. A subset of abstracts 

is thereby selected for poster presentation 

to the Guest Judge at the Academic 

Evening. All individuals who submit 

abstracts are invited to present their 

work at the poster-discussion session. 

Each poster presenter provides a brief 

tour of the poster and participates in 

a discussion session led by a senior 

faculty member and attendees of the 

Academic Evening. 

Presentations are followed by a 

lecture, dinner, discussion and awards 

by the Guest Judge. Previous Judges 

have included Roger L. Royster, M.D., 

Donald S. Prough, M.D., Thomas F. 

Hornbein, M.D., John Kampine, M.D., 

Ph.D., James C. Eisenach, M.D., Richard 

J. Traystman, Ph.D., and Steven Shafer, 

M.D. The Academic Evening is 

approved for 3.0 hours in Physician’s 

Recognition Award Category I of the 

American Medical Association. 

In 2000, we were honored to have 

as Guest Judge, Margaret Sedensky, 

M.D., Ph.D., Professor, Department of 

Anesthesiology, Assistant Professor, 

Department of Genetics, Case Western 

Reserve University School of Medicine. 

Dr. Sedensky presented a superb and 

entertaining lecture entitled: “Trends in 

anesthesia research: To infinity and 

beyond.” 

Interest in this event is reflected 

by the fact that we received 43 abstracts 

and hosted over 100 attendees. This 

year's event was generously supported 

by Abbott Laboratories, Aspect Medical, 

AstraZeneca LP, Roche Pharmaceuti- 

cals, Organon, Inc., Purdue Pharma 

L.P., and Glaxo Wellcome, Inc. 

A gala dinner was then held. Dr. 

Sedensky presented awards in the following 

categories (embellished with 

her own gift of T-shirts from the Rock 

and Roll Hall of Fame): 

Post Doctoral Laboratory 

1st Place: G. Burkhard Mackensen, M.D. 

Finalists: Jose Pineda, M.D., Santi 

Punnahitananda, Ellen Lockhart, M.D. 

Dick Smith Award - Post Doctoral 

Clinical 

1st Place: Alina Grigore, M.D. 

Finalists: Timothy Stanley, M.D., Maribel 

Gamoso, M.D., Karen Nielsen, M.D. 

Pre-Doctoral Non Medical Student 

1st Place: Janet Hall, CRNA 

Finalist: Amy Kondyra 

Case Report 

1st Place: Adil Kamal, M.D. 

Finalist: Peter DeBalli III, M.D. 

Medical Student 

1st Place: Carolyn Clayton 

Finalist: Kelly Schofield 

The Dick Smith Award honors 

L. Richard Smith, Ph.D., who passed 

away in 1996. Dr. Smith not only provided 

many years of superb statistical 

support to our Department, but also 

epitomized qualities of intellect, selfeffacement, 

wisdom, good humor and 

immense personal courage. He serves 

as a role model for us all. 

The Department is indebted to Mrs. 

Elizabeth Barbee, Mrs. Beverly Hester, 

Ms. Jessica Harris and Ms. Kimberly 

Westbrooks who performed the organizational 

duties resulting in the great 

success of the event. 

The 2001 Annual Academic 

Evening is scheduled to be held May 1, 

2001, and Guest Judge will be Alex 

Evers, M.D. from Washington University.

2000 BUSINESS OFFICE ANNUAL REPORT 

Edward F. Cousineau, M.A., 

M.B.A. 

Business Manager 

Private Diagnostic Clinic 

At mid year 2000 the clinical case-loads 

for Anesthesiology began to fall off by 

about 10% as surgical volumes shifted 

away from Duke Hospital. By late in 

the year these volumes were again 

climbing a bit. The phenomenon 

resulted in the closure of several operating 

rooms at various times. By year’s 

end the Hospital was preparing to reopen 

these rooms to accommodate its 

still shifting volumes and to provide surgical 

specialties with needed time. 

The PDC’s implementation of a 

new cost allocation mechanism hit the 

department rather hard. Under these 

norms, the department was allocated a 

share in the PDC administrative costs of 

other clinical departments. This meant 

that these extra costs not usually borne 

by other anesthesiology groups and 

academic anesthesiology departments 

would be added on to our fair share of 

the operating and administrative burden. 

The establishment of a joint billing and 

collections service to be known, as the 

Professional Revenue Management 

Organization—the PRMO—in mid 2001 

would further complicate the cost allocation 

process. There is some specula- 

tion that the Duke Health System will 

insist on true activity-based cost accounting 

for the PRMO. This would 

bolster the department’s contention 

over the last three years that PDC costs 

should be properly managed in a manner 

consistent with industry-wide practices. 

Only one other PDC department 

has consistently sided with this point 

of view. 

The PDC continued to provide 

improved financial information during 

calendar year 2000. A major initiative 

sought to accelerate collections for 

both Duke Hospital and the PDC. This 

resulted in the formation of a “Cash 

Acceleration Team” for Anesthesiology 

in July of 2000. Best estimates suggest 

that the department collected perhaps 

$800,000 in old accounts. Moreover, 

clearing the backlog enables better 

collection efforts to now be directed 

toward newer denials. 

Departmental 

Office space continued to be in 

extremely short supply throughout the 

department during the year. In-house 

chiefs were appointed for the Divisions 

of Women’s Anesthesia and Critical 

Care Medicine; Pain Management; and 

General, Vascular, Transplant Anesthesia 

and Critical Care Medicine. 

The new interdisciplinary pain 

clinic facility at Morreene Road was 

opened in late October. The facility 

makes patient access for chronic pain 

treatment much easier. Two dedicated 

block rooms designed for C-arm fluroscopy 

have been placed in use. Patient 

and procedural volumes are beginning 

to grow. However, the PDC has had 

some operational issues that must be 

addressed before the clinic will generate 

a positive revenue stream. 

The department's national ranking 

in NIH research awards has constantly 

remained in the top four over the past 

three years. During the 2000 NIH reporting 

period, the department's total NIH 

awards surpassed the amount reported 

by the number one institution in the 

previous 1999 reporting period. For 

calendar 2000 the department’s total 

external funding for research was over 

$6.1 million. 

Two key members of the business 

office staff received promotions outside 

of the department in autumn 2000. 

Steve Williams, former administrative 

manager, was made director of PDC 

Reimbursement. Mary W. Smith, former 

HR manager, was recruited back into 

the University Human Resources activity 

and was given a senior post within the 

university’s wage and salary function. 

Ms. Natalie Schneider and Mrs. Charlene 

Hundley assumed their respective positions 

at year’s end. Ms. Gloria Howard 

took over the role of staff specialist 

within the business manager’s office. 

Hospital 

The department now functions as a 

personnel records custodian for hospital 

employees in most instances. An 

increased role in management of the 

CRNA staff has fallen back into the 

department after resting exclusively 

with the hospital's peri-operative management 

team. The divisional chiefs 

have a much expanded role. 

The department continued to provide 

services for the selection and evaluation 

of anesthesia capital equipment 

to the hospital. Calendar 2000 saw the 

implementation of the new automated 

anesthesia record keepers, Saturn, from 

North American Drager. The review 

and purchase of other needed clinical 

equipment has slowed somewhat as 

Duke Hospital re-organizes its capital 

equipment request processes. 

The Departments of Anesthesiology, 

Surgery and Obstetric and Gynecology 

each began paying a share of the costs 

of the Physicians Assistants and Nurse 

Practitioners assigned to the pre-operative 

screening unit. These mid-level 

practitioners have added funding from 

Duke Hospital. Placing these positions 

within the PDC structure helps assure 

proper reporting relationships for compliance 

purposes. 

2000 BUSINESS OFFICE ANNUAL REPORT 101

102 SUPPORT STAFF.. 

Anesthesia Clinical Research Staff 

First row left to right: 


Michele Ladd 

Suzanne Aycock, R.N. 

Scott McEwen 

Second row left to right: 

Lee McClurkin, R.N. 

Aaron Harrison 

Karen Ramsey, R.N. 

Not Pictured: 

Debbie Jones, R.N. 

Jolin Reeves 

SUPPORT STAFF 

Administrative Staff 

First Row left to right 

Natalie Schneider, B.B.A. 

Rosemary Cumbie, A.A. 

Patricia Cruse, A.A.S. 

Second Row left to right 

Edward Cousineau, M.A., M.B.A. 

Larry Dowell, A.A.S. 

Charlene Hundley, B.B.A. 

Not Pictured: 

Steve Williams, B.B.A. 

Mary Smith, B.S., M.Ed. 

Anesthesia Support 

Left to right 

Lessie Owens, MLPN 

Delmar Shelton, PA-C 

Allison Taylor, B.S., PA-C

Anesthesia Technician Staff 

Sitting left to right 

Anesha Smith 

Amanda Cheek 

Heidi Brothers 

Standing left to right 

Daniel Huffman 

Jessie Swain 

Roger Hall 

Helen Trotter 

Todd Rogers 

Not Pictured 

Mattie Bradley 

Katie Cook 

Les Manning 

Sanders Massey III 

Horacio Salgado 

Ricky Sallars 

Korkeshia Taylor 

Dwayne Thompson 

SUPPORT STAFF 

Cardiothoracic Anesthesia Clinical Research 

Seated left to right 

Erin Ward, B.S. 

Terri Moore, B.A. 

Amanda Cheek, B.A. 

Second Row left to right: 

Melanie Tirronen, B.S. 

Malissa Harris, R.N., B.S.N. 

Beverly Perry 

Third Row left to right 

Erich Lauff, B.A. 

Chonna Campbell, B.S. 

Tori Latiker, B.S. 

Vincent Gaver, B.A. 

Jerry Kirchner, B.S., CCRA 

Mary Helen Currier, B.A. 

Not pictured 

Franz Derilus, B.S. 

Jason Hawkins, R.N., B.S.N. 

Tanya Kagarise, B.S. 

Aimee Butler, M.S. 

Keinya Lee, B.S 

SUPPORT STAFF 103

SUPPORT STAFF 

Divers Alert Network 

First Row left to right 

Denise Haskins 

Betty Orr 

Hattie Hargraves 

Jeannie Floyd 

Sherry Strickland 

Eileen Weckerle 

Jane Foley 

Rick Melvin 

Cindi Easterling, M.Ed. 

Chris Wachholz, M.B.A. 

Lisa Li 



Faye Bowen 

Panchabi Vaithiyanathan 

Donna Heath, B.S., M.S. 

Dave Lawler 

Kim Walker 

Beth Hawkins 

Laura Johnson 

Julie Ellis 

Donna Uguccioni 

Colin Taylor 

Scott Norris 

Bill Clendenen, M.B.A. 

James Fisher 

Duke North Support Staff 

Left to right 


Cheryle Davis 

LaTanya Rhames 

Kimberly Westbrooks 

Barbara Blank 

Pamela Upadhaya 

Annette Eddins 

Marilyn Helms 

Angela Rogers 

Thomas Pafford 

Not pictured 

Brenda Mickley 

Laraine Tuck 

Sara Yetsko 

Josie Tackett 

Sharon Skeeter 

Emily Coburn 

Tonya Meadows 

Patsy Crutchfield 

Shelia Johnson 

Allen Gattis 

Valorie Smith 


Bill Terry 

Larry Crabtree 

Tommy Fowler 

Shirley Fowler 

Bud Elvin 

Barry Shuster, M.B.A. 

Nathalie Judkins 

Webb Roberts, M.B.A. 

Celia Evesque 

Peter Bennett, Ph.D., D.Sc. 

Dan Kinkade 

Deb Taft 

Shelly Hicks 

Chris Shoemaker 

Bryon Buesser 

Dan Leigh 

Fourth Row left to right 

Randy Sitzes 

Dan Orr, B.S., M.S. 

Mark Butler 

Nathan Duryea 

David Martinez 

Chris Bennett, M.B.A. 

Deborah Williams 

Steve Mehan 

Rick La Reno 

Brian Levering 

Ron Eldridge 

Petar Denoble, M.D., D.Sc. 

Eric Douglas 

Steve Barnett 

Jamahl Green 

Jim Gaston 

Wesley Hyatt 

Ralph Ariail 

James Hallmon 

Deborah Belk 

Melina Shabani 

Michelle Harward

Hyperbaric Center 

Left to right 

Eric Schinazi 

Richard Moon, M.D., C.M., M.Sc., 


Albert "Sonny" Boso 

Carmen Hurst 

Michael Natoli 

Eugene Hobbs 

Neal Pollock, Ph.D. 

Benjamin Comfort 

Ivan Demchenko, D.Sc. 

Deborah Brann 

Klaus Torp, M.D. 

Paul Thomas Edwards 

John Freiberger, M.D. 

Bryant Stolp, M.D., Ph.D. 

Duke South Support Staff 

Seated left to right 

Maria Johnson 

Kathryn White 

Lonie Purefoy 

Gloria Howard 


Alan Dunn 

Larry O’Neal 

Not Pictured 

Donna Harris 

Ocie Ingram 

Eris Joffe 

Marcie Robinson 

Claude Piantadosi, M.D. 

Barry Castle 

Richard Vann, Ph.D. 

Eric Alford 


Not Pictured 

Peter Bennett, Ph.D., D.Sc. 


Owen Doar 

Kevin Kraft, RN 

John Rice, RN 

Roberta Rose, RN 

Herbert Saltzman, M.D. 

Sherry Strickland 

Edward Thalmann, M.D. 

Aaron Walker 

SUPPORT STAFF 

SUPPORT STAFF 105

SUPPORT STAFF 


Information Systems 

Standing left to right. 

Iain Sanderson, M.B 

William Gilbert, B.S., C.N.E. 

Christopher Wester 

Kisan Upadhaya, A.A.S. 

Richard Adrain, B.S. 


Larry Dowell, A.A.S. 

Not Pictured 

Stephen White 

Human Neurophysiology 

and Pharmacology Laboratory 


David Wright, M.B., Ch.B. 

Kerri Robertson, M.D., FRCP(C) 



John Keifer, M.D. 

Eugene Moretti, M.D. 

Sitting left to right 

Aaron Harrison, B.S. 

Karen Ramsey, R.N., B.S.N., M.B.A., M.H.A. 

David MacLeod, M.B., B.S., FRCA 

The Medical Assembler Seniors 

Left to right 

Ky Taing 

Linda Harris, Supervisor 

Mattie Bradley 

Barry Nichols 

Yuhsuan Chen 

Not Pictured 

Sanders Massey III

Molecular Pharmacology Laboratory 

Front row left to right 

Terese Camp 

Michael Smith, M.S. 

Debra Schwinn, M.D. 

Back Row left to right 

Daniel Morris, Ph.D. 

Elizabeth Barbee 

Jessica Morris 

Gregory Michelotti, Ph.D. 

Not Pictured 

Beilei Lei, M.D., Ph.D. 

Simon Millar, M.B., Ch.B., FRCA 

SUPPORT STAFF 

Multidisciplinary Neuroprotection Laboratory 


Ann Brinkhous 

Beverly Hester 

Jim Onigkeit 

Ellen Bennett, Ph.D. 

Jose Pineda, M.D. 

Mitsuo Aono, M.D. 

Second row left to right 

Gary Massey 

Betty Smith 

Yukie Sato, M.D. 

Jesica Pandika 

Carla Calvi 

Hilary Grocott, M.D., FRCP(C) 

Augusto Parra, M.D. 

Matthew McGirt 

Third row left to right 

William Matthew, Ph.D. 

Daniel Laskowitz, M.D. 

David Warner, M.D. 

Robert Pearlstein, Ph.D. 

Huaxin Sheng, M.D. 

Kyosang Kim, M.D. 

Ronald Goldberg, M.D. 

SUPPORT STAFF 107

SUPPORT STAFF 


Preoperative Screening Unit (2D) 

Front Row left to right 

Patricia Fenlon, RN, M.S.N. 

Lelia Gentry, PA-C 

Mary Crawford, RN 

Brenda Doris 

Anthony Basil, RN 

Mark Johnson, PA-C 


Ella Smith 

John Stover, F.N.P. 

Lou Breedlove 

Wanda G. Johnson, RN, MA 


Dynetta Tatum 

Yolanda Mack 

Sheila Lambert-Adams 

Amy Batchelder, PA-C 

Anita Stallings, NCA II 

Fourth Row left to right 

Ronald Olson, M.D. 

Joyce Ruffin 

Iain Sanderson, M.B. Ch.B., FRCA 

Not Pictured 

Denise Bass 

William Buckmaster, RN 

Tammy Coble, RN 

Jennifer Gunn, F.N.P. 

Mary Hawthorne, A.N.P. 

Deborah Hobbs, N.C.A. II 

Rhonda McNeil 

Jeffrey McNeil, F.N.P. 

Elizabeth Owen, A.N.P. 

Shelfna Pettiway 

Patricia Quinlan, F.N.P. 

Shelia Ruffin 

Stanton Simmerson, RN 

Allison Smith, PA-C 

Suzanne Spence, F.N.P. 

Theresa Vinson 

Bobbit Wilkins, PA-C 

Pain Clinic 

Left to right 

Deanna Carson 

Connie Winstead

Signal Transduction Laboratory 

Front Row Left to Right 

Jason Kilts, Ph.D. 

Tammy Evans, A.B. 

Banalata Sen, Ph.D. 

Scott Hagen, M.D. 

Back Row Left to Right 

Keisuke Yamaguchi, M.D. 

Madan Kwatra, Ph.D. 

Yuri Klyachkin, B.A. 

VA Support Staff 

Patti Yetsko 

Women’s Anesthesia 

Back Row left to right 

Peter Dwane, M.D., C.M., FRCP(C) 

Terrance Breen, M.D., FRCP(C) 

Ashraf Habib, M.B., Ch.B., FRCA 

James Reynolds, Ph.D. 

John Schultz, M.D. 


Lou Ellen Andrews 

Holly Muir, M.D., FRCP(C), Chief 

Tede Spahn, CRNA 

Not Pictured 

Emily Coburn 

SUPPORT STAFF 

SUPPORT STAFF 109

Institutional Review Board 

APPROVED HUMAN PROTOCOLS 

Bell, Elizabeth A., M.D., M.P.H. 

How much labor is in a labor epidural? Impact of 

changes in technique on costs associated with maintaining 

an obstetric anesthesia service. 

CORD: Comprehensive obstetric neonatal research database. 

Bennett, Peter B., Ph.D., D.Sc. 

Effect of daily exposure to compressed air on immune 

system. 

Booth, John V., M.B., Ch.B., FRCA 

Genetic basis of preterm delivery. 

Adrenergic receptor mutations associated with hypertension 

in women. 

Borel, Cecil O., M.D. 

The presence of vascular growth factors in CSF following 

subarachnoid hemorrhage. 

Effect of vascular growth factors on cerebral blood 

vessels. 

Breen, Terrance W., M.D., FRCPC 

The effective dose of epidural bupivacaine, ropivacaine 

and levobupivacaine for pain relief in nulliparous labor. 


and levobupivacaine for pain relief in multiparous labor. 


and levobupivacaine, plus fentanyl, for pain relief in nulliparous 

labor. 

Retrospective analysis of high spinal anesthesia in 

patients undergoing cesarean section. 

Brewer, Randall P., M.D. 

Comparison of serum and cerebrospinal fluid magnesium 

levels after an intravenous bolus dose of magnesium sulfate 

in patients with intracranial hypertension. 

Carmer, Alexis C., M.D. 

Lumbar plexus continuous catheters vs. patient controlled 

analgesia. 

D’Ercole, Francine J., M.D. 

A multi-center clinical outcome and cost-finding study 

of the use of the HemoSonic 100 cardiac output monitor 

compared to routine care in spinal surgery patients 

110 CLINICAL RESEARCH 

CLINICAL RESEARCH 

A multicenter, randomized, single-blind, red blood cellcontrolled, 

parallel-group study to evaluate the effect 

on allogeneic red blood cell use and the safety of room 

temperature stable hemoglobin-based oxygen carrier-201 

(HBOC-201) when administered therapeutically and perioperatively 

in orthopedic surgery patients who have not 

received erythropoietin no undergone preoperative 

autologous blood donation. 

Eck, John B., M.D. 

The efficacy of sciatic nerve blockade vs. caudal epidural 

blockade for pain control following club foot repair in 

children. 

Erb, Thomas O., M.D., F.M.H. 

Propofol or isoflurane anesthesia for pediatric radio frequency 

catheter ablation: A feasibility and cost analysis. 

Fras, Anne Marie, M.D. 

Determination of CSF neurotransmitters during treatment 

for chronic pain. 

Gan, T.J., M.B., B.S., FRCA 

A comparison of cardiac output and stroke volume using 

esophageal Doppler, non-invasive cardiac output monitor 

and PA catheter. 

The clinical use of Hextend ® compared to 5% albumin 

in patients undergoing radical retropubic prostatectomy 

or partial or total nephrectomy. 

A comparative study between serum potassium levels 

determined by point of care testing (POCT) vs. clinical 

chemistry laboratory (CCL). 

An open evaluation of the safety and clinical utility of 

E-TRANS ® for the management of post-op pain following 

short -stay surgical procedures. 

An open label, randomized comparative study to compare 

the effects of intubating doses of rapacuronium, 

rocuronium, cisatracurium or succinlycholine on the 

clinical durations of maintenance doses of cisatracurium 

or rocuronium under isoflurane anesthesia. 

An open evaluation of safety and clinical utility of 

E-TRANS ® for management of post-operative pain in 

elderly patients. 

A research study to place a value on postoperative 

muscle pain. 

A research study to determine a monetary value on the 

avoidance of intraoperative awareness. 

Methohexital and propofol as sedative agents during 

monitored anesthetic care (MAC).

The determination of the MAC reduction of sevoflurane 

with acupuncture analgesia. 

Evaluate the safety and efficacy of poly SFH-P injection 

in the total elimination of allogenic red cell transfusion 

RTBSE-8-07. 

Comparison of acupuncture vs. ondansetron for the 

prevention of post operative nausea and vomiting. 

Efficacy of BIS monitor-eirected verbal therapeutic 

suggestion during general anesthesia for abdominal 

hysterectomy. 

Determination of the onset and timing of tolerance of 

opioids following opioid antagonists. 

Comparison of recovery and postoperative neuropsychological 

function after remifentanil or fentanyl 

based anesthetic during carotid endarterectomy. 

A randomized, double-blind comparison of the efficacy 

of patient-controlled antiemesis with propofol vs. 

ondansetron in the treatment of PONV. 

PentaLyte ®, dose escalation safety study. 

Research study to improve recovery outcomes in elderly 

ambulatory patients. 

Ginsberg, Brian, M.B., Ch.B. 

A multi-center, multi-national, open-label extension study 

of oral naloxone for the treatment of opioid-induced 

constipation in patients with chronic, non-malignant 

or malignant pain. 

Multi-center, randomized, double-blind, placebo-group, 

dose ranging comparison of the analgesic efficacy and 

safety of Numorphan ® IR (oxymorphone HCL immediate 

release), Percolone ® and placebo in patients with postsurgical 

pain following orthopedic total hip and knee 

replacement. 

A randomized, open-label, single-dose, pilot study to evaluate 

the safety & efficacy of Dilaudid CR (TM) in patients 

with acute, moderate to severe postoperative pain. 

Double blind, placebo controlled single dose evaluation 

of the safety & efficacy of hydromorphone hydrochloride 

controlled release 24 mg capsules in acute post-operative 

pain. 

Comparison of the analgesic efficacy of Ultracet versus 

Tylenol with codeine no. 3 vs. placebo for the treatment 

of post-surgical pain. 

Safety & efficacy of electrotransport (E-TRANS ®) fentanyl 

for the treatment of post-operative pain. 


Safety & efficacy of electrotransport (E-TRANS ®) fentanyl 

compared to IV PCA morphine for the treatment of postoperative 

pain. 

Greengrass, Roy A., M.D., FRCP(C) 

Post open herniorrhaphy pain comparison of local 

anesthetic vs. saline wound perfusion on analgesic 

requirements. 

A comparison of dolasetron with dolasetron plus dexamethasone 

in the prevention of PONV in laparoscopic 

cholecystectomy patients. 

Efficacy of subclavian perivascular brachial plexus blockade 

using Doppler ultrasound and nerve stimulator for 

upper extremity surgery. 

Habib, Ashraf S., M.B., B.Ch., M.Sc., FRCA 

Ethnicity and analgesic requirements following cesarean 

section. 

Does magnesium sulfate reduce analgesic requirements 

following cesarean section. 

Hill, Steven E., M.D. 

Clinical trial to evaluate the efficacy and safety of 

Hemolink in patients undergoing primary CABG surgery. 

Paravetebral nerve blockade for perioperative analgesia 

during thoracoscopic surgery. 

Huh, Billy K., M.D., Ph.D. 

Lumbar facet block with high concentration mixture 

of tetracaine and bupivacaine. 

Yohimbine infusion as test for sympathetically maintained 

pain. 

King, Kathryn E., M.D., MSN 

Teaching intubation using cadaver vs. mannequin 

models. 

Klein, Stephen M., M.D. 

Post-operative pain relief after rotator cuff repair: a randomized 

study comparing continuous interscalene 

brachial plexus blockade vs. intra-articular infusion. 

Paravertebral lumbar somatic nerve blocks vs. local infiltration: 

postoperative analgesia for outpatient inguinal 

herniorrhaphy. 

Efficacy of interscalene nerve block vs. intra-articular 

infusion for shoulder arthroscopy. 

CLINICAL RESEARCH 111


Kwatra, Madan M., Ph.D. 

Effect of cardiopulmonary bypass (CPB) on signaling 

through G protein-coupled receptors in peripheral blood 

mononuclear cells (PBMCs). A pilot study. 

Effect of age on g-protein coupled receptor system in 

human peripheral blood mononuclear cells. 

MacLeod, David B., M.B., B.S., FRCA 

Paravertebral nerve blockade vs. local infiltration for 

iliac crest bone graft. 

Martin, Gavin, M.B., Ch.B., FRCA 

A phase 3, randomized, double-blind, placebo controlled, 

parallel group, dose-ranging study to evaluate the safety 

& efficacy of a single epidural dose of sustained-release 

encapsulated morphine (SKY0401) in the management 

of post-operative pain in patients undergoing hip 

arthroplasty. 

A multi-center clinical outcome and cost-finding study 

of the use of the HemoSonic 100 cardiac output monitor 

compared to routine care in spinal surgery patients. 

Mathew, Joseph P., M.D. 

Assessment of myocardial and splanchnic organ perfusion 

during coronary artery bypass graft surgery (CABG) 

by contrast echocardiography. 

Inflammation, coagulation and cognitive decline after 

cardiac surgery. 

A phase 2 randomized, double-blind, placebo-controlled 

study of the effect of h5G1.1-scFv on total mortality and 

adverse cardiovascular ischemic outcomes in patients 

undergoing cardiopulmonary bypass. 

Moon, Richard E., M.D., C.M., M.Sc., FRCP(C), 

FACP, FCCP 

An evaluation of 3-hydroxy-3-methylglutaryl (HMG)-CoA 

reductase inhibitors on hypoxic pulmonary vasoconstriction. 

The effects of hyperbaric exercise on pulmonary gas 

exchange in older divers. 

The relationship of s-nitrosohemoglobin and hypoxicvasoconstriction 

over a prolonged altitude exposure. 

Effects of abdominal surgery on signaling through G protein-coupled 

receptors. 


Moretti, Eugene W., M.D. 

Effect of surgery on mangesium stores. 

The association of apolipoprotein gene polymorphism 

with acute renal failure in the critically ill. 

An evaluation of the antimicrobial properties of the 

Vantex central venous catheter with Oligon material. 

Muir, Holly A., M.D., FRCP(C) 

A trial to compare the safety & efficacy of labor and 

delivery analgesia using ropivacaine alone and in combination 

with fentanyl versus bupivacaine in combination 

with fentanyl during epidural administration (CARE). 

Murdoch, John A.C., M.B., Ch.B., B.Sc. 

Recovery from abdominal aortic aneurysm repair: 

comparison between transabdominal and endovascular 

surgical repair. 

Newman, Mark F., M.D. 

Neuromonitoring to improve quality and decrease cost 

of coronary artery bypass graft surgery. 

A prospective trial of a temperature management system 

in OPCAB cardiac surgery and the effect of OPCAB on the 

systemic inflammatory response. Intraoperative cardiac 

function, and postop renal, pulmonary and cognitive 

function. 

A phase II, multicenter, placebo-controlled, randomized, 

double-blind, dosing regimen optimization and dose 

escalation study to evaluate safety, toleration and clinical 

pharmacology of CP-597,396 administered for vascular 

surgery. 

The role of genetics on cardiac surgery outcomes. 

A prospective trial of a temperature management system 

in OPCAB cardiac surgery. 

A randomized double blind placebo controlled study of 

neuroprotection with lidocaine during cardiac surgery. 

Peri-operative genetic outcome (POGO-1) Trial 

Effectiveness of 2.7 g PFC/kg of AF0144 to augment intraoperative 

autologous donation in CABG with CPB. 

The effect of off pump coronary artery bypass (OPCAB) 

on cognitive function - one year longitudinal follow-up 

Genetic basis of cognitive decline after surgery - five year 

longitudinal study. 

Randomized trial of a temperature management system 

during routine cardiac surgery.

Magnesium neuroprotection in cardiac surgery (MANIC). 

Genetic basis of cognitive decline after anesthesia and 

surgery. 

An open label pharmacokinetic study to evaluate the 

pharmacokinetics, pharmacodynamics, toleration and 

safety of CP-597, 396 administered for 24 hours in subjects 

undergoing coronary artery bypass graft (CABG) surgery. 

Nielsen, Karen C., M.D. 

A cohort study assessing the effectiveness and costs of 

total knee arthroplasty performed under continuous 

peripheral nerve blocks in an ambulatory setting. 

Postoperative pain relief after open shoulder surgery: A 

non-randomized controlled trial comparing continuous 

interscalene brachial plexus blockade in the 23 hour 

recovery care center vs. home catheter program. 

A randomized prospective trial comparing paravetebral 

nerve block and general anesthesia for surgical treatment 

of breast cancer pilot study. 

A randomized controlled trial assessing the effectiveness 

of general anesthesia vs. lumbar plexus/sciatic nerve 

block vs. lumbar plexus/sciatic nerve block with continuous 

home catheter for postoperative pain control after 

knee surgeries. 

A comparison of low dose lidocaine and ropivacaine 

spinal blocks in the ambulatory setting. 

Olson, Ronald P., M.D., CCFP 

Hyperkalemia in patients completing vascular surgery: 

prevalence and morbidity. 

Prevalence of abnormal preoperative hemoglobin levels. 

Olufolabi, Adeyemi J., M.B., B.S., FRCA 

Is there an increase in the incidence cesarean sections in 

mothers with positive HIV following evidence of reduced 

vertical transmission to the neonate? 

A randomized, prospective double-blind comparison of 

the efficacy of generic propofol with diprivan. 

The use of near infrared spectroscopy to determine 

oxygenation in the placental tissue. 

Efficacy of BIS monitor-eirected verbal therapeutic 

suggestion during general anesthesia for abdominal 

hysterectomy. 


Podgoreanu, Mihai V., M.D. 

The role of genetic polymorphisms of the beta 2 adrenergic 

receptors in cardiac surgery outcome. 

Reves, J.G., M.D. 

Use of discarded materials. 

Hemodilution and brain protection in cardiac surgery. 

Aging and post cardiopulmonary bypass afterdrop. 

Reynolds, James D., Ph.D. 

Enhanced research training for medical students. 

Ross, Allison K., M.D. 

Ropivacaine for caudal analgesia in children. 

Optimal ropivacaine concentration for sciatic nerve block 

in children. 

Schultz, John R., M.D. 

Comparing a modified ECG to the standard three lead 

ECG for detecting myocardial ischemia and p wave 

height in high risk patients in the non-invasive cardiac 

diagnostic laboratory. 

Motion induced artifactual ventilatory absence-motion 

induced artifact (MIA). 

Schwinn, Debra A., M.D. 

Adrenergic receptor polymorphisms and hypertension. 

Adrenergic receptor mutations associated with 

hypertension. 

Why do cardiac surgical patients choose to participate 

or not participate in medical research studies? 

Does cardiopulmonary bypass with cardioplegic arrest 

cause adrenergic receptor desensitization in adults with 

chronic disease undergoing elective cardiac surgery? 

Slaughter, Thomas F., M.D. 

Mechanisms of aprotinin-mediated hemostasis. 

Somma, Jacques, M.D., FRCP(C) 

Research on age, effect and interaction between propofol 

and remifentanil. 

A double blind randomized study to compare the 

analgesia and respiratory effect of dexmedetomidine 

and remifentanil. 

A randomized, double-blind, parallel-design, placebo 

and active controlled multicenter ascending dose ranging 

study of the safety and efficacy of single doses of Org 

41739 in the treatment of post-operative pain in ASA class 

I and II surgical patients. 

CLINICAL RESEARCH 113


Stafford Smith, Mark, M.D., C.M., FRCP, DABA 

Mitral valve surgery and acute renal dysfunction: 

Heartport vs. median sternotomy. 

Markers of renal dysfunction as outcome predictors 

in coronary artery bypass surgical patients. 

Trial to evaluate the efficacy of fenoldopam mesylate 

in preserving renal function and decreasing healthcare 

resource utilization of coronary artery bypass grafting 

(CABG) patients. 

Swaminathan, Madhav, M.D. 

The role of genetics on cardiac transplant surgery 

outcomes. 

The association of renal dysfunction and neurocognitive 

deficit after cardiac surgery. 

Vann, Richard D., Ph.D. 

The effects of ascent rate on DCS and VGE. 

Effects of early delivery of oxygen during exercise. 

Decompression in space: simulated altitude exposure at 

30,000 feet. 

Project Dive Exploration. 

Surface intervals before flying after diving. 

Total Anesthesiology Research Dollars 

$6,500,000 

$6,000,000 

$5,500,000 

$5,000,000 

$4,500,000 

$4,000,000 

$3,500,000 

$3,000,000 

$2,500,000 

$2,000,000 

$1,500,000 

$1,000,000 

$500,000 

$0 


Warner, David S., M.D. 

Integrated training in anesthesiology research. 

Welsby, Ian M.B., B.S., B.Sc., FRCA 

Computerized thromboelastography coagulation analyzer 

guided coagulation monitoring and transfusion management 

in the cardiac surgical patient. 

In vitro measurement of the anti-factor Xa activity of low 

molecular weight heparin. 

Young, Christopher C., M.D., FCCCM 

Long term infusion of rocuronium in adult ICU subjects. 

Government Industry Combined 

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Active Institutional Animal Care 

and Use Protocol 

Benveniste, Helene D., M.D., Ph.D. 

Prolonged maturation of stroke in rat brain over 24 hours 

followed by diffusion weighted imaging. 

Neuroimaging of control and APP overexpressing mice. 

A digital mouse brain atlas. 

Grocott, Hilary P., M.D., FRCP(C) 

Cerebral mRNA expression during cardiopulmonary 

bypass in the rat. 

Evaluation of liposome encapsulated ropivicaine for sciatic 

nerve blockade in the rat. 

Neuroprotective strategies during cardiopulmonary 

bypass in the rat. 

The effect of temperature on cognitive impairment and 

cerebral inflammation following cardiopulmonary bypass 

in the rat. 


Effect of age on cardiac g protein-coupled receptors. 

Niklason, Laura E. M.D., Ph.D. 

Tissue engineered vascular grafts in swine. 

LABORATORY RESEARCH 


Magnesium sulfate and preterm fetal brain injury. 

Effects of insufflation/laparoscopic procedures on fetal 

cerebral oxygenation. 

Magnesium sulfate and fetal hypoxic brain injury. 

Ethanol (alcohol) and in utero fetal cerebral hypoxia. 

Enhanced research training for medical students. 

Maternal laparoscopic surgery and postnatal outcome. 

Use of nitric oxide to control the hemodynamic effects of 

CO 2. 

Effects if maternal anesthesia on fetal brain oxygen levels. 


Heterogeneity of adrenergic receptors. 

Warner, David S., MD 

Characterization of complement-mediated hypoxicischemic 

reperfusion injury in the immature rat brain. 

Extracellular oxygen radicals and ischemic brain injury. 

Role of extracellular superoxide dismutase and ApoE in 

outcome from head injury. 

Cerebral ischemia: minimizing damage during anesthesia. 

Mechanisms of post-subarachnoid hemorrhage delayed 

arteriopathy in the mouse. 

Effects of RSR13 and mild hypothermia against ischemic 

brain injury. 

LABORATORY RESEARCH 115

Bell, Elizabeth A., M.D. 

Anesthetic Choice for Cesarean Section 

in the Setting of the Fetal Distress: 

Research Applications for the Comprehensive 

Obstetrical-Neonatal Research 

Database (CORD) 

Sponsor: International Anesthesia 

Research Society 

Benveniste, Helene D., M.D., Ph.D. 

Magnetic Resonance Microscopy and 

Alzheimer's Disease: Early Detection 

of Alzheimer's Pathology in Transgenic 

Mice Overexpressing Beta Amytoid 

Protein 

Sponsor: Alzheimer's Association 

A 3D C57BL6/J Mouse Brain Atlas by 

Magnetic Resonance Microscopy 

Sponsor: National Institutes of Health 

In Vivo Magnetic Resonance Microscopy 

and Alzheimer's Disease: Defining and 

Staging the Progression of Alzheimer’s 

Pathology in Transgenic Mice 

Sponsor: American Federation for Aging 

Research 

Gan, Tong Joo, M.B., B.S., FRCA 

Enhancing Recovery Outcomes in 

Elderly Ambulatory Patients 

Sponsor: International Anesthesia 

Research Society 

The Clinical Use of Extend Compared 

to 5% Albumin in Patients Undergoing 

Radical Retroperitoneal Prostatectomies 

Sponsor: Abbott Laboratories 

Trial to Evaluate the Interaction of 

Maintenance Doses of Rocuronium with 

an Intubating Dose of Rapacuronium, 

Rocuronium, or Succinylcholine 

Sponsor: Organon Teknika, Inc. 

PentaLyte Dose Escalation Safety Study 

Sponsor: Biotime, Inc. 

116 RESEARCH GRANTS 

RESEARCH GRANTS 

An Open Evaluation of the Safety and 

Clinical Utility of E-TRANS(fentanyl) for 

the Management of Post-Operative Pain 

in Elderly Patients. 

Sponsor: Alza Corporation and PPD, Inc. 


Clinical Utility of E-TRANS(fentanyl) 

for Management of Post-Operative Pain 

Following Short-Stay Surgical Procedure 


A Randomized, Double Blind Comparison 

of Ondansetron and Placebo in 

the Prevention of Postoperative Nausea 

and Vomiting After Craniotomy Surgery 

Sponsor: Glaxo Wellcome Inc. 

Ginsberg, Brian, M.B., Ch.B. 

The Safety and Efficacy of Electrotransport 

(E-TRANS) Fentanyl for the 

Treatment of Post-Operative Pain: A 

Double-Blind, Multicenter, Placebo- 

Controlled Trial. 


Study to Access the Analgesic Efficacy 

and Safety of Injectable Acetaminophen 

for the Treatment of Post-Operative Pain 

Following Orthopedic Surgery 

Sponsor: Laboratories UPSA 

A Double-Blind, Placebo Controlled 

Single Dose Evaluation of the Safety 

and Efficacy of Hydromorphone Hydrochloride 

Controlled-Released 24mg 

Capsules in Acute Post-Operative Pain 

Sponsor: Purdue Pharma L.P. 

Clinical Protocol for a Double-Blind, 

Placebo-Controlled Comparison of the 

Analgesic Activity of SC-69124A 20 mg 

IV, SC- 

Sponsor: G. D. Searle and Company, 

Inc. 

A Multicenter, Multinational, Openlabel, 

Extension of Oral Naloxone for 

the Treatment of Opoid -Induced 

Constipation in Patients with 

ChronicNon-Malignant or Malignant 

Pain 

Sponsor: Roxane Laboratories 

Hill, Steven E., M.D. 

A Phase III Randomized, Double-Blind, 

Controlled Clinical Trial to Evaluate 

the Efficacy and Safety of Hemolink in 

Patients Undergoing Primary Coronary 

Artery Bypass Grafting Surgery 

Sponsor: Hemosol (USA), Inc. 

Hodgins, Lewis R., M.D. 

Sevoflurane vs Fentanyl Plus Midazolam 

for the Induction of Anesthesia In 

Patients for Coronary Artery Bypass and 

Grafting 


Klein, Stephen M., M.D. 

A Comparison of Continuous Interscalene 

Brachial Plexus Blockade With 

Single Injection Technique for Open 

Shoulder Repair In Outpatients 

Sponsor: I-Flow Corporation 


Function Of Human Substance P 

Receptor 


Aging And G Protein Coupled 

Receptors In Human Heart 


Lockhart, Ellen M., M.D. 

Progesterone as an Endogenous 

Neuroprotectant 

Sponsor: Foundation For Anesthesia 

Education and Research

Mackensen, George B., M.D. 

Peri-Ischemic Cerebral Blood Flow in 

Near-Complete Forebrain Ischemia in 

Rats 

Sponsor: Society Of Cardiovascular 

Anesthesiologists 

Martin, Gavin, M.B., Ch.B., FRCA 

A Phase II, Open-Label, Dose Escalation 

/ De-Escalation Study of the Sustained 

Release Encapsulated Morphine 

(C0401) AdministeredEpidurally for 

the Treatment of Post-Operative Pain in 

Patients Undergoing Hip Arthroplasty 

Procedures 

Sponsor: Syke Pharma Inc. 

A Multicenter, Randomized, Single- 

Blind, Red Blood, Cell-Controlled, 

Parallel-Group Study to Evaluate the 

Effect on Allogenic Red Blood Cell Use 

and the Safety of Room Temperature 

Stable Hemoglobin-Based Oxygen 

Carrier-201 (HBOC-201) When Administered 

Therapeutically and Perioperatively 

in Orthopedic Surgery Patients 

Who Have Not Received Erythropoietin 

Nor Undergone Preoperative Autologous 

Blood Donation 

Sponsor: BioPure Biopharmaceuticals 

Mathew, Joseph P., M.D. 

Inflammation, Coagulation, and 

Cognitive Decline After Cardiac Surgery 

Sponsor: American Heart Association 

Evaluation of the Safety and Efficacy 

of Parecoxib 40mg Q 12H Followed by 

Valdecoxib 40 mg 

Sponsor: G. D. Searle and Company, Inc. 

Moretti, Eugene W., M.D. 

An Evaluation of the Antimicrobial 

Properties of the Vantex Central Venous 

Catheter with Oligon Material 

Sponsor: Edwards Life Sciences LLC 

Newman, Mark F., M.D. 

A Phase III, Single-Blind, Randomized, 

Parallel-Group, Multicenter, Controlled 

Study of the Effectiveness of 2.7-g 

PFC/kg 

Sponsor: Alliance Pharmaceutical 

Corporation 

Genetics, Inflammation and Post-Op 

Cognitive Dysfunction 


A Phase II, Multi-Center, Placebo- 

Controlled, Randomized, Double-Blind 

Dosing Regimen Optimization and 

Dose-Escalation Study to Evaluate the 

Safety, Toleration and Clinical Pharmacology 

of CP-597-396 Administered 

4 Days to Subjects Undergoing 

Vascular Surgery 

Sponsor: Pfizer, Inc. 

Neuromonitoring to Improve Quality 

and Decrease Cost of Coronary Artery 

Bypass Graft Surgery 

Sponsor: Somanetics Corporation 

An Open-Label, Pharmacokinetic Study 

to Evaluate the Pharmacokinetics, 

Pharmacodynamics, Toleration and 

Safety of CP-597,396 Administered 24 

Hours in Subjects Undergoing CABG 

Sponsor: Pfizer, Inc. 

Genetic Basis of Cognitive Decline After 

Surgery 


A Randomized Controlled Trial of the 

Arctic Sun Temperature Management 

System in the Efficient Use of Hypothermia 

and Avoidance of Hyperthermia 

in Patients Undergoing CPB 

for Cardiac Surgery 

Sponsor: Medivance, Inc. 


A Prospective Trial of the Arctic Sun in 

Maintaining Normothermia In OPCAB 

Cardiac Surgery 

Sponsor: Medivance, Inc. 

Randomized Double Blind Placebo 

Controlled Study of Neuroprotection 

with Lidocaine 

Sponsor: American Heart Association 

Niklason, Laura E., M.D., Ph.D. 

Novel Vascular Scaffolds 

Sponsor: Johnson and Johnson 

Piantadosi, Claude A., M.D. 

Particle Exposure and Acute Lung 

Injury 

Sponsor: Environmental Protection 

Agency 

Protection From Lung Injury by 

Blockade of Coagulation with FFR-VIIa 

Sponsor: Novo Nordisk 

Reves, Joseph G., M.D. 

Aging And Cognition After Cardiac 

Surgery 


Pharmacokinetic Based Drug Delivery 

In The Elderly 

Sponsor: Harvard Clinical Technology 


Enhanced Research Training Programs 

For Medical Students 


Ross, Allison K., M.D. 

A Longitudinal MRI Study of Brain 

Development in Developmentally and 

Non-Developmentally Disordered 

Populations 

Sponsor: UNC (Sub-Contract) 

RESEARCH GRANTS 117


Sanderson, Iain C., M.B., Ch.B., 

FRCA 

Anesthesia Information System 

Sponsor: North American Drager, Inc. 

Schulman, Scott R., M.D. 


Clinical Utility of E-TRANS(fentanyl) for 

Management of Post-Operative Pain in 

Children and Adolescents 

Sponsor: Alza Corporation and Ppd, 

Inc. 


Molecular Distribution and Regulation 

of Adrenergic Receptors 


Beta Adrenoceptors During 

Cardiopulmonary Bypass 


$3,500,000 

$3,000,000 

$2,500,000 

$2.000,000 

$1,500,000 

$1,000,000 

$500,000 

$428,178 

$864,736 

118 RESEARCH GRANTS 

Distribution Of A1-Adrenergic Receptor 

Subtypes In Human Spinal Cord 

Sponsor: Roche Bioscience 

Molecular Pharmacology of Vascular 

A1-Adrenergic Receptors 


Transcriptional Regulation of the 

Human A1-Adrenoceptors (Training 

Grant) 


Slaughter, Thomas F., M.D. 

Tissue Transglutaminase and Vascular 

Repair 


Assessment of the Utility of the PFA-100 

in Detecting Patients With Dysfunction 

in a High Risk Preoperative Setting 

Sponsor: Dade Behring, Inc. 

NIH GRANTS 

A Phase III Double-Blind, Randomized 

Study Comparing Transgenic Recombinant 

Human Antithrombin III and 

Plasma Antithrombin III In Patients 

Undergoing Elective Cardiac Surgery 

Requiring Cardiopulmonary Bypass 

Sponsor: Genzyme Corporation 

Evaluation of Heparin Activity Using the 

TAS COAG-1 Analyzer 

Sponsor: Cardiovascular Diagnostics Inc. 

Mechanisms Underlying Shear-Mediated 

Platelet Dysfunction During Cardiac 

Surgery 

Sponsor: Bayer Inc. 

Somma, Jacques, M.D., FRCP(C) 

A Novel Anesthetic Drug Delivery 

System 

Sponsor: Harvard Clinical Technology 

Dollar Amounts Ranking from #1 Position 

$$1,349,797 

$1,549,928 

0 

Fiscal Year 92 93 94 95 96 97 98 99 00 

$1,638,992 

$2,697,386 

$2,590,148 

$3,092,671 

$3,769,062 

Fiscal Year 

2000 

1999 

1998 

1997 

1996 

1995 

1994 

1993 

1992 

1991 

4 

2 

3 

4 

5 

7 

Ranking 1 5 10 15 20 25 

10 

15 

19 

22

A Randomized, Double-Blind, Parallel- 

Design, Placebo-and-Active-Controlled, 

Multicenter, Ascending Dose-Ranging 

Study of the Safety and Efficacy of 

Single Doses of Org 41793 in the 

Treatment of Post-Operative Pain in 

ASA Class I and II Surgical Inpatients 

Sponsor: Organon Teknika, Inc. 

Stafford Smith, Mark, M.D., C.M., 

FRCP, DABA 

A Phase III, Randomized, Double-Blind, 

Placebo-Controlled Trial to Evaluate the 

Safety of Fenoldopam Mesylate in 

Preser 

Sponsor: Elan Pharmaceutical, Inc. 

Sum Ping, Sam T., M.B., Ch.B., FRCA 

A Phase IIIb, Multi-Center, Open-Label, 

Randomized Study Comparing the 

Safety and Efficacy of Dexmedetomidine 

to Propofol-Based Standard of Care 

for ICU Sedation Following Coronary 

Artery Bypass Grafting Surgery 


Thalmann, Edward D., M.D. 

Establishing a Multi-Center, Multi- 

Disciplinary Program for Improving 

Diver Thermal Protection Hardware in 

Warm and Cold Water 

Sponsor: U.S. Navy 

Oxygen Acceleration of Nitrogen - 

Oxygen Decompression In Submarine 

Rescue 

Sponsor: U.S. Navy 

Vann, Richard D., Ph.D. 

Prebreathe Reduction Protocol (PRP) 

Trials 

Sponsor: National Aeronautics and 

Space Administration 

Determination of Safe Post-Drive Surface 

Intervals Before Military Free-fall 

Parachuting 

Sponsor: U.S. Special Operations 

Command 


Warner, David S., M.D. 

Effects Of Allosteric Modulation of 

Hemoglobin Affinity on Outcome from 

Cerebral Ischemia 

Sponsor: Allos Therapeutics, Inc. 

Extracellular Oxygen Radicals and 

Ischemic Brain Injury 


Apolipoprotein E and the Ischemic 

Brain 


Integrated Training in Anesthesiology 

Research 


Morreene Road Pain Clinic Building Opened November 2000 

RESEARCH GRANTS 119

PETER B. BENNETT, Ph.D., D.Sc. 

Founder, President and CEO, Divers 

Alert Network 

Senior Director, Duke Hyperbaric 

Center 


AREAS OF RESEARCH: 

Hyperbaric and Diving Medicine 

Efforts involve administrative and organizational 

responsibility for the nonprofit 

Divers Alert Network (DAN), 

a diving safety and emergency service 

organization located on Colony Drive 

at The Peter B. Bennett Center. DAN 

has a permanent staff of 70 and a budget 

of over $13 million. It is supported 

by a membership of over 200,000 

divers, the recreational diving industry, 

and large numbers of dive instructors 

and stores. Research at DAN ($500,000) 

has revolved around epidemiology 

analysis of accidents and deaths of U.S. 

divers to determine their cause. There 

are over 1,000 accidents with some 90 

deaths per year. The results are analyzed 

in an annual report and reported 

at many national and international 

meetings. DAN is an international organization 

with DAN Europe, DAN Japan, 

DAN Australia, DAN Southern Africa 

and is continuing to expand into South 

America. 

Other research projects at DAN 

have included the use of precordial 

doppler to determine the presence of 

bubbles heard in the heart as a warning 

indicator of decompression illness in 

divers carrying out normal recreational 

diving. Project Dive Exploration includes 

the collection of divers’ profiles 

and accident data from computers and 

downloading the data to DAN. This 

information provides a realistic accident 

database. Studies are underway in 

the Hyperbaric Center of the effects of 

ascent rate on the incidence of decompression 

illness. Risks due to flying 

after diving have recently been completed 

and a paper is in preparation. 

Studies on the risks of diabetes in diving 

are being completed. Further DAN 

120 LABORATORY PROGRAMS 

LABORATORY PROGRAMS 

research work can be found in the 

reports of Drs. Richard D. Vann and 

Richard E. Moon. 

HELENE D. BENVENISTE, M.D., Ph.D. 

Associate Professor, Department of 


Assistant Research Professor, 

Department of Radiology 

Assistant Professor, Department of 

Neurobiology 

Co-Director, Center for In Vivo 

Microscopy 


Magnetic resonance (MR) imaging of 

disease processes in the brain and the 

peripheral nervous system; MR imaging 

of local anesthesia toxicity 

Intrathecal lidocaine can potentially 

cause spinal cord injury in patients 

undergoing spinal anesthesia. The 

pathophysiological mechanisms underlying 

lidocaine-induced neurotoxicity 

are unknown. It has been hypothesized 

that lidocaine and other local anesthetics 

in higher than normal concentration 

might induce ischemia. We recently 

showed, by use of MR imaging in the 

rat, that excessive intrathecal concentrations 

of lidocaine do not cause spinal 

cord ischemia. 

3-D MR imaging of the paravertebral 

space in human cadavers 

Several investigators have attempted 

to spatially visualize the paravertebral 

space (PVS) in humans. Most 3D 

models of the PVS are illustrations 

based on standard anatomical textbooks. 

Two-dimensional models of the 

PVS have been reconstructed by injecting 

contrast medium into the paravertebral 

space in vivo or by observing the 

distribution of dye injected into the 

paravertebral space in human cadavers. 

We have constructed a three-dimensional 

model of the PVS in human 

cadavers using non-invasive high-resolution 

magnetic resonance imaging and 

3-D visualization algorithms. The 3D PVS 

models enable our conceptualization 

of the anatomical complexity of the 

PVS and facilitate teaching paravertebral 

blockade. Ongoing investigations 

are focused on extending the in vitro 

MR studies into the in vivo domain. 

Brain biopsy-induced hemorrhage and 

edema quantified by 3-D MR imaging: 

Effect of blood pressure 

In collaboration with Professor 

Allan H. Friedman, Chief, Division of 

Neurosurgery, we have conducted an 

investigation on the effect of mean 

arterial blood pressure (MABP) on 

intracerebral hemorrhage and edema 

after biopsy in the rat brain. We showed 

that only during acute hypertensive 

conditions (MABP ≈ 130 mmHg) does 

large intracerebral hemorrhages occur 

after biopsy. 

Defining neuropathology with MR 

microscopy: sensitivity and specificity 

This project is focused on creating 

a database of MR images illustrating 

specific brain pathologies. Dr. 

Benveniste is directing the neuropathology 

core of the Duke Center for In Vivo 

Microscopy and is systematically creating 

a neuroimaging database that will 

make explicit connection between MR 

images and specific pathologies. 

Currently the following pathologies are 

being characterized by MR: (a) Neuritic 

plaques in Alzheimer's disease; (b) hippocampal 

atropy; (c) ventricular 

enlargement and (d) gliosis. 

References to support this research 

are found in the Publication Section of 

this annual report. 

FRANK H. KERN, M.D., FCCM 

Chief, Division of Pediatric Anesthesia 

and Critical Care Medicine 




Brain, Lung, and Total Body Endothelial 

Injury During Pediatric Cardiac Surgery. 

Brain and Lung Inflammatory Effects of 

CPB.

Cardiac surgery in infants and children 

can result in activation of the inflammatory 

cascade and hypoxia/reperfusion 

injury. Mechanism for cardiac, lung 

and generalized endothelial injury are 

most likely mediated by endothelial cell 

injury. Protective strategies, including 

modified ultrafiltration, perflubron, high 

dose preoperative methylprednisolone 

and complement antagonists are being 

investigated by our group. In a laboratory 

setting, we have developed a 

sophisticated piglet model for evaluating 

CPB injury and protection. Important 

and protective strategies currently in 

use today, have had their roots in studies 

performed in our multi disciplinary 

laboratory. Modified ultrafiltration techniques, 

high dose steroids, perflubron 

and techniques to reduce the risks of 

neurologic injury associated with circulatory 

arrest such as pH stat, intermittent 

perfusion, and prolonged lengths 

of brain cooling have received extensive 

trials in animal based research in 

our laboratories. 

MADAN M. KWATRA, Ph.D. 


Assistant Professor of Pharmacology 

and Cancer Biology 


Substance P Receptor/G Proteins/Protein 

Kinases/Receptor Desensitization/ 

Aging/Post-operative Delirium 

A wide array of physiological functions 

(including vision, smell, taste, heart 

rate, neurotransmission, and cell proliferation) 

are mediated through receptors 

of the G protein-coupled receptor superfamily. 

Characterized by the presence 

of seven transmembrane spanning 

domains, G protein-coupled receptors 

function by interacting with heterotrimetric 

G proteins. On receptor activation, 

these G proteins dissociate into 

alpha and beta-gamma subunits which 

modulate the activities of various enzymes 

(adenylate cyclases, phospholipases) 

and ion channels. Our labora- 

tory seeks to understand the function of 

G protein-coupled receptors in normal 

and disease states. Toward this end, we 

are currently working on two NIH-funded 

projects. Our first project is to 

understand the function of the human 

substance P receptor (SPR) at the molecular 

level. SPR is a G protein-coupled 

receptor that plays a key role in pain 

transmission and has also been identified 

as a novel target for anti-depressants. 

Our goal is to delineate the molecular 

components involved in SPR function; 

this information on SPR is needed 

to identify novel targets to control pain 

and depression. Our second project is 

to study the effect of age on the function 

of G protein-coupled receptors in 

the human heart. Normal functioning 

of the heart involves several G proteincoupled 

receptors (such as (-adrenergic, 

muscarinic cholinergic, angiotensin, 

endothelin) and an age-dependent 

decrease in the responsiveness of these 

receptors has been observed in a variety 

of animal models. Our studies are 

designed to explore the mechanism of 

age-induced decreases in G proteincoupled 

receptor function. An understanding 

of these mechanisms should 

help in developing pharmacological 

and genetic therapies to improve the 

cardiac function of older people. In 

addition, we recently initiated studies 

to delineate the molecular mechanism 

of post-operative delirium in the elderly. 

These studies will focus on post-operative 

delirium in the elderly undergoing 

hip replacement and will use modern 

techniques of DNA microarray and 

proteomics. 


MARK F. NEWMAN, M.D. 

Vice-Chair, Department of 


Chief, Division of Cardiothoracic 

Anesthesiology and Critical Care 

Medicine 

Director: Neurologic Outcomes 

Research Group 

Assistant Professor of Medicine 


J.G. REVES, M.D. 

Professor and Chair 


AREA OF RESEARCH: 

Neurologic and Neuropsychologic 

Outcome after Cardiac and Noncardiac 

Surgery 

The Neurologic Outcome Research 

Group of Duke Heart Center is a multidisciplinary 

group of cardiac anesthesiologists, 

cardiac surgeons, neuropsychologists, 

neurologists, neuroscientists, 

and nurse coordinators assessing the 

incidence and significance of central 

nervous system injury after cardiopulmonary 

bypass. Efforts over the last 

nine years have resulted in recent publications 

defining preoperative risk 

factors for and the extent of adverse 

neurologic outcomes after cardiopulmonary 

bypass, published in the New 

England Journal of Medicine and 

Circulation. Most recently, Dr. Newman 

published an article in the New England 

Journal of Medicine that highlights the 

detrimental impact of early cognitive 

decline on long-term cognitive dysfunction 

after cardiac surgery. 

This research group is currently 

funded through three NIH grants, an 

American Heart Association Roundtable 

grant, and multiple industry 

sources to allow nineteen full-time 

research personnel to carry on perioperative 

and longitudinal assessments in 

more than three hundred patients a 

year undergoing cardiopulmonary 

bypass. In addition, several new studies 

are examining the relationship between 

neurological deficits and genetics, the 

inflammatory response to cardiopul- 

LABORATORY PROGRAMS 121


monary bypass (CPB), and bypass 

surgery conducted without CPB. 

In conjunction with the Department 

of Neurology and Duke Clinical 

Research Institute, the newest focus 

of the neurologic outcomes research 

group is the development of the Multicenter 

“Perioperative Organ Protection 

Consortium.” This is a collection of 38 

Academic Sites in the United States and 

Canada whose goal is to determine the 

impact of clinical practice on organ 

(brain, heart, kidney) protection during 

and after CPB. 

At the basic science level, research 

directed by Dr. Hilary Grocott in an experimental 

model of cardiopulmonary 

bypass in the rat, has been complementary 

to the ongoing clinical research 

aims. Through this model, investigations 

have been undertaken to examine 

the potential molecular mechanisms 

(including CPB-induced diferential 

cerebral gene expression) contributing 

to the neurologic injury associated with 

cardiac surgery. 

LAURA E. NIKLASON, M.D., Ph.D. 




Biomedical Engineering 


Surgery 


Tissue engineering of vascular prostheses; 

cell-biomaterial interactions; biomechanical 

modeling. 

Atherosclerosis manifesting in small— 

and medium—caliber arteries accounts 

for the majority of deaths annually in 

the United States. Surgical bypass of 

diseased arteries if most often done 

using autologous artery or vein, but 

many patients lack suitable conduit for 

replacement of their diseased vessels. 

For these reasons, efforts in my laboratory 

have been focused on the development 

of techniques to culture arbitrary 

lengths of engineered artery using a 


small biopsy of autologous vascular tissue. 

Vascular endothelial and smooth 

muscle cells are harvested from vascular 

biopsies and expanded in culture. 

Vascular cells are then seeded onto 

biocompatible and degradable scaffold 

substrates, and are cultured under pulsatile 

bio-mimetic conditions using 

defined culture media. Vascular cell 

growth coupled with substrate degradation 

during culture yields a confluent 

tubular tissue with impressive mechanical 

properties. 

Current specific areas of interest 

include understanding the effects of 

various mechanical stimuli that are 

applied during culture on the phenotype 

and mechanical characteristics of 

the engineered vessels. We are pursuing 

autologous implantations in a swine 

model to characterize the biological 

response of the engineered vessels to 

the in vivo environment. The effects of 

the degradable substrate on cellular differentiation 

and phenotype are being 

studied. In addition, we are exploring 

methods by which the techniques for 

culturing vessels from cells that are 

obtained from young animals may be 

translated to apply to cells that are 

obtained from elderly human donors. 

JAMES D. REYNOLDS, Ph.D. 

Research Director, Division of Women's 

Anesthesia 


Assistant Professor in the Department of 

Surgery 

ELLEN M. LOCKHART, M.D. 




Elucidating the Fetal Brain Responses 

to Pathophysiologic Insult (e.g. hypoxia, 

maternal surgery) and Maternal Drug 

Exposure (e.g. ethanol, cocaine). Adult 

Physiologic Responses to Surgical 

Manipulations. 

The Obstetric Anesthesia Research 

Laboratory is the basic science arm 

of the Division of Women's Anesthesia. 

Laboratory members conduct in vivo 

and in vitro experiments that are 

designed to mimic a variety of different 

clinical scenarios. Specific ongoing 

studies include: the use of Near Infrared 

Spectroscopy to measure changes in 

fetal cerebral oxygen levels caused by 

ethanol, volatile anesthetics, or pneumoperitoneum; 

the use of tissue culture 

to evaluate the potential CNS protective 

abilities of neurosteroids; monitoring 

the hemodynamic and tissue blood 

flow changes produced by insufflation; 

and conducting outcome investigations 

and postnatal animal behavioral assessments 

following surgery during pregnancy. 

The lab also functions as a 

resource for clinical investigations, e.g. 

quantitating human plasma and CSF 

ionized magnesium levels. 

The laboratory has seen a number 

of changes during the past year. In 

June, Dr. Donald Penning departed 

North Carolina for a position at 

Sunnybrook and Women's College 

Health Sciences Center at the University 

of Toronto. Dr. Penning's departure 

was soon followed by that of Mr. Ben 

Hopkins who enrolled at Wake Forest 

Medical School and Dr. Yaozhi “Walter” 

Wang who accepted a fellowship position 

at the University of New Mexico. 

Incoming personnel included Mr. Saeed 

Mehrabani, who was recruited to help 

Dr. Ellen Lockhart complete the second 

year of her FAER-funded research 

on brain protection by neurosteroids; 

Ms. Nina Athar and Mr. Bassem El Daif, 

two third-year medical students enrolled 

in the ASEP study track program; 

and Ms. Kristy Thompson, the laboratory’s 

new staff assistant. Through the 

work of Drs. James Reynolds and Santi 

Punnahitananda (who is entering the 

final year of his neonatology fellowship), 

the lab continues its close association 

with the Neonatal-Perinatal 

Research Institute.

An exciting development is the 

establishment of formal ties with Dr. 

Steve Eubanks in the Department of 

Surgery and the members of the US 

Surgical Endosurgical Research Center. 

Utilizing the different strengths of each 

group, collaborative projects will focus 

on understanding the physiologic 

responses to surgery, with a special 

emphasis upon the fetal effects of nonobstetric 

related maternal surgery 

during pregnancy. 

DEBRA A. SCHWINN, M.D. 

Director, Molecular Pharmacology 

Laboratory 

Professor of Anesthesiology, 

Pharmacology/Cancer Biology, and 

Surgery 


Molecular Pharmacology and Genetics of 

Adrenergic Receptors 

Our laboratory combines molecular 

pharmacology approaches with translational 

human functional genomics. 

The laboratory is involved in studying 

mechanisms underlying regulation of 

adrenergic receptors (ARs) in health 

and disease. Over the last ten years, we 

(with help from several collaborators) 

initially described and determined 

mechanisms underlying acute myocardial 

βAR desensitization during cardiopulmonary 

bypass (a procedure 

required to provide oxygenated blood 

during heart surgery at most medical 

centers world-wide) (Circulation, 1991; 

84:2559; Circulation, 1998; 98:II275; 

Anesthesiology, 1998; 89:602). Based on 

successful animal studies, we initiated a 

clinical interventional trial designed to 

prevent acute myocardial βAR desensitization 

during heart surgery. By 

enhancing myocardial βAR functioning 

after cardiopulmonary bypass, fewer 

inotropic drugs should be required during 

heart surgery, facilitating patient 

recovery with fewer side effects. 

In addition to studying βARs during 

heart surgery, the laboratory primarily 

focuses on regulation of α 1ARs in 

health and disease. Since these receptors 

are important in smooth muscle 

and the heart, diseases such as hypertension, 

myocardial hypertrophy, and 

benign prostate hypertrophy are our 

main focus. Three α 1AR subtypes exist 

(α 1a, α 1b, and α 1d); over the years we 

have been involved in cloning cDNAs 

encoding each of these subtypes from 

both animal and human sources 

(PNAS, 1988; 85:7159; J Biol Chem, 

1990; 265:8183; J Biol Chem, 1991; 

266:6365; JPET 1995; 272:134). Our laboratory 

recently demonstrated that 

α 1aARs are present and functional in 

human vasculature (particularly resistance 

vessels and coronary arteries) 

and are modified (increased, along 

with the α 1aARs) by age (Circulation, 

Dec 1999). In order to understand 

mechanisms underlying these changes, 

our laboratory is currently examining 

regulation of the human α 1aAR at transcriptional 

and protein levels (J Biol 

Chem, 1997; 272:28237). After identification 

of the α 1aAR in human prostate 

smooth muscle (J Urol, 1993; 150:546), 

we more recently examined a novel 

role of other α 1ARs (specifically the 

α 1dAR) in bladder hypertrophy associated 

with BPH (J Urol, 1998; 160:937). 

A new emphasis in the laboratory 

is the role of genetic variability on human 

cardiovascular disease. Specifically 

the role of naturally occurring single 

nucleotide polymorphisms (SNPs) and 

insertions/deletions of α 1-adrenergic 

receptors in hypertension is being investigated. 

This involves using classical 

genetic approaches, large scale genomic 

sequencing, SNP identification, and 

analysis for association with disease in 

highly phenotyped populations. It also 

includes investigating the biology of 

each SNP in terms of α 1AR signal transduction 

pathways. 

A broad spectrum of individuals 

interact and study in our laboratory 

(undergraduates, medical students, 

graduate students, postdoctoral fellows, 


junior faculty, various collaborators), 

and wide ranging approaches are utilized 

(e.g. molecular biology, classical 

pharmacology, biochemistry, pharmacogenetics, 

and clinical trials). The 

goal of our laboratory is to examine 

clinically important questions using 

basic science approaches, with the final 

goal of ultimately taking answers back 

to the clinic. 

THOMAS F. SLAUGHTER, M.D. 



Perioperative Hemostasis and 

Thrombosis; Coagulation Factor XIII and 

Tissue Transglutaminase 

Both clinical and basic science investigations 

are currently in progress to 

define mechanisms of excessive bleeding 

and thrombosis in the perioperative 

period. Our clinical studies continue 

to focus on the role of the fibrinolytic 

system in perioperative abnormalities 

of hemostasis and thrombosis and to 

define pharmacologic approaches to 

alleviate fibrinolytic bleeding in the 

surgical patient. In addition, we are 

engaged in field trials to develop novel 

point-of-care assays of coagulation for 

use in the perioperative setting. Basic 

laboratory investigations continue to 

focus on tissue transglutaminase and 

factor XIII, members of an enzymatic 

gene superfamily essential for intermolecular 

stabilization. Recent evidence 

suggests that transglutaminases 

play an important regulatory role in the 

life cycle of the cell by modulating cell 

growth and angiogenesis. Our laboratory 

is specifically interested in the role 

of these enzymes in modulating the 

extracellular matrix and consequently 

the processes of thrombosis, angiogenesis, 

and atherosclerosis. Recent 

investigations have focused on mechanisms 

for the post-translational regulation 

of transglutaminase activity as well 

as the role of transglutaminases in fibrin 

stabilization. 



JACQUES SOMMA, M.D., FRCP(C) 


Director, Human Neurophysiology and 

Pharmacology Laboratory 

AREA OF RESEARCH: 

Phase I Studies 

The Human Pharmacology Laboratory 

is a fully equipped laboratory supported 

by a comprehensive team of professionals 

who have the skills required to efficiently 

design, perform and analyze 

data for Phase I studies. 

Faculty 



Eugene W. Morretti, M.D. 


David R. Wright, M.B., Ch.B. 

Fellow 


Support Staff 

Jennifer K. Fier, Staff Assistant 

Aaron K. Harrison, B.S., Clinical Trial 

Research Associate 

Karen W. Ramsey RN, BSN, M.B.A., 

MHA, Non-Cardiac Clinical Research 

Coordinator 

The Facility 


is located on the fourth floor of the 

Orange Zone in Duke South. It is fully 

equipped with standard life support 

and exhaustive monitoring equipment, 

which includes: EKG, NIBP, arterial 

blood pressure, end tidal CO 2, pulse 

oximetry, nerve stimulator, Respitrace, 

Medoc computer-controlled thermode, 

4 channels EEG, Bispectral Index and 

Evoked Potentials. All the data is collected 

on a powerful data acquisition 

system based on a LabView platform. 


is also equipped with Computer Controlled 

Infusion Pumps. It stands that 

Duke is the leader in the field and owns 

the patent for CACI (Computer Assisted 

Continuous Infusion). The laboratory 


can, actually, host up to two hundred 

subjects per year. 

The Service Provided 


offer a complete solution for phase I 

study including: 

• using existing preliminary data (animal 

or human) to perform simulations 

that will help designing the protocol. 

• recruiting and performing the trial 

• analyzing, modeling and publishing 

the results of the study. 

Designing the protocol 

Using existing preliminary data (animal 

or human) simulations are performed to 

help design the protocol. Simulations 

are made for the lowest and the highest 

expected Cl’s and V’s using a reasonable 

inter and intra-individual variability. 

Simulated experimental data are generated 

according to different potential 

protocols. The protocols are then tested 

for their ability to answer the clinically 

relevant question. Different scenarios 

are considered and the best protocol is 

selected. Simulations help design better 

cost-effective studies by optimizing the 

quality of the results as well as minimizing 

the number of subjects needed for 

Phase II studies. 

Performing the study 


is a state of the art facility operated by 

a skilled team of professionals that offer 

superior and timely service. Duke University's 

excellent reputation for research, 

as well as the large population 

of healthy young adults living in the 

area, are the two key factors for fast and 

efficient enrollment. 

Analyzing the data 

State-of-the-art tools, such as NONMEM, 

are used to analyze and model the 

data. NONMEM is a sophisticated and 

powerful software package designed to 

perform population analysis for pharmacokinetics 

and dynamics. Intra and 

inter-variability can be modeled simultaneously 

with NONMEM. One of the 

strength of NONMEM includes the ability 

to adequately model PK/PD data sets 

with very few data points per subjects. 

Providing an adequate number of subjects, 

data sets can be modeled with as 

little as three data points per subjects. 

Active Protocols 

Two protocols are currently active: 

“A Double Blind Randomized Study to 

Compare the Analgesia and Respiratory 

Effect of Dexmedetomidine and 

Remifentanil," and “Age Effect on the 

Interaction between Propofol and 

Remifentanil.” 

The Human Neurophysiology and 

Pharmacology Laboratory in 2001 

There will be an expansion of the 

Human Neurophysiology and Pharmacology 

Laboratory in 2001 with the 

addition of Dr. Lucian Radu Radulescu 

and Dr. Luis Ignacio Cortínez. Dr. 

Radulescu is a trained anesthesiologist 

from Romania. Since 1995, Dr. 

Radulescu has acquired a strong background 

in clinical trials through working 

in Dr. Steven L. Shafer’s Pharmacology 

Laboratory at Stanford University, 

and at Roche Laboratory. Dr Radulescu 

will join the Human Neurophysiology 

and Pharmacology Laboratory as an 

Associate in Research. Dr Cortinez is a 

Chilean anesthesiologist with a strong 

interest in pharmacology and computer 

controlled infusions. He is anticipated 

to start a two-year clinical-research fellowship 

with us in summer 2001. 

Our Labview data acquisition system 

is a project in constant evolution. 

In 2001 and in the future years the 

Labview project will expand and evolve 

in a very powerful research tool that 

will integrate CACI and network capabilities 

in addition to its powerful data 

acquisition capabilities. The project 

will be programmed using MFC and 

the visual C++ tools for Labview. 

In the upcoming year the Human 

Neurophysiology and Pharmacology 

Laboratory will broaden its research 

activities and will offer its expertise and

services to pharmaceutical companies 

in fields outside anesthesia. The 

Human Neurophysiology and Pharmacology 

Laboratory is now being promoted 

on the World Wide Web at 

www.pharmacokin.com. 

RICHARD D. VANN, Ph.D. 

Director of Applied Physiology, 

F.G. Hall Hyperbaric Center 

Director of Research, Divers Alert 

Network 



EDWARD D. THALMANN, M.D. 

Assistant Medical Director, Divers Alert 

Network 




Community/Occupational Medicine 

NEAL W. POLLOCK, Ph.D. 



Georgia Southern University 

JOHN J. FREIBERGER, M.D., M.P.H. 

Hyperbaric Fellow 


Hyperbaric, Diving, and Aerospace 

Physiology; Ventilatory Control; Bubble 

Formation; Decompression Sickness; 

Hypoxia; Oxygen Toxicity; Breathing 

Apparatus Design; Biomaterials. 

Fields of study at the F.G. Hall Hypo/ 

Hyperbaric Environmental Laboratory 

include the physiology, medicine, and 

epidemiology of special respiratory 

environments and the development of 

equipment and operational procedures 

that allow humans to live and work 

in them safely. Relevant environments 

include diving, compressed air work, 

mountaineering, and aerospace. High 

altitude and high pressure are simulated 

in laboratory chambers under wet or 

dry conditions while inspired oxygen, 

carbon dioxide, inert gas, and total 

pressure are controlled to desired levels. 

Measurement capabilities include arterial 

blood gases, tidal volume, respiratory 

frequency, respiratory minute volume, 

oxygen and carbon dioxide partial pressures, 

oxygen consumption, and nitrogen 

uptake or elimination. Specific 

investigations have included: (1) environmental 

and physiological factors 

affecting cerebral blood flow, cerebral 

oxygenation, and CNS oxygen toxicity; 

(2) nitrogen elimination during oxygen 

breathing; (3) effect of hypercapnia on 

arterial oxygen saturation and cerebral 

oxygenation during hypoxia; (4) effects 

of hyperventilation and oxygen breathing 

on breath-hold; (5) mechanisms 

and locations of in vitro and in vivo 

bubble formation and their relation to 

decompression sickness; (6) physiological 

damage resulting from in situ bubbles 

and from bubbles associated with 

implanted biomaterials. Respiratory 

physiology studies include optimizing 

oxygen delivery equipment for sea level 

and altitude. Human decompression 

studies have included: (1) factors affecting 

decompression sickness in astronauts 

during extravehicular activity in 

space; (2) surface interval oxygen and 

in-water oxygen repetitive dive tables; 

(3) determination of safe surface intervals 

before flying after diving; 

(4) use of dive computers to record 

recreational dive profile and medical 

outcome data for the Divers Alert 

Network; (5) development of statistical 

models of decompression sickness. Ongoing 

projects include: (1) optimization 

of oxygen delivery equipment for medical 

emergencies and mountain climbing; 

(2) development of decompression 

procedures for Extravehicular Activity 

from the Space Station; (3) breath-hold 

diving with oxygen; and (4) investigation 

of safe ascent rates after diving. 


DAVID S. WARNER, M.D. 

Professor of Anesthesiology, 

Neurobiology and Surgery 

Director, Experimental Anesthesiology 


Mechanisms and Treatment of Ischemic/ 

Traumatic Brain Injury; Mechanisms of 

Cerebral Vasospasm; Perinatal Hypoxia/ 

Ischemia; Management of Intraoperative 

Cerebral Ischemia; Effects of Anesthetic 

Agents on Patients with Intracranial 

Space-Occupying Lesions 

The Multidisciplinary Neuroprotection 

Research Laboratory is dedicated to 

examining the pathophysiology of 

acute brain injury with particular reference 

to disease states managed in the 

perioperative or neurointensive care 

environments. Rodent recovery models 

of cerebral ischemia, head trauma, 

cardiopulmonary bypass, subarachnoid 

hemorrhage, and perinatal hypoxia 

have been established with requisite 

control of relevant physiologic variables. 

Experimental protocols examine 

the pathophysiologic response to these 

insults and seek to define appropriate 

therapeutic interventions. Additional 

work examines the roles of excitatory 

neurotransmitters and reactive oxygen 

species in acute brain injury with emphasis 

on how pharmacologic or genetic 

variants modulate these processes. 

Effects of altered synthesis of superoxide 

dismutase and apolipoprotein E are 

investigated in transgenic/knock out 

mice. Outcome studies allow definition 

of efficacy of pharmacologic agents 

including superoxide dismutase mimetics, 

allosteric modifiers of hemoglobin 

affinity for oxygen, recombinant apolipoprotein 

E and its peptide fragments, 

and anesthetics on histologic and 

behavioral recovery from ischemic/ 

traumatic insults. Advanced neurochemical 

techniques are used to define 

the mechanistic basis of observations 

made in outcome studies. Primary neuronal/glial 

cultures are used to investigate 

mechanistic interactions between 

pharmacologic agents and metabolic 



stresses. This year the laboratory initiated 

research models employing genomic 

and proteomic analytic methods. Additional 

space (1232 sq. ft.) in the Sands 

Building was obtained and renovated 

for expansion of the molecular biology 

and neurochemistry domains in the 

laboratory. 

The laboratory has become a focus 

of both research and physician-scientist 

Cardiothoracic Anesthesia–Vincent Gaver, B.A. and 

Beverly Perry 


training for a variety of disciplines within 

the Medical Center including anesthesiology, 

neurology, neurosurgery, 

pediatrics, biochemistry, pediatric neurology, 

radiology, and neurocritical 

care. In 2000, the MNL was home to 

nine post-doctoral fellows, three medical 

students, and one undergraduate. 

Computer Support–Christopher Wester

Gerontological Research in 

Anesthesia and Surgery 

Program (GRASP) 

MADAN M. KWATRA, Ph.D. 


Assistant Professor of Pharmacology 

and Cancer Biology 

J.G. REVES, M.D. 

Professor and Chairman of 


AREA OF INTEREST: 

Geriatric Research and Education 

Focusing on the Special Needs of the 

Elderly Patient Undergoing Surgery 

FOCUS 

GRASP seeks to identify areas of basic 

and clinical research that will reduce 

the incidence of adverse post-surgical 

outcomes that frequently occur in the 

elderly. To this end, GRASP holds 

monthly meetings, organizes biennial 

conferences entitled “Surgery and the 

Elderly,” and develops research projects. 

MONTHLY GRASP MEETINGS 

These meetings, attended by basic 

science and clinical faculty, residents, 

fellows, and medical students from the 

departments of anesthesiology, surgery, 

and the center for aging research, discuss 

a variety of topics related to the 

elderly. Topics covered in GRASP meetings 

are listed in the Lectures, Conferences, 

and Didactic section of this 

report. 

BIENNIAL SURGERY AND THE 

ELDERLY CONFERENCES 

These conferences are held biennially 

and focus on specific issues affecting 

the elderly surgical patient. The first 

Duke conference on surgery and the 

elderly was held on September 17, 

1997; anesthesiologists, basic scientists, 

geratricians, and surgeons from major 

medical centers across the country 

were in attendance. This conference 

highlighted the risks faced by an elderly 

patient undergoing surgery and how 

age affects the various organ systems. In 

addition, this meeting was instrumental 

in establishing contacts between the 

American Society of Anesthesiology 

(ASA) and the American Geriatric 

Society (AGS). These meetings were 

attended by basic scientists (AGS/the 

Hartford Foundation) whose goals are 

to introduce geriatrics into the curricula 

of various non-primary specialties. 

The second Duke conference on 

surgery and the elderly was held on 

September 30, 1999. The focus of this 

conference was on cognitive dysfunction 

in the elderly after non-brain 

surgery. The conference was divided 

into morning and afternoon sessions. 

The morning session was devoted to 

understanding the incidence of postoperative 

cognitive dysfunction after 

cardiac, hip fracture, and major noncardiac 

surgeries. The afternoon session 

focused on two issues: whether regional 

anesthesia produces less post-operative 

cognitive dysfunction and the cholinergic 

hypothesis of post-operative cognitive 

dysfunction. A total of 40-50 people 

were in attendance including anesthesiologists, 

basic scientists, geratricians, 

and surgeons from Duke and other 

universities. 

The third Duke conference on 

surgery and the elderly will be held 

on September 20, 2001. The theme of 

this conference will be “What we know 

and need to know about the elderly 

from existing databases.” 

RESEARCH PROJECTS 

A major aim of GRASP is to pursue 

research that will lead to better postoperative 

outcomes for the elderly. To 

this end, we are currently developing 

projects devoted to understanding post- 


operative delirium in the elderly. 

Several projects are identified and 

include the following: 

1) What is the role of pain in postoperative 

delirium? 

2) Is regional anesthesia accompanied 

by a lower incidence of delirium? 

3) Are certain combinations of 

anesthetics contributing to a higher 

incidence of post-operative delirium? 

4) What is the molecular basis of 

post-operative delirium? 

Duke Chapel outdoor walkway 


RESEARCH 

ASSOCIATE 

Ivan T. Demchenko, D.Sc. 


128 RESEARCH STAFF 

RESEARCH STAFF 

Mitsuo Aono, M.D. 

Peter J. Denoble, M.D., Ph.D. 

Jason D. Kilts, Ph.D. 

Gopa Biswas, Ph.D. 

Tracey V. Du Laney, Ph.D. 

Kyo Sang Kim, M.D.

Masaya Kudo, M.D. 

Daniel Morris, Ph.D. 

Barbara Phillips-Bute, Ph.D. 

Yoonki Lee, M.D., Ph.D. 

Carlos L. Nebreda, M.D. 

Mark D. Richardson, Ph.D. 


Bengt M. Nellgard, M.D., Ph.D. 

Yukie Sato, M.D. 


RESEARCH STAFF 129


Yaozhi Wang, M.D. Kengo Warabi, M.D. 

Keisuke Yamaguchi, M.D. 

130 RESEARCH STAFF 

NOT PICTURED 

Banalata Sen, Ph.D. 


FACULTY 

MULTIDISCIPLINARY NEUROPROTECTION LABORATORIES (Left to Right) Carla Calvi; Yukie Sato, M.D.; Hercilia Homi, M.D.; Ann Brinkhous

RESEARCH 

ASSISTANT 

Amy L. Kondyra Vikas Prabhakar 


FACULTY 

RESEARCH STAFF 131

Abstracts 

Airey PJ, Ruroede K, Myers RM, Thom SR, Ferguson BJ, 

Moon RE. Hyperbaric oxygen for the treatment of 

rhinocerebral mucormycosis. Undersea Hyperb Med 

2000; 27(Suppl):64. 

Apfelbaum J, Gan TJ, Chen C. Current hospital acute 

pain management practices: patient education and 

post-discharge follow-up. American Pain Society 2000; 

759. 

Apfelbaum J, Gan TJ, Chen C. Patient perception of postoperative 

pain experience after outpatient surgery: 

patient survey. Anesthesiology 2000; 93:A1. 

Aronson S, Buckingham R, Cahalan M, Konstadt S, Mark 

J, Ramsay J, Savage R, Savino JS, Shanewise JS, Smith 

J, Thys D. Relationship between training and experience 

with performance on the Certification Exam for 

Perioperative TEE. Anesth Analg 2000; 90(4): SCA75. 

Bailey AG, Ross AK, Bukowski T, Eck J. Caudal ropivacaine 

and the optimal concentration for elective lower 

abdominal pediatric surgery. Anesthesiology 2000; 93: 

A1270. 

Bell EB, Olufolabi AJ, Booth JV, Muir HA. Does anesthetic 

technique affect the time spent managing labor 

analgesia? Anesthesiology 2000; 93:A1041. 

Booth JV, Grossman D, Sheffield D, Lineberger CK, Reves 

JG. Substance abuse among anesthesiologists: a 

survey of academic institutions in the USA. Anesthesiology 

2000; 93(3A):223. 

Booth JV, Spahn D, El-Moalem H, McRae RL, Chesnut L, 

Leone BJ, Schwinn DA. Esmolol administration during 

cardiopulmonary bypass prevents acute myocardial 

adrenergic receptor desensitization and improves left 

ventricular systolic function. Anestheology 2000; 

90(4):SCA40. 

Breen TW, Campbell DC, Kronberg JE, Nunn RT, Fick GH. 

The clinically relevant potencies of ropivacaine and 

bupivacaine: a PCEA study. Anesthesiology 2000; 93: 

A1101. 

Buch DA, Dovenbarger JA, Uguccioni DM, El-Moalem H, 

Moon RE. Effect of cigarette smoking on the severity 

of decompression illness (DCI) symptoms. Undersea 

Hyperb Med 2000; 27:29. 

Butler BD, Vann RD, Nishi RY, Gerth WA, Beltran E, Fife 

CE, Conkin J, Schneider SM, Loftin KC, Sullivan PA, 

Acock K, Foster PP, Dervay JP, Waligora JM, Powell 

132 PUBLICATIONS 

PUBLICATIONS 

MR, Gernhardt ML. Human trials of a two hour prebreathe 

protocol for extravehicular activity. Aviat 

Space Environ Med 2000; 71(3): 278, A44. 

Campbell DC, Breen TW, Kronberg JE, Nunn RT, Fick GH. 

The motor blocking properties of ropivacaine and 

bupivacaine during labor analgesia. Anesthesiology 

2000; 93:A1044. 

Caruso JL, Uguccioni DM, Ellis JE, Dovenbarger JA, Vann 

RD, Bennett PB. Ten years of diving fatality epidemiology: 

the Divers Alert Network database, 1989-1998. 

Undersea and Hyperbaric Medicine 2000; 27(Supp):180. 

Conkin J, Gernhardt ML, Foster PP, Pilmanis AA, Butler 

BD, Beltran E, Fife CE, Vann RD, Gerth WA, Loftin KC, 

Acock K, Dervay JP, Waligora JM, Powell MR, Feiveson 

AH, Nishi RY, Sullivan PA, Schneider SM. Relationship 

of exercise, age, and gender on decompression sickness 

and venous gas emboli during two-hour oxygen 

pre-breathe prior to hypobaric exposure. Undersea 

Hyperbaric Med 2000; 27(Suppl): A10. 

Dear G de L, Uguccioni DM, Denoble PD, Vann RD. 

Recreational diving injuries, 1987 - 1997; a review. 

Undersea Hyperbaric Med 2000; 27S:51. 

Demchenko IT, Boso AE, Doar PO, Bennett PB, 

Piantadosi CA. Peroxynitrite production in hyperbaric 

oxygen-induced neurotoxicity. Undersea and Hyperbaric 

Medicine 2000; 27(Supp):117. 

Denoble PD, Vann RD, Gerth WA. Reported and estimated 

decompression sickness in recreational diving. 

Undersea Hyperbaric Med 2000; 27(Suppl): A137. 

Dovenbarger JA, Uguccioni DM, Sullivan KM, Dear G de 

L, Moon RE. Paralysis in 69 recreational scuba 

injuries. Undersea Hyperb Med 2000; 27(Suppl):43. 

Dunford RG, Vann RD, Gerth WA, Pieper CF. Huggins K, 

Wachholz C, Bennett PB. The incidence of venous gas 

emboli in recreational diving. Undersea and Hyperbaric 

Medicine 2000; 27(Supp):179. 

Finegan BA, Guenther CR, Hill SE, George PB, Carmichael 

L. O-raffinose crosslinked human hemoglobin (hemolink): 

effect on clinical chemistry in patients undergoing 

coronary arterybypass surgery. Anesthesiology 

2000; 93(3A):A184. 

Gan TJ, Apfelbaum J, Chen C. Acute pain management 

programs in the US: survey of 225 hospitals. 

Anesthesiology 2000; 93:A1207.

Gan TJ, Apfelbaum J, Chen C. Institutional impact of 

JCAHO pain management standards. American Pain 

Society; 2000; 648. 

Gan TJ, Apfelbaum J, Chen C. Patient surgery experience: 

primary concerns, analgesia preference and 

patient satisfaction. Anesthesiology 2000; 93:A880. 

Gan TJ, Franiak R, Reves J, Hartle A. Ondansetron disintegrating 

tablets (ODT) reduces post-discharge emesis 

and increases patient satisfaction. Anesthesiology 

2000; 93:A34. 

Gan TJ, Hill RP, Moretti E, Kucmeroski D, Pappas T, 

Eubanks S. Triple antiemetic prophylaxis involving 

propofol, droperidol and ondansetron is highly effective 

in preventing PONV. Anesth Analg 2000; 90:S4. 

Gan TJ, Klein SM, Slaughter TF, Alexander R. 

Thrombelastography as a measure of anticoagulation 

from low molecular weight heparin. Anesth Analg 

2000; 90:S501. 

Garcia-Oria MJ, Ali A, Cumming T, Fina MC, Clary E, 

Burch S, Penning DH, McMahon R, Reynolds JD, 

Gandsas A, McRae R, Eubanks S. The effects of pneumoperitoneum 

during pregnancy on fetal brain histology. 

Surgical Endoscopy 2000; 14:S185. 

Garcia-Rodriguez CR, Cassell C, Young C, Sum Ping J, 

Mark JB. Cardiac output measurement without central 

venous catheterization: a clinical assessment of the 

lithium dilution method. Anesthesiology 2000; 

93:A587. 

Gardner SF, Penning DH, Murtha AP, Hendrix BM, Booth 

JV. Medical management of the seizing pregnant 

patient maternal-fetal conflicts. Anesthesiology 2000; 

93:A1076. 

Gernhardt ML, Conkin J, Foster PP, Pilmanis AA, Butler 

BD, Fife CE, Vann RD, Gerth WA, Loftin KC, Dervay JP, 

Waligora JM, Powell MR. Design of a two-hour prebreathe 

protocol for space walks from the International 

Space Station. Aviation Space Environ Med 2000; 

71(3):277, A43. 

Gernhardt ML, Conkin J, Foster PP, Pilmanis AA, Butler 

BD, Beltran E, Fife CE, Vann RD, Gerth WA, Loftin KC, 

Acock K, Dervay JP, Waligora JM, Powell MR, Feiveson 

AH, Nishi RY, Sullivan PA, Schneider SM. Design and 

testing of a two-hour oxygen pre-breathe protocol for 

space walks from the International Space Station. 

Undersea Hyperbaric Med 2000; 27(Suppl):A11. 

PUBLICATIONS 

Gleaton CH, Rose RE, Hendircks DM, Carraway MS, Dear 

G de L, Moon RE, Piantadosi CA, Stolp BW, Thalmann 

ED, Dunn R, Logue PE, Cokgor I, Friedman AH, 

Fiedman HS. Hyperbaric oxygen for the treatment of 

radionecrosis of the brain. Undersea Hyperbaric Med 

2000; 27S:38. 

Grant SA, Nielsen KC, Greengrass RA, Steele SM, Klein 

SM. Continuous peripheral nerve blocks for ambulatory 

surgery. Anesthesiology 2000; 3A:A-9. 

Hampel C, Dolber PC, Bremer RE, Schwinn DA, Thuroff 

JW, Thor KB. Increased expression of gap junctions 

(connexin43) in rat bladder outlet obstruction. 

J Urol 2000; 163:4. 

Hampel C, Dolber PC, Savic SL, Schwinn DA, Thuroff JW, 

Thor KB. Changes in 1-adrenergic receptor (AR) subtype 

gene expression during bladder outlet obstruction 

of rats. J Urol 2000;163:228. 

Helsley SE, Bell E, Breen TW, Penning D. Total spinal 

anesthesia requiring tracheal intubation in parturients: 

the association with failed epidural anesthesia. 

Anesthesiology 2000; 93:A1078. 

Hendricks DM, Kraft KL, Moon RE, Piantadosi CA, Stolp 

BW. Dose-response for hyperbaric oxygen treatment 

of radiation cystitis. Undersea Hyperbaric Med 2000; 

27(Suppl): 39. 

Hill RP, Soppitt AJ, Gan TJ. The effectiveness of rescue 

antiemetics in patients who received a prophylactic 

antiemetic. Anesthesiology Analg 2000; 90:S8. 

Hobbs GW, Natoli MJ, Pollock NW, Stolp BW, Corkey WB, 

Gabrielova I, Hendricks DM, Schinazi EA, Almon AK, 

Pieper CF, Vann RD. Oxygen-enhanced breath-hold 

diving: immersion and temperature effects. Undersea 

Hyperbaric Med 2000; 27(Suppl):A130. 

Klein SM, Steele SM, Grant SA, Nielsen KC, Greengrass 

RA. Paravertebral somatic nerve block versus local 

infiltration for outpatient inguinal herniorrhaphy. 

Anesthesiology 2000; (3A):A885. 

Klein SM, Grant SA, Greengrass RA, Nielsen KC, Speer KP, 

White W, Warner DS, Steele, SM. Continuous ambulatory 

brachial plexus block with a new catheter insertion 

system and a disposable infusions pump. 

Anesthesiology 2000; (3A):A-83. 

Knudsen NW, Fulkerson WJ, Sebastian MW. Family communication 

enhanced by 24 hour in house intensivists. 

PUBLICATIONS 133

PUBLICATIONS 

Presented at SCCM in February 2001. Critical Care 

Medicine, December 2000; 28 (12S):A109. 

Kudo M, Lee Y, Massey G, Warner DS, Pearlstein RD. 

Effects of volatile anesthetics on NMDA excitotoxicity 

in primary and mixed neuronal/glial cultures. 


Lee TWR, Jacobsohn E, Maniate JM, Schwinn D, Grocott 

HP and the Cardiac anesthesia and surgical groups 

at Manitoba HSC. High spinal anesthesia in cardiac 

surgery: effects on hemodynamics, perioperative 

stress response, and atrial ß-receptor function. Anesth 

Analg 2000; 90:SCA90. 

Lynch JR, Pineda J, Morgan D, Warner DS, Laskowitz DT. 

Apolipoprotein E modulates CNS cytokine expression 

and the development of edema after head injury. Soc 

Neurosci 2000; 26:A4925. 

Mackensen GB, Grocott HP, Pineda J, Nellgård B, 

Newman MF, Warner DS. Neurologic and neurocognitive 

dysfunction following cardiopulmonary by pass 

in the rat. Anesth Analg 2000; SCA36. 

Mackensen GB, Nellgård B, Kudo M, Sheng H, Pearlstein 

RD, Warner DS. Periischemic cerebral blood flow 

does not explain beneficial effects of isoflurane on 

outcome fromnear-complete forebrain ischemia in 

rats. Anesthesiology 2000; 93:1102-1106. 

Mackensen GB, Patel MN, Crapo JD, Batinic-Haberle I, 

Warner DS. Neuroprotection from delayed postischemic 

administration of a metalloporphyrin catalytic 

antioxidant in the rat. Anesthesiology 2000; 

93:A701. 

Mackensen GB, Ti LK, Grocott HP, Phillips-Bute B, 

Newman MF. Cerebral embolization during cardiac 

surgery: the impact of aortic atheroma burden. 


Mackensen GB, Grocott HP, Cohen W, Phillips-Bute B, 

Newman MF. Post-operative temperature following 

cardiac surgery: the influence of warm versus cold 

bypass. Anesthesiology 2000; 93:A166. 

Maroof M, Gan TJ, York WS, Monnig A. Patient tailored 

infusion of cisatracurium during general anesthesia. 


Massey EW, Dovenbarger JA, Nord DA, Dear G de L, 

Moon RE. Seizures in divers. Undersea Hyperb Med 

2000; 27(Suppl):65-66. 


McCammon MR, Moreland MR, Hickner RC, Shaw DK, 

Poehlman GS, Pollock NW. The effects of a moderateintensity 

exercise program on improving coronary 

artery disease risk factors in previously sedentary 

African-Americans. Abstracts of the Southeast 

American College of Sports Medicine Annual Meeting: 

2000; 40. 

Muir HA, Breen TW, Campbell DC, Halpern SH, Liston R, 

Blanchard W. A multicenter study of the effects of 

analgesia on the progress of labor. Anesthesiology 

2000; 92:A23. 

Natoli MJ, Hobbs GW, Pollock NW, Stolp BW, Corkey WB, 

Gabrielova I, Hendricks DM, Schnazi EA, Almon AK, 

Pieper CF, Vann RD. Oxygen-enhanced breath-hold: 

immersion and temperature effects. Undersea Hyperb 

Med 2000; 27(Suppl):49. 

Nellgård B, Mackensen GB, Pineda J, Wellons J, Pearlstein 

RD, Warner DS. Anesthetic effects on cerebral metabolic 

rate predict histologic outcome from near-complete 

forebrain ischemia in the rat. J Neurosurg 

Anesthesiology 2000; 12:168. 

Nielsen KC, Steele SM, Klein SM. Pietrobon RS, 

Greengrass RA. Continuous interscalene brachial 

plexus blockade at home after major shoulder surgery. 

Anesthesiology 2000; (3A):A15. 

Olufolabi AJ, Bell E, Hartle A. Probability of difficult 

tracheal intubation in the obstetric population: does 

ethnic origin matter? Anesthesiology 2000; 4:A1089. 

Parra A, Sheng H, Pearlstein R, Warner DS. Delayed transient 

arteriopathy resulting from subarachnoid hemorrhage 

in C57 B1/6 vs. EC-SDD transgenic mice: external 

vascular diameter measurement vs. histologic 

quantitative technique. Soc Neurosci Abs 2000; 

26:671.8 

Patel MN, Mackensen GB, Calvi C, Liang LP, Batinic- 

Haberle I, Day BJ, Fridovich I, Crapo JD, Pearlstein RD, 

Warner DS. A metalloporphyrin catalytic antioxidant 

protects against ischemic brain damage with a six-hour 

therapeutic window. Soc Neurosci Abs 2000; 

(2A):26:289.7 

Pierce BA, Young JA, Pollock NW. Validation of pulse 

oximetry measures of hemoglobin saturation. Abstracts 

of the Southeast American College of Sports Medicine 

Annual Meeting: 2000; 31.

Pineda JA, Lynch JR, Laskowitz DT, Warner DS, Zhang L, 

Beneveniste H. In vivo MR microscopy of C57BL/6J 

and apolipoprotein E deficient mice before and after 

closed head injury: a 6-week longitudinal study. Soc 

Neurosci 2000; 26:494.4. 

Pollock NW, Hobbs GW, Natoli MJ, Hendricks DM, 

Gabrielova I, Delphia BC, Vann RD. REMO2: an O2 

rebreather for use in emergency medical applications. 

Wilderness Environ Med 2000; 11(1):60. 

Pollock NW, Moreland MR, McCammon MR, Hickner RC, 

Shaw DK, Poehlman GS. Inability of low-intensity exercise 

to improve glycemic control in a rural, high-risk 

community. Med Sci Sports Med 2000; 32(5):5217. 

Ross AK, Bailey AG, Bukowski T, Eck J. Caudal ropivacaine 

and the optimal concentrations for elective 

lower abdominal pediatric surgery. Anesthesiology 

2000; 93:A1270. 

Schultz JR, Bell E, Muir H, Olufolabi Y. Does the PCEA 

technique reduce the number of physicians-administered 

“top-ups” required to maintain analgesia during 

labor? Anesthesiology 2000; 3A:A82. 

Sheng H, Batinic-Haberle I, Crapo JD, Fridovich I, 

Laskowitz DT, Pearlstein RD, Warner DS. Postischemic 

IV administration of Mn-TE-2PYP, a metalloporphyrin 

catalytic antioxidant, reduces histologic/neurologic 

damage after murine MCAO. Soc Neurosci 2000; 

(2A):26:289. 

Soppitt AJ, Robertson K, Moretti E, Weatherwax K, Gan 

TJ. Recovery profile of succinylcholine in severe 

hepatic failure. Anesth Analg 2000; 90:S464. 

Spear-Smith J, Reynolds JD. Maternal progesterone and 

17 - (estradiol levels in nearterm pregnant sheep during 

chronic exposure to ethanol. Alcoholism: Clinical 

and Experimental Research 2000 24; (Suppl.): 101A. 

Sreeram GM, Grocott HP, White WD, Stafford-Smith M, 

Newman MF. Transcranial doppler emboli count 

predicts rise in creatinine following cardiac surgery. 

Anesth Analg 2000; 90(4S):SCA 37. 

Sum Ping ST, Cassell C, Joseph A: Effects of dexmedetomidine 

on time to extubation. Crit Care Med 2000; 28: 

(12) A124. 

Ti LK, Mackensen GB, Grocott HP, Phillips-Bute BG, 

Mathew JP. Apolipoprotein E4 increases atheroma 

burden in cardiac surgical patients. Anesthesiology 

2000; 93:A401. 

PUBLICATIONS 

Ti LK, Mackensen GB, Grocott HP, Phillips-Bute BG, 

Mathew JP. The clinical significance of routine TEE in 

patients undergoing CABG with normal LV function. 


Uguccioni DM, Dear G de L, Dovenbarger JA, Feinglos M, 

Moon RE, Pollock NW. Plasma glucose response to 

recreational diving in insulin-requiring diabetics and 

controls. Undersea Hyperb Med 2000; 27(Suppl):66. 

Vann RD, Natoli MJ, Hobbs GW, Gabrielova I, Hendricks 

DM, Schnazi EA, Pieper CF, Pollock NW. Oxygenenhanced 

breath-hold diving: O2 vs. air. Undersea 

Hyperb Med 2000; 27(Suppl):49-50. 

Vote DA, Rose R, Gleaton CH, Moon RE. Serial plasma 

glucose in diabetic patients during hyperbaric oxygen 

therapy. Undersea Hyperb Med 2000; 27(Suppl):62. 

Waligora JM, Conkin J, Foster PP, Schneider SM, 

Gernhardt ML, Loftin KC, Vann RD. Operational implementation 

of a two hour pre-breathe protocol for international 

space station. Aviat Space Environ Med 2000; 

71:278, A46. 

Wellons JC, Sheng H, Laskowitz D, Mackensen GB, 

Pearlstein RD, Warner DS. A comparison of strainrelated 

susceptibility in two murine recovery models 

of global cerebral ischemia. Brain Res 2000; 868:14-21. 

Wellons JC, Sheng H, Pineda J, Massey GW, Pearlstein 

RD, Warner DS, Laskowitz DT. Intracerebral infusion 

of human recombinant apolipoprotein E3 reduces 

global ischemia brain injury in apolipoprotein E deficient 

mice. Neurosurgery 2000; 47:532. 

Williams R, Gadde KM, Clary GL, Grichnik KP, Kuhn CM, 

Marchuk DA, Shanberg AM, Stafford-Smith M, Svenson 

IK. Serotonin transporter promoter genotypes, CNS 

serotonin turnover and cardiovascular reactivity to 

stress. Psychosomatic Medicine 2000; 62:101. 

Young CC, Garcia-Rodriguez CR, Cassell C, El-Moalem H, 

Mark JB. Lithium dilution versus thermodilution cardiac 

output measurement in cardiac surgery patients. 

Anesthesiology 2000; 93:B13. 

Young CC, Knudsen NW, Hilton AK, Reves JG. Sedation 

in the intensive care unit. Critical Care Medicine 2000; 

28(3):854-866. 

PUBLICATIONS 135

PUBLICATIONS 

Peer Reviewed Articles 

Allen, BW, CA Piantadosi, LA Coury. Electrode materials 

for nitric oxide detection. Nitric Oxide: Biol. And Chem. 

2000; 4(1):75-84. 

Arrowsmith JE, Grocott HP, Newman MF, Reves JG. 

Central nervous system complications of cardiac surgery. 

Br J Anaesth 2000; 84: 378-393. 

Arrowsmith JE, Grocott HP, Newman MF. Neurologic risk 

assessment, monitoring and outcome in cardiac surgery. 

J Cardiothorac Vasc Anesth 2000; 13: 726-743. 

Balakrishnan G, Raudzens P, Samra SK, Song K, Boening 

JA, Bosek V, Jamerson B, Warner DS. Safety and efficacy 

of remifentanil versus fentanyl in patients undergoing 

surgery for intracranial mass lesions. Anesth Anlg 2000; 

91: 163-169. 

Bell EA, Penning DH, Cousineau EF, White WD, Hartle AJ, 

Gilbert WC, Lubarsky DA. How much labor is in a labor 

epidural? manpower cost and reimbursement for an 

obstetric analgesia service in a teaching institution. 

Anesthesiology 2000; 92: 851-858. 

Benveniste H, Kim KR, Hedlund LW, Kim JW, Friedman 

GA. Cerebral hemorrhage and edema following brain 

biopsy in rats: significance of mean arterial blood pressure. 

J Neurosurgery 2000; 92: 100-107. 

Benveniste H, Kim KR, Zhang L, Johnson GA. Magnetic 

resonance microscopy of the C57BL mouse brain. Neuro 

Image 2000; 11: 601-611. 

Booth JV, Lindsay DR, Olufolabi AJ, El-Moalem HE, 

Penning DH, Reynolds JD. Subarachnoid meperidine 

(pethidine) causes significant nausea and vomiting during 

labor. Anesthesiology 2000; 93: 418-421. 

Borel, CO. Management of neurological ICU catastrophes: 

airway, breathing, and circulation. Critical Care 

Neurology Section, Current Treatment Options in 

Neurology 2000; 2(6): 499-506. 

Boushel R, Piantadosi CA. Near infrared spectroscopy for 

monitoring muscle oxygenation. Acta Physiol Scand 

2000; 168: 615-622. 

Brandom BW, Margolis JO, Bikhazi GB, Ross AK, Ginsberg 

B, Dear G, Kenaan CA, Eck JB, Woelfel SK, Lloyd ME. 

Neuromuscular effects of rapacuronium in pediatric 

patients during nitrous oxide-halothane anesthesia: comparison 

with mivacurium. Can J Anesth 2000; 47(2): 

143-149. 


Breen TW, McNiel T, Dierenfield L. Obstetric anesthesia 

practice in Canada. Can J Anesth 2000; 47: 1230-42. 

Brown JM, Schulman SR. Sedation in the Paediatric ICU. 

S Afr J Crit Care 2000 Apr; 16 (1): 15-20. 

Buchheit T, Crews J. Lateral cervical epidural catheter 

placement for continuous unilateral upper extremity analgesia 

and sympathetic blockade. Regional Anesthesia 

and Pain Medicine 2000 May-June; 25(3): 313-317. 

Carraway MS, Ghio AJ, Carter JD, Piantadosi CA. 

Expression of heme oxygenase-1 in the lung in chronic 

hypoxia. Am J Physiol (Lung Cell Mol Physiol) 2000; 278: 

L806-L812. 

Carraway MS, Ghio AJ, Piantadosi CA. GM-CSF in pulmonary 

alveolar proteinosis. Am J Resp Crit Care Med 

2000; 161: 1294-1299. 

Chew ST, Newman MF, White WD, Conlon PJ, Saunders 

AM, Strittmatter, WJ, Landolfo K, Grocott HP, Stafford- 

Smith M. Preliminary report on association of 

apoplipoprotein E polymorphisms with postoperative 

peak serum creatinine concentrations in cardiac surgical 

patients. Anesthesiology 2000; 93: 325-331. 

Coles RE, Clements FM, Hey LM, Nunley JA, Levin LS, 

Pearsall AW. Transesophageal echocardiography in 

quantification of emboli during femoral nailing: reamed 

versus unreamed techniques. Southern Orthopedic 

Journal 2000; 9(2): 98-104. 

Cronin A, Keifer JC, Davies MF, King TS, Bixler EO. 

Melatonin secretion after surgery. Lancet 2000; 356 

(9237): 1244-1245. 

Dahm P, Roland FH, Vaslef SN, Moon RE, Price DT, 

Georgiade GS, Vieweg J. Outcome analysis in patients 

with primary necrotizing fasciitis of the male genitalia. 

Urology 2000; 56: 31-35. 

Darling E, Harris-Holloway S, Kern F, Ungerleider R, 

Jaggers J, Lawson S, Shearer I. Impact of modifying priming 

components and fluid administration using miniaturized 

circuitry in neonatal cardiopulmonary bypass. 

Perfusion 2000; 5: 3-12. 

Demchenko IT, Boso AE, O'Neill TJ, Bennett PB, 

Piantadosi CA. Nitric oxide and cerebral blood flow 

responses to hyperbaric oxygen. J Appl Physiol 2000; 88: 

1381-1389. 

Demchenko IT, Boso AE, O'Neill TJ, Bennett PB, Whorton 

AR, Piantadosi CA. Hyperbaric oxygen reduces cerebral 

blood flow by inactivating nitric oxide. Nitric Oxide 2000; 

4(6): 597-608.

East CJ, Clements F, Mathew J, Slaughter TF. 

Antiphospholipid syndrome and cardiac surgery: 

Management of anticoagulation in two patients. Anesth 

Analg 2000; 90: 1098-1101. 

Eck JB: Outpatient pediatric anesthesia. Current 

Anesthesiology Reports 2000; 2: 269-275. 

Eisenstein, E, Peterson E, Jollis J, Tardiff B, Califf R, Knight 

JD, Mark D. Evaluating the potential ‘economic attractiveness’ 

of new therapies in patients with non-ST elevation 

acute coronary syndrome. Pharmacoeconomics 

2000 March 17; (3): 263-272. 

Fabling JM, Gan TJ, Guy J, El-Moalem HE, Molaisoodum 

T, Warner DS, Borel CO. A randomized, double-blind 

comparison of ondansetron, droperidol and placebo 

for prevention of post-operative nausea and vomiting 

after supratentorial craniotomy. Anesth Analg 2000; 

91: 358-61. 

Filntisis GA, Moon RE, Kraft KL, Farmer JC, Scher RL, 

Piantadosi CA. Laryngeal radionecrosis and hyperbaric 

oxygen therapy: report of 18 cases and review of 

the literature. Ann Otol Rhinol Laryngol 2000; 109: 

554-562. 

Gamoso MG, Phillips-Bute B, Landolfo KP, Newman MF, 

Stafford-Smith M. Off-pump versus on-pump coronary 

artery bypass and postoperative renal dysfunction. 

Anesth Analg 2000; 91: 1080-1084. 

Gan TJ. The esophageal Doppler as an alternative to the 

pulmonary artery catheter. Current Opinion in Critical 

Care. 2000; 6: 214-221. 

Garcia-Rodriguez C, Cassell C, Young C, Sum Ping ST, 

Mark JB. Cardiac output measurement without pulmonary 

artery or central venous catheterization: a 

clinical assessment of the lithium dilution method. 

Anesthesiology 2000; 93: A587. 

Ghio AJ, Roggli VL, Kennedy TP, Piantadosi CA. Calcium 

oxalate, iron accumulation and sarcoidosis. Sarcoidosis, 

Vasculitis and Diffuse Lung Diseases 2000; 7(2): 

140-150. 

Ginsberg B, Gan TJ, Grichnik K, Sullivan F, Muir M, Sibert 

K, Glass PSA. The use of patient-controlled analgesia 

to compare the efficacy and relative potency of sufentanil 

versus morphine after abdominal surgery. 

Journal of Pharmaceutical Care in Pain and Symptom 

Management 2000; 5: 3. 

PUBLICATIONS 

Grant SA, Nielsen KC, Greengrass RA, Steele SM, Klein 

SM. Continuous peripheral nerve blocks for ambulatory 

surgery. Regional Anesthesia and Pain 

Management 2000; 93(3A): A-9. 

Grant SA, Nielsen KC. Continuous peripheral nerve 

catheters for ambulatory anesthesia. Current 

Anesthesiology Reports 2000 July 2; 4: 304-307. 

Greengrass RA. Regional anesthesia for ambulatory 

surgery. Anesthesiology Clinics of North America, 

Regional Anesthesia 2000; 341-353. 

Greengrass RA, Steele SM. Regional anesthesia for ambulatory 

surgery. Problems in Anesthesia 2000; 148-158. 

Grigore AM, Grocott HP. Pro: epiaortic scanning should 

be used routinely during cardiac surgery. J Cardiothorac 

Vasc Anesth 2000; 14: 1-5. 

Grigore AM, Mathew JP. Con: magnesium should not be 

administered to all coronary artery bypass graft surgery 

patients undergoing cardiopulmonary bypass. J 

Cardiothorac Vasc Anes 2000; 14: 344-346. 

Grigore AM, Phillips-Bute B, Grocott HP, Butler A, 

Stanley T, Reves JG, Newman MF. The association of 

rewarming rate and neurocognitive dysfunction after 

cardiac surgery. Anesth Analg 2000; 90: SCA34. 

Grocott HP, Mackensen GB. A recovery model of complete 

cardiopulmonary bypass in the rat. Perfusion 

2000; 15: 1-7. 

Grocott HP, Schinderle D, Scales G, King KP. A new 

method for lung isolation in acute thoracic trauma. J 

Trauma 2000; 49: 1-3. 

Helsley SE, Bell E, Breen T, Penning D. Total spinal anesthesia 

requiring tracheal intubation in parturients: the 

association with failed epidural anesthesia. 

Anesthesiology 2000; 93(3A): A1078. 

Hendricks DM, Pollock NW, Natoli MJ, Vann RD. 

Mountaineering oxygen mask performance at 4572 m. 

Aviat Space Environ Med 2000; 71: 1142-1147. 

Hill RP, Lubarsky DA, Phillips-Bute B, Fortney J, Creed M, 

Glass PSA, Gan TJ. Cost effectiveness of prophylactic 

antiemetic therapy with ondansetron, droperidol or 

placebo. Anesthesiology 2000; 92: 958-967. 

PUBLICATIONS 137

PUBLICATIONS 

Hill SE, van Wermeskerken GK, Lardenoye J-W, Phillips- 

Bute B, Smith PK, Reves JG, Newman MF. Intraoperative 

physiologic variables and outcome in cardiac 

surgery: part in-hospital mortality. Ann Thorc Surg 

2000; 69: 1070-1076. 

Hilton AK, Jaggers J, Mathew J. An unexpected flow 

abnormality. J Cardiothorac Vasc Anes 2000; 14: 

347-349. 

Hogue S, Reese PR, Colopy M, Fleisher L, Tuman K, 

Twersky RS, Warner DS, Jamerson BD. Validation 

of a tool to measure patient functional ability following 

outpatient surgery. Anesth Analg 2000; 91: 97-106. 

Iselin-Chaves I, El Moalem H, Gan TJ, Ginsberg B, Glass 

PSA. Changes in the auditory evoked potentials and 

the bispectral index following propofol or propofol 

and alfentanil. Anesthesiology 2000; 92: 1300-1310. 

Joseph A, Cassell C, Garcia-Rodriguez C, El-Moalem HE, 

Sum Ping ST. Effects of dexmedetomidine on respiration. 


Joshi G, Jamerson B, Roizen MF, Fleisher L, Twersky RS, 

Warner DS, Colopy M. Is there a learning curve associated 

with the use of remifentanil? Anesth Analg 2000; 

91: 1049-1055. 

Kantrow SP, Tatro LG, Piantadosi CA. Oxidative stress and 

adenine nucleotide control of mitochondrial permeability 

transition. Free Rad Biol Med 2000; 28:251-260. 

Kilts JD, Gerhardt MA, Richardson MD, Sreeram GM, 

Burkhard G, Grocott HP, White WD, Newman MF, 

Reves JG, Schwinn DA, Kwatra MM. (2-adrenergic and 

several other G protein-coupled receptors in human 

atrial membranes active both GS and GI: GI proteincoupling 

in human heart. Circulation Research 2000; 

87: 705-709. 

King KP, Stolp BW, Borel CO. Hidden Damage to a Reinforced 

LMA-Fastrach Endotracheal Tube (Response). 

Anesth Analg 2000; 90: 1251. 

Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass 

RA. Thoracic paravertebral block for breast surgery. 

Anesth Analg 2000; 90: 1402-1405. 

Klein SM, Grant SA, Greengrass RA, Nielsen KC, Speer KP, 

White W, Warner DS, Steele SM. Interscalene brachial 

plexus block with a continuous catheter insertion system 

and a disposable infusion pump. Anesth Analg 

2000; 91(6). 


Klein SM, Slaughter TF, Vail PT, Ginsberg B, El-Moalem 

HE, Alexander R, D’Ercole F, Greengrass RA, Thangam 

TM, Welsby IJ, Gan TJ. Thromboelastography as a 

perioperative measure of anticoagulation resulting 

from low molecular weight heparin: A comparison 

with anti-Xa concentrations. Anesth Analg 2000; 91: 

1091-1095. 

Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass 

RA. Thoracic paravertebral block for breast surgery. 

Anesth Analg 2000; 90: 1402-1405. 

Klein SM. Ambulatory Anesthesia for the 21st Century. 

Surgical Services Management 2000; 6: 45-47. 

Klein SM. Clinical trial review. Current Anesthesiology 

Reports 2000; 2: 267-268. 

Klein SM. Ambulatory anesthesia, Current Anesthesiology 

Reports 2000; 2(4). 

Knudsen NW, Fulkerson WJ, Sebastian MW. Family communication 

enhanced by 24 hour in house intensivists. 

Critical Care Medicine 2000; 4(4): 256-264. 

Lardenoye HW, van Wermeskerken V, Hill SE, Grocott 

HP, Phillips-Bute B, Smith PK, Reves JG, Newman MF. 

Association of intraoperative physiologic variables 

with outcome in cardaic surgery: part II, neurologic 

outcome mean arterial pressure, minimum hematocrit 

and maximum glucose with neurologic. Ann Thorac 

Surg 2000; 69: 1077-1083. 

Lubarsky D, Fisher SD, Slaughter TF, Lineberger C, Green 

CL, Wildermann N, Greenberg CS, Inge W, Krucoff 

MW. Myocardial ischemia correlates with reduced fibrinolytic 

activity following peripheral vascular surgery. 

J Clin Anesth 2000; 12: 136-141. 

Mackensen GB, Grocott HP, Pineda J, Newman MF. 

Neurological and neurocognitive dysfunction following 

cardiopulmonary bypass in the rat. Anesth Analg 

2000; 90: SCA36. 

Mackensen GB, Nellgård B, Kudo M, Sheng H, Pearlstein 

RD, Warner DS. Periischemic cerebral blood flow 

does not explain beneficial effects of isoflurane on outcome 

from near-complete forebrain ischemia in rats. 

Anesthesiology 2000; 93: 1102-1106. 

Mackensen GB, Nellgård B, Sarraf-Yazdi S, Dexter F, 

Steffen RP, Warner DS. Postischemic RSR13 amplifies 

the effect of dizocilpine on outcome from transient 

focal cerebral ischemia in the rat. Brain Res 2000; 853: 

15-21.

Mackensen GB, Stanley TO, Grocott HP, Cohen WM, 

Phillips-Bute BG, Reves JG, Newman MF. Temperature 

after cardiopulmonary bypass: can we do better? The 

Annual of Thoracic Surgery 2000; 70: 1793. 

Martin G, Gan TJ. Gender: hype or fact. Seminars in 

Anesthesia, Perioperative Medicine and Pain 2000; 19: 

76-92. 

Michelotti GA, Price DT, Schwinn DA. Alpha-1 adrenergic 

receptor regulation: basic science and clinical implications. 

Pharmacol Ther 2000; 88: 1-2. 

Michelotti GA, Price DT, Schwinn DA. Regulation and 

clinical implications of alpha-1-adrenergic receptor 

function. Pharmacol and Therapeut 2000; 83: 281-309. 

Moon RE. Adjunctive therapy in decompression illness: 

present and future. SPUMS J 2000; 30: 99-112. 

Moon RE. All divers with decompression illness require 

recompression. SPUMS J 2000; 30: 149-151. 

Moon RE. Recompression treatment should only be 

administered in a hospital-based facility. SPUMS J 

2000; 30: 161-163. 

Moon RE. Recompression treatments should be to a pressure 

equivalent to 18 m depth. SPUMS J 2000; 30: 

152-154. 

Moon RE. The natural progression of decompression illness 

and development of recompression procedures. 

SPUMS J 2000; 30: 36-45. 

Muir H. Patient controlled analgesia in labor. Current 

Anesthesiology Reports. 2000; 2: 25-29. 

Nebreda CL, Urban BJ, Taylor AE. Upper extremity pain 

of ten years duration caused by glomus tumor. 

Regional Anesthesia and Pain Medicine 2000; 25(1): 

69-71. 

Nebreda CL, Urban BJ. Use of diagnostic spinal anesthesia 

in women with chronic pelvic/lower abdominal. 

American Journal of Pain Management 2000; 10(3): 

98-102. 

Nellgård B, Mackensen G, Pineda J, Wellons JC, Pearlstein 

RD, Warner DS. Anesthetic effects on cerebral metabolic 

rate predict histologic outcome from near complete 

forebrain ischemia in the rat. Anesthesiology 

2000; 93: 431-436. 

PUBLICATIONS 

Nellgård B, Mackensen GB, Massey G, Pearlstein RD, 

Warner DS. The effects of anesthetics on stress 

responses to forebrain ischemia and reperfusion in the 

rat. Anesth Analg 2000; 91: 145-151. 

Newman MF, Grocott HP, Stanley TO, Mackensen GB, 

Kirchner JL, Mark DB, Bluemthal JA. Neurocognitive 

dysfunction and quality-of-life after cardiac surgery. 

Anesth Analg 2000; 90: SCA4. 

Newman MF, Stanley TO, Grocott HP. Strategies to 

protect the brain during cardiac surgery. Sem 

Cardiothorac Vas Anesth 2000; 4: 53-64. 

Niklason, LE. Engineering of bone grafts. Nature 

Biotechnology 2000; 18: 929-930. 

Nozik-Grayck E, Dieterle C, Piantadosi CA, Enghild J, Oury 

T. Secretion of active EC-SOD in neonatal lung. Am J 

Physiol (Lung Cell Mol Physiol) 2000; 279: 977-984. 

Olufolabi AJ, Bell ED, Hartle AJ. Probability of difficult 

tracheal intubation in the obstetric population: does 

ethnic origin matter? Anesthesiology 2000; 93(3A): 

A1089. 

Olufolabi A, Booth JV, Wakeling H, Glass PS, Penning DH, 

Reynolds JD. A preliminary investigation of remifentanil 

as a labor analgesic. Anesth Analg 2000; 91: 606- 

608. 

Ongjoco RRS, Richardson CD, Rudner XL, Stafford-Smith 

M, Schwinn DA. Adrenergic receptors in human dorsal 

root ganglia: predominance of alpha-2b and alpha- 

2b subtype mRNAs. Anesthesiology 2000; 92: 968-976. 

Panten RR, Harrison JK, Warner J, Grocott, HP. Aortic dissection 

following angioplasy and stenting of an aortic 

coarctation: detection by intravascular ultrasound but 

not transesophageal echocardiography. Anesth Analg 

2000; 90: SCA95. 

Price DT, Rudner X, Michelotti GA, Schwinn DA. 

Immortalization of a human prostate cell line using a 

recombinant retroviral approach. J Urol 2000; 164: 

2145-2150. 

Reynolds JD, Grubbs EG, Dexter F, Punnahitananda S, 

Dense TA, Penning DH. Acute cord occlusion increases 

blood ionized magnesium concentration in preterm 

fetal sheep during maternal magnesium sulfate exposure. 

Can J Physiol Pharmacol 2000; 78: 301-306. 

Ross AK, Eck JB, Tobias JD. Pediatric regional anesthesia: 

beyond the caudal. Anesth Analg 2000; 91: 16-26. 

PUBLICATIONS 139

PUBLICATIONS 

Schulman SR. Sedation in the Pediatric Intensive Care 

Unit. Curr Anesth Rep 2000 Nov; 2(6): 504-509. 

Schwinn DA. Latest results of the research on alpha-1adrenoceptor 

subtypes. Drugs of Today 2000; 36: 7-9. 

Schwinn DA. Novel role for alpha-1-adrenergic receptor 

subtypes in lower urinary tract symptoms. Br J Urol 

Intl 2000; 86: 11-22. 

Schwinn DA, Michelotti GA. Alpha-1-adrenergic receptors 

in the lower urinary tract and vascular bed: potential 

role for the alpha1D-subtype in filling symptoms and 

effects of aging on vascular expression. Eur J Urol 

2000; 85: 6-11. 

Sharma AB, Bittner HB, Sreeram G, Slaughter TF. 

Diagnostic dilemma: interesting right ventricular 

transesophageal echocardiography findings. J 

Cardiothoracic Vasc Anesth 2000; 14: 617-619. 

Sharma AD, Slaughter TF. Utilization of a retrograde cardioplegia 

catheter for rapid central venous infusion. 

Anesth Analg 2000; 91: 1560-1565. 

Sharma AD, Sreeram G, Erb T, Grocott HP, Slaughter TF. 

Leukocyte-reduced blood transfusions: perioperative 

indications and implications. Anesth Analg 2000; 90: 

131-133. 

Sharma AD, Sreeram G, Slaughter TF. Renal cell carcinoma 

with extensive involvement of the inferior 

vena cava and right atrium: diagnostic utility of intraoperative 

transesophageal echocardiography. Am J 

Anesthesiology 2000; 27(7): 425-428. 

Sharma AD, Sreeram G, Slaughter TF. Spontaneous coronary 

artery dissection (SCAD) in a 24 y/o healthy 

female. J Cardiothoracic Vasc Anesth 2000; 14: 

312-313. 

Sheng H, Kudo M, Mackensen GB, Pearlstein RD, Crapo 

JD, Warner DS. Mice overexpressing extracellular 

superoxide dismutase have increased tolerance to 

global cerebral ischemia. Exp Neurology 2000; 163: 

392-398. 

Slaughter TF, Mark JB. Heparin-mediated hypotension 

associated with cardiac surgery. Anesth Analg 2000; 

91: 766-767. 

Soppitt AJ, Glass PSA, Howell S, Weatherwax K, Gan TJ. 

The use of propofol for its antiemetic effect: a survey 

of clinical practice in the United States. J Clin Anesth. 

2000; 12: 265-269. 


Soppitt AJ, Gan TJ, Sanderson I, Weatherwax K, Glass 

PSA. Duration and recovery profile of cisatracurium 

after succinylcholine during propofol and isoflurane 

anesthesia. J Clin Anesth. 1999; 11: 652-656. (Omitted 

in the 1999 Annual Report publication section.) 

Spear-Smith J, Brien JF, Grafe M, Allrich R, Reynolds JD. 

Chronic ethanol exposure during late gestation produces 

behavioral anomalies in neonatal lambs. 

Neurotox Teratol 2000; 22: 205-212. 

Sreeram GM, Grocott HP, White WD, Stafford-Smith M, 

Newman MF. Transcranial doppler emboli count predicts 

rise in creatinine following coronary artery 

bypass graft surgery. Anesth Analg 2000; 90: SCA37. 

Stafford-Smith M, Phillips-Bute, Reddan D, Black J, 

Newman MF. The association of (-Aminocaproic with 

postoperative decrease in creatinine clearance in 1502 

coronary bypass patients. Anesth Analg 2000; 91: 

1085-1090. 

Stafford-Smith M, Redden D, Newman MF, Phillips-Bute, 

Winn M. Association of postop peak and fractional 

serum creatinine change with post-CABG mortality. 


Stafford-Smith M, Redden DN, Philips-Bute, Newman MF, 

Winn MP. Markers of renal dysfunction as outcome 

predictors in coronary artery bypass (CABG) patients. 

J American Society of Nephrology (ASN), 2000; 

September, Toronto, Canada. 

Stafford-Smith M, Schwinn DA. In Situ hybridization 

of adrenergic receptor mRNA in brain. Adren Recep 

Protoc 2000; 136: 519-533. 

Stanley TO, Grocott HP, Phillips-Bute B, Newman MF. 

Aortic atheroma and the risk of stroke and encephalopathy 

after cardiac surgery. Anesth Analg 2000; 90: 

SCA38, 2000. 

Stover EP, Siegel LC, Body SC, Levin J, Parks R, Maddi R, 

D’Ambra MN, Mangano DT, Spiess BD. Institutional 

variability in red blood cell conservation practices for 

coronary artery bypass graft surgery. J Cardiothorac 

Vasc Anes 2000; 14: 171-176. 

Taekman JM, Web alert. Current Anesthesiology Reports 

2000 Jan 1; 2(1): 3-4. 


2000 July 1; 2(4): 259-260.


2000 Mar 1; 2(2): 90-91. 


2000 May 1; 2(3): 165. 

van Wermeskerken GK, Lardenoye J-W, Hill SE, Grocott 

HP, Phillips-Bute B, Smith PK, Reves JG, Newman MF. 

Intraoperative physiologic variables and outcome in 

cardiac surgery: part II. Neurologic Outcome. Ann 

Thorc Surg 2000; 69: 1077-1083. 

Warner DS, Petrozza P. Journal Club: J Neurosurg Anesth 

2000; 12: 152-158. 


2000;12: 279-86. 


2000; 12: 376-81. 

Warner DS. Opioid management for intracranial tumor 

resection. Eur J Anesth 2000; 17 19S: 96-8. 


2000; 12: 62-69. 

Weissleder R, Moore A, Mahmood U, Bhorade R, 

Benveniste H, Chiocca EA, Basilion JP. In Vivo MR 

Veltkamp R, Warner DS, Domoki F, Brinkhous AD, 

Toole JF, Busija DW. Hyperbaric oxygen decreases 

infarct size and behavioral deficit after transient focal 

cerebral ischemia in rats. Brain Res 2000; 853: 68-73. 

Wellons JC, Sheng H, Laskowitz D, Mackensen GB, 

Pearlstein RD, Warner DS. A comparison of strainrelated 

susceptibility in two murine recovery models 

of global cerebral ischemia. Brain Res 2000; 868: 14-21. 

Welty-Wolf KE, Carraway MS, Ghio A, Kantrow SP, Huang 

YCT, Piantadosi CA. Pro-inflammatory cytokines increase 

in sepsis after anti-adhesion molecule therapy. 

Shock 2000; 13: 404-409. 

Wright D, Gan TJ. Do we need a measure of anesthetic 

depth? Current Anesthesiology Reports 2000; 2: 283- 

287.8. 

Young CC, Knudsen NK, Hilton AK, Reves JG. Sedation in 

the intensive care unit. Critical Care Medicine 2000; 28: 

854-866. 

Books 

PUBLICATIONS 

Gallagher CJ, Hill SE, Lubarsky DA. Board Stiff Too: 

preparing for the anesthesia orals. 2nd ed. Miami: 

Butterworth-Heinemann; 2000. 

Nebreda, CL, Urban BJ. Fields H, Scholz R, eds. Manual 

de Drogas Usadas en el Manejo del Dolor Cronico. Seattle 

WA: IASP Press; 2000. 

Book Chapters 

Booth JV, Schwinn DA. Sites of drug action. Hemmings 

H, Hopkins P, editors. Basic and applied science for 

anesthesia. Philadelphia: Mosby International; 2000. 

p. 65-72. 

Clements FM. Transesophageal echocardiography in 

minimally invasive cardiac surgery. Skarvan K, 

Poelaert J, editors. Transesophageal echocardiography 

in anaesthesia. London: BMJ; 2000. p. 242. 

Croughwell ND, Newman MF. Jugular bulb monitoring. 

Newman S, Harrison M, editors. The brain and cardiac 

surgery. Switzerland: Hardwood Academic Publishers; 

2000. p. 165-171. 

Dear GL, Panten RR, Lubarsky DA. Operating room information 

systems. Katz RL, Ward DS, editors. Seminars 

in Anesthesia, Perioperative Medicine and Pain. 

Philadelphia: WB Saunders Company; 1999. p. 322-333. 

(Omitted in the 1999 Annual Report publication 

section.) 

Garcia-Rodriguez CR, Hilton AK, Mark JB. Intraoperative 

hemodynamic monitoring. Willerson JT, Cohn JN, editors. 

Cardiovascular Medicine. 2nd ed. New York: 

Churchill Livingstone; 2000. p. 2116-2141. 

Grocott HP, Laskowitz DT, Newman MF. Markers of cerebral 

injury. Newman S, Harrison M, editors. The Brain 

and Cardiac Surgery. Switzerland: Hardwood 

Academic Publishers; 2000. p. 113-142. 

Mark JB, Slaughter TF, Reves JG. Cardiovascular monitoring. 

Miller RD, editor. Anesthesia. 5th ed. 

Philadelphia: Churchill Livingstone; 2000. p. 1117- 

1206. 

Moretti E. Handbook of surgical intensive care. Chapter 

23: Anesthesia and Analgesia. 5th ed. Mosby 

International Ltd; 2000. p. 415-432. 

PUBLICATIONS 141

PUBLICATIONS 

Piantadosi CA. Altitude Illness. Encyclopedia of Life 

Sciences. 2000. 

Piantadosi CA. RL Harris, editor. Physiology of altered 

barometric pressure. Patty's Industrial Hygiene, Fifth 

Edition, John Wiley & Sons, Inc, 2000. Vol. 2, Chapter 

23: 985-1014. 

Piantadosi CA. The Brain. Pulmonary and Peripheral Gas 

Exchange in Health and Disease. Roca, Rodrigues- 

Roisin and Wagner, editors. 2000. 16: 435-445. 

Vann RD, Denoble PJ, Gerth WA. Reverse Dives and 

Project Dive Exploration. Reverse dive profiles workshop. 

Lang and Lehner, editors. Oct 29-30, 1999; 

Washington, DC, Smithsonian Institution; 2000. 

p. 181-187. 

Warner DS, Todd MM. Anaesthesia and the nervous system. 

Crockard A, Hayward R, Hoff JT, editors. 

Neurosurgery. Oxford UK: Blackwell Science; 2000. 

p. 557-571. 

Conference Papers 

Gan TJ. Current controversies in the management of 

PONV. Advances in anesthesia research and patient 

management. Luncheon Symposium in conjunction 

with IARS 74th Clinical and Scientific Congress; Mar 

13; 2000. p. 2-4. 

Gan TJ. New perspectives in the management of PONV. 

Key issues in outpatient and office-based anesthesia. 

An educational symposium held in conjunction with 

the Society for Ambulatory Anesthesia 15th Annual 

Meeting; May 4; 2000. p. 19. 

Gan TJ. Postoperative pain still major concern of patients 

undergoing surgery.American Society of Anesthesiologist 

Annual Meeting; Oct 14-18; San Francisco, 

California; 2000. p. 9-12. 

Hill SE. Blood product use and blood substitutes. 

Grichnik K, editor. Third Annual Duke University 

Medical Center Cardiothoracic Update; Jun 22-25; 

Kiawah Island, South Carolina; 2000. p. 38-42. 

Hall J, Schulman SR, Kern FH, Erb T. Comparing the incidence 

of postoperative nausea and vomiting in 

radiofrequency catheter ablation: propofol versus 

isoflurane. Duke University Medical Center: 

Department of Anesthesiology Academic Evening; May 

2; Durham, North Carolina; 2000. p. 33. 


Hill SE. Oxygen therapeutics. Cheng D, Feindel C, editors. 

Blood conservation in cardiac surgery. Canadian 

Cardiovascular Congress Satellite Symposuim; Oct 28; 

Vancouver, British Columbia, Canada; 2000. p. 25-30. 

Klonin H, Henry J, Moses JW, Clark RL, Schulman SR. 

Ambient noise in pediatric intensive care. World 

Congress on Pediatric Intensive Care; June 27; 

Montreal, Quebec, Canada; 2000. 

Klein SM. Novel regional anesthesia techniques in ambulatory 

surgery. FASA Update Oct 28-31; San Fransisco, 

California; 2000. p. 1473-1478. 

Lanzinger MJ, Moretti EW, Wildermann RF, Toffaletti JG, 

Moon RE. Mechanisms of acute postoperative hypomagnesemia. 

Society of Critical Care Anesthesiologist 

Annual Meeting. Oct. 14; San Francisco, California; 

2000. 

Lockhart EM, Boustany RM, Penning DH. Progesterone 

increases cellular growth in human NT2 cells. Thirtysecond 

Annual Society for Obstetric Anesthesia and 

Perinatology Meeting; May 31-Jun 4; Montreal, 

Canada; 2000. p.13. 

Lockhart EM, Boustany RM, Penning DH. Effects of 

Allopregnanolone on NMDA-induced excitotoxicity. 

Society for Neuroscience Annual Meeting; Nov 4-7; 

New Orleans, Louisiana; 2000. p. 593. 

Olson RP. Preoperative anemia in out patient surgical 

candidates. American Society of Anesthesiologists 

Annual Meeting; Oct 14-18; San Francisco, California; 

Oct; 2000. p. 198. 

Panten R, Grichnik KP, Newman MF, Kastkis P, Landolfo 

KP. Initial experience with off-pump coronary artery 

bypass shows decreased intubation time, ICU stay and 

ICU/respiratory costs. European Society for Cardiovascular 

Anesthesia Meeting; June; Quebec, Canada; 

2000. 

Panten R, Grichnik KP, Newman MF, Kastkis P, Landolfo 

KP. Off pump coronary artery bypass, intubation 

times, and ICU stays. The International Minimally 

Invasive Cardiac Surgery Congress; June; Atlanta, 

Georgia; 2000. 

Reynolds JD, Punnahitananda S, Wang Y, Hopkins M, 

Dexter F, Penning DH. Blood ionized magnesium 

concentration in preterm fetal sheep increases during 

umbilical cord occlusion. Society for Obstetric 

Anesthesia and Perinatology Meeting 32nd Annual 

Meeting; May 31-Jun 4; Montreal, Canada; 2000. 

S(A15).

Robertson KM. Donor management. Proceedings of the 

12th World Congress of Anaesthesiologists; June 4-9; 

Montreal, Canada; 2000. p. 668-671. 

Robertson KM. Laparoscopic cholecystectomy and the 

heart transplant patient. Problem-based learning discussion 

casebook. American Society of Anesthesiologists; 

Oct 14-18; San Francisco, California; 2000. 

p. 1-6. 

Ross AK, Bailey AG, Bukowski T, Eck JB. Comparison of 

three concentrations of caudal ropivacaine for elective 

groin or lower abdominal surgery in the pediatric 

patient. Society for Pediatric Anesthesia. Feb 24-27; 

Fort Myers, Florida; 2000. p. 133. 

Schultz JR. Does the PCEA Technique Reduce the 

Number of Physician-Administered “top-ups” required 

to maintain analgesia during labor? Thirty-second 

Annual Society for Obstetric Anesthesia and Perinatology 

Meeting; May 31-Jun 4; Montreal, Canada; 2000. 

p.12. 

Invited Articles 

Gan, TJ, Bennett-Guerrero E, Mythen M. Excessive use 

of hetastarch: an iatrogenic cause of bleeding and 

hypocalcemia? (response letter). Anesthesia and 

Analgesia 2000; 90: 1455-1456. 

Klein SM, Benveniste H. In reply [letter]. Reg Anesth Pain 

Med 2000; 25: 104. 

Klein SM, Greengrass RA, Steele SM, Grant SA, Nunley JA. 

Major ambulatory surgery with continuous regional 

anesthesia and a disposable infusion pump. In Reply 

[letter]. Anesthesiology 2000; 93: 582-3. 

PUBLICATIONS 

Kwatra MM. Cognitive function after non-brain surgery 

studied: second Duke conference on surgery and the 

elderly. (ASA Newsletter) 2000; 64(5): 10-11. 

Mythen M, Gan TJ. Intraoperative plasma volume optimization 

and postoperative outcome. (special report). 

Anesthesiology News 2000; 1-7. 

Ross AK. Lumbar epidurals should be performed in children 

under general anesthesia. (newsletter). Society 

for Pediatric Anesthesia 2000; 13: 10-12. 

Warner DS. Editorial Comment. Stroke 2000; 31: 191-192. 

Warner DS. Isoflurane neuroprotection: A passing 

fantasy, again? (editorial) Anesthesiology 2000; 92: 

1223-1225. 

Warner DS. Neuroanesthesia 2000 [editorial]. Anesth 

Analg 2000; 90: 1238-1240. 

Rosemary Cumbie Edward Cousineau 

PUBLICATIONS 143

144

145

HISTORY OF THE DEPARTMENT OF ANESTHESIOLOGY 

Like many American Departments of Anesthesia, the roots of the current Department lay in nurse anesthesia. 

In fact, from 1930 to 1944 all anesthesia at Duke was administered by nurses under the supervision of surgeons. 

Duke had one of the first schools of nurse anesthesia, begun in 1931 and pioneered nurse anesthesia education 

by extending the duration of education to two years in 1966. Dr. Ruth Martin was recruited as the first physician 

anesthetist in 1944 and she was succeeded in 1950 by the brilliant and energetic leader of anesthesia, Dr Ronald 

Stephen from Canada. During the Stephen years, the anesthesia residency flourished, as did clinical research. 

The residency grew from a number of 3 to 16 when Dr. Stephen left Duke in 1966. 

The Division of Anesthesia of the Department of Surgery became an independent academic Department of 

Anesthesia in 1968 under the guidance of Dr. Sarah Dent. In 1971, the distinguished professor and Chairman of 

Anesthesia at New York Downstate Medical Center and at the Pritzker School of Medicine in Chicago, Dr. Merel H. 

Harmel was recruited to Duke to continue to develop the young Department. The Department grew in quality and 

quantity with the addition of faculty and residents as well as the inauguration of a basic science research program. 

Clinical programs also were developed during this time with new programs in critical care medicine, hyperbaric 

medicine and pain management. Dr. Harmel retired from the chairmanship in 1983 and was followed by Dr. W. 

David Watkins who was recruited from the Harvard system. Dr. Watkins emphasized a strong residency program 

and increased the size from 29 to 50 residents in the seven years of his leadership. The Department continued to 

play an important institutional role boasting the Clinical Director of the Hyperbaric Medicine Center, Director of the 

Pediatric Intensive Care Unit, Co-Director of the Surgical Intensive Care Units at the VA and Duke Hospitals, and 

Director of the Duke Heart Center. Research also continued to expand as reflected by additional Ph.D. faculty and 

the award of multiple outside grants. 

The Department is now led by Dr. Jerry Reves, a cardiac anesthesiologist, whose plans include the development 

of stronger subspecialty anesthesia programs, creation of more fellowships, and emphasis of research in molecular 

pharmacology, neurobiology, and clinical pharmacology. With steady progress through the years, the Department 

is now poised to be one of the very few centers of academic excellence in the field of anesthesiology. All the 

requirements are in place: an outstanding well organized residency education program, a large and diverse clinical 

case load of over 35,000 operations and deliveries, superb facilities, solid research base, a first-rate Department of 

Surgery with which to work closely, and a Medical Center Administration committed to an Anesthesia Department 

of the highest order. This is probably the most exciting time in the entire history of Duke Anesthesia.

Rosemary W. Cumbie 

Special Assistant, 

Clinical Programs 

Editor 

EDITORIAL STAFF 

Eris Joffe 

Staff Assistant 

Assistant Editor 

The editorial staff appreciates the helpful support of J.G. Reves, M.D., each physician, 

and support staff for their contribution(s) to this successful report. 

Lou Ellen Andrews 

Elizabeth Barbee 

Patsy Clifton 

Rosemary Cumbie 

Emily Coburn 

Tammy Evans 

Carmen Hurst 

Larry Dowell 

Tammy Evans 

Jessica Harris 

Linda Harris 

Malissa Harris 

COORDINATORS 

Photographs 

Lectures 

Tonya Meadows 

Richard Moon 

Julie Rosato 

Beverly Hester 

Gloria Howard 

Carmen Hurst 

Wanda Johnson 

Karen Ramsey 

Kimberly Westbrooks 

Connie Winstead 

Patti Yetsko 

Cases by Divisions/Sections Grant Ranking 

William Gilbert Patricia Cruse 

Institutional Review Board Research Grants and Anesthesiology Research Dollars 

T.J. Gan Patricia Cruse 

Angela Rogers 

Departmental Committees, Clinical Divisions and Sections, Laboratory Programs, 

Publications, Duke Faculty Chairs, ASA Alumni Reception, Division Chiefs and Committee Chairpersons 

Rosemary Cumbie 

Eris Joffe 

FRONT AND BACK PHOTOGRAPHY 

Ronald L. (Butch) Usery, Division of Audiovisual Education 

Shery Strickland 

Helen Trotter 

Pamela Upadhaya 

Patti Yetsko



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DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT

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