DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT
DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT
DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT
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AMBULATORY<br />
<strong>ANESTHESIOLOGY</strong><br />
Susan M. Steele, M.D.<br />
Chief, Division of Ambulatory<br />
Anesthesia<br />
Medical Director of the<br />
Ambulatory Surgery Center<br />
Director of Ambulatory and<br />
Regional Anesthesia<br />
Associate Clinical Professor of<br />
Anesthesiology<br />
MEMBERS<br />
Roy A. Greengrass, M.D., FRCP(C)<br />
Stephen M. Klein, M.D.<br />
Karen C. Nielsen, M.D.<br />
CRNA COORDINATOR FOR<br />
AMBULATORY ANESTHESIA<br />
Paula D. Alford, CRNA<br />
CRNA STAFF<br />
Narda D. Croughwell, CRNA<br />
Fred Fesel, CRNA<br />
Robert E. Foy, CRNA<br />
Ronald C. Iacone, CRNA<br />
Carolyn C. Knoop, CRNA, MSN<br />
David D. Lee, CRNA<br />
Mary K. Murphy, CRNA<br />
Flora C. O’Brien, CRNA<br />
Frances R. Smith, CRNA<br />
CLINICAL ACTIVITIES<br />
RESEARCH NURSE<br />
Aliki H. Martin, RN<br />
SUPPORT STAFF:<br />
LuAnne C. Latta, Staff Assistant<br />
Kathy K. Clifton, Administrative<br />
Secretary<br />
Linda B. Rocker, Data Entry<br />
The Division of Ambulatory Anesthesia<br />
was established on September 1, 1997<br />
and assumed daily operations at the<br />
Ambulatory Surgery Center in the North<br />
Pavilion in May 1998.<br />
Clinical Service<br />
The Division of Ambulatory Anesthesia<br />
is responsible for the delivery of all<br />
anesthesia services at Ambulatory<br />
Surgery Center (ASC) which opened<br />
to patients on July 13, 1998 in the North<br />
Pavilion. The center has nine operating<br />
rooms with seven presently functional.<br />
From July 13, 1998 through December<br />
2000, our Division provided anesthesia<br />
coverage to 12,620 patients and postoperative<br />
acute pain management services<br />
to 2203 overnight patients in our<br />
eight bed 23-hour Recovery Care Center<br />
(RCC).<br />
The Division of Ambulatory Anesthesia<br />
offers availability of a wide variety<br />
of novel regional anesthesia techniques.<br />
These ambulatory regional anesthesia<br />
techniques greatly enhance the options<br />
available to patients for both their intraoperative<br />
experience and for the management<br />
of post-operative pain.<br />
Approximately 56% of our patients<br />
had surgery under regional anesthesia<br />
or regional anesthesia/combined technique<br />
(7074 of 12,620 patients). See<br />
Table 1 for the description of the wide<br />
variety of Regional Anesthesia techniques<br />
done at the ASC. Most notably is<br />
our emphasis on the predominant use<br />
of non-central neuraxial regional techniques<br />
for both extremity and truncal<br />
surgery when possible. The peripheral<br />
nerve regional anesthesia techniques<br />
allow the most flexibility and facilitate<br />
early, stress free recovery for our ambulatory<br />
surgery patients. The excellent<br />
postoperative analgesia afforded by<br />
the use of single shot and continuous<br />
catheter peripheral nerve blockade<br />
is unparalleled. 89.2% of the patient<br />
population at our Center rate their<br />
experience with anesthesia and pain<br />
management as very satisfied 24 hours<br />
postoperatively and 89.1% 7 days postoperatively.<br />
See Table 2 for the extraordinary<br />
patient satisfaction ratings.<br />
The Duke ASC successfully implemented<br />
the Saturn Anesthesia Information<br />
System on September 13, 1999.<br />
With 28 units in our network covering<br />
the entire peri-operative event, it is one<br />
of the largest and most ambitious installations<br />
of its type in the world. The<br />
ultimate goal is to create a paperless<br />
peri-operative record.<br />
Education<br />
The Division of Ambulatory Anesthesia<br />
provides one month rotations at the ASC<br />
for CA3 and CA2 Residents. Our Division<br />
offers fellowship in Regional and<br />
Ambulatory Anesthesia. The fellowship<br />
involves peri-operative clinical patient<br />
care: Preoperative Patient Evaluation,<br />
Operative Ambulatory Regional and<br />
General Anesthesia and Acute Pain<br />
Management in the RCC. Upon completion<br />
of their fellowship training our<br />
fellows may expect to have a broad<br />
expertise in regional and ambulatory<br />
anesthesia.<br />
Our Division hosts a traineeship in<br />
Regional Anesthesia that has been very<br />
successful in establishing Duke Medical<br />
Center as a forerunner in this science.<br />
This training involves a one to two-day<br />
training opportunity in the performance<br />
of regional anesthesia techniques. This<br />
training includes OR observation and<br />
individually designed workshops for<br />
practicing board certified physicians.<br />
The response to this educational opportunity<br />
has been excellent and identifies<br />
the division as being on the cutting edge<br />
in offering didactic opportunities in<br />
regional anesthesia. This training initiative<br />
has expanded in conjunction with<br />
an AstraZeneca unrestricted educational<br />
grant. The Division of Ambulatory<br />
CLINICAL ACTIVITIES 41
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