DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT

CLINICAL ACTIVITIES
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.
54 CLINICAL ACTIVITIES
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
Associate Clinical Professor of
Anesthesiology
Members
T.J. Gan, M.B., B.S., FRCA
Eugene W. Moretti, M.D.
Laura E. Niklason, M.D., Ph.D.
Jacques Somma, M.D., FRCP(C)
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.