DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT

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
Jeffrey M. Taekman, M.D.
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
Dianne L. Scott, M.D.
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
CLINICAL ACTIVITIES
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 O. Borel, M.D.
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.
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