DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT

CLINICAL ACTIVITIES
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
70 CLINICAL ACTIVITIES
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