DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT
DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT
DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT
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CLINICAL ACTIVITIES<br />
WOMEN’S ANESTHESIA<br />
AND CRITICAL CARE<br />
MEDICINE<br />
Holly A Muir, M.D., FRCP(C)<br />
Chief, Division of Women's<br />
Anesthesia (DWA)<br />
Assistant Professor of Anesthesia<br />
Associate of Obstetrics and<br />
Gynecology<br />
Members<br />
Elizabeth A. Bell, M.D., M.P.H.,<br />
Terrance W. Breen, M.D.<br />
Peter D. Dwane, M.D., C.M., FRCP(C),<br />
Clinical Director<br />
Ellen M. Lockhart, M.D.<br />
Adeyemi J. Olufolabi, M.B., B.S., FRCA<br />
James D. Reynolds, Ph.D.<br />
John R. Schultz, M.D.<br />
CRNA Staff<br />
Carolyn E. Burgess, CRNA, Ph.D.<br />
Julie T. Fritz, CRNA, MSN<br />
Sarah O. Jinwright, CRNA<br />
Tede E. Spahn, CRNA<br />
Yolanda G. Wright, CRNA<br />
72 CLINICAL ACTIVITIES<br />
Clinical Service<br />
The Division of Women's Anesthesia<br />
(DWA) is responsible for obstetric and<br />
gynecologic anesthesia and provides<br />
continuous in-house faculty coverage<br />
of obstetrics. There were over 3,200<br />
deliveries in 2000. Anesthesia was<br />
involved with over 75% of these patients<br />
at some point in their care. The DWA<br />
provides all major modalities of labor<br />
analgesia including neuraxial narcotics,<br />
combined spinal-epidural analgesia<br />
(CSE), and patient-controlled epidural<br />
analgesia (PCEA).<br />
Over the past year, we have settled<br />
in to the newly constructed Duke<br />
Birthing Center. As a result of a significant<br />
change in our physical layout we<br />
needed to update departmental procedures<br />
and policies to meet the clinical<br />
demands of our service. Residents and<br />
faculty have had to endure almost daily<br />
changes in the way we do business.<br />
Efforts to improve our clinical service<br />
have included the introduction of new<br />
PACU and post-op pain orders, a new<br />
anesthesia record, and access to PCEA<br />
for all patients on labor and delivery.<br />
Unfortunately the year 2000 also resulted<br />
in the loss of the computerized record<br />
keeping system in the OR, (Arkive) with<br />
a delay in its replacement, SATURN. On<br />
the obstetric side we welcomed a new<br />
medical director for labor and delivery,<br />
Dr. Philip Heine. We are looking forward<br />
to a renewed collaborative relationship<br />
with our obstetric colleagues.<br />
The gynecology service saw significant<br />
renovation in OR’s 19 and 20 to allow<br />
for the construction of a high radiation<br />
therapy unit. This project, with direction<br />
from Dr. Peter Dwane, proceeded very<br />
smoothly. This unit allows an expansion<br />
of therapeutic modalities for our<br />
gyn-oncology patients, as well as adding<br />
some challenging anesthetic issues.<br />
Education<br />
Resident education is a major mission<br />
of the Division of Women’s Anesthesia.<br />
We have two residents rotating on<br />
obstetrical anesthesia at all times.<br />
Under the guidance of Dr. Holly Muir,<br />
the DWA Residency Director, we have<br />
reexamined and renewed our commitment<br />
to format education in obstetric<br />
anesthesia. In our continuum of<br />
change, the Divisional meeting was<br />
changed to Thursday afternoons at 5:00<br />
p.m. to avoid conflict with the GVLT<br />
and Cardiac meetings. Here faculty<br />
and fellows review important developments<br />
in the field and discuss research<br />
progress. Residents are encouraged<br />
to attend and contribute. With a good<br />
balance of high-risk and normal pregnancies,<br />
we are confident that our residents<br />
get an education in obstetrical<br />
and gynecological anesthesia that is<br />
second to none. In this new academic<br />
year, we have seen an increased interest<br />
in CA-3 and advanced clinical track<br />
rotations on the obstetric service.<br />
We offer 1-2 fellowship positions<br />
per year in obstetrical anesthesia. These<br />
fellows undertake clinical care and<br />
teaching as well as participate in clinical<br />
and laboratory research. This year<br />
saw a change in our Fellowship Director<br />
from Dr. Elizabeth Bell to Dr. Yemi<br />
Olufolabi. Under his leadership the program<br />
has flourished. This years fellows<br />
included Dr. Sheila Gardner, Dr. John<br />
Schultz and Dr. Ashraf Habib. Our fellowship<br />
program has recently introduced<br />
a new option of combining the<br />
OB experience with Cardiac Anesthesia<br />
and Echo Experience in collaboration<br />
with Dr. Mark Stafford-Smith. Interest is<br />
strong and we are seeing many superb<br />
applicants.<br />
Dr. Peter Dwane, in his capacity as<br />
coordinator of the fourth year clinical<br />
elective, facilitates the introduction of<br />
numerous medical students to the field<br />
of anesthesia, including our own service,<br />
women’s and obstetric anesthesia.<br />
Research<br />
Elizabeth A. Bell, M.D., M.P.H. continues<br />
to coordinate the Combined Obstetric<br />
Research Database (CORD). Using data<br />
obtained from the database, Dr. John<br />
Schultz, under the guidance of Drs. Bell
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