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Department of Anesthesiology
Duke University Medical Center
Box 3094
Durham, NC 27710

Office of Medical Education
Duke University Medical Center
Box 3005
Durham, NC 27710

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General, Vascular, High-Risk Transplant & Critical Care Medicine

Clinical Program

The responsibilities of the GVTCCM division encompass the complete perioperative experience. A clinical day may include directing the Preoperative Screening Unit, supervising residents or CRNAs in the OR, operational management of the OR, medically supervising and teaching in the PACU, or providing critical care expertise in the SICU.

The faculty provide comprehensive clinical anesthesiology services for patients undergoing general surgery, peripheral and major vascular surgery (open and endovascular), urologic, trauma, and abdominal transplantation operations (donor and recipient; pancreas, kidney, and liver). This is a very busy service with our monthly OR block utilization at times exceeding 100%, due to the emergency leveled cases that are accommodated during daytime hours. Our OR time has been expanded to include covering an OR procedural room (central access in patients with pulmonary hypertension, trach/PEG and vascular access for hemodialysis), robotic laparoscopic prostatectomies, and living-related donor hepatectomy for pediatric liver transplantation. Each of our faculty have advanced training and subspecialty interests which affords our group the luxury of have immediate consultation with an “in-house expert” directed at optimizing the care of our patients in this tertiary care clinical practice. Excellence in patient care continues to be the highest priority of the division.

The development of automated anesthesia information systems (Saturn) and outcomes databases has been crucial in facilitating perioperative outcomes research directed towards organ protection and the establishment of “best practices.” The impact on our clinical practice includes the establishment of peer-reviewed clinical practice guidelines for specific conditions, access to new therapeutic approaches, cost reduction, development of innovative patient care for new surgical techniques (robotic laparoscopic surgery, living donor for pediatric liver transplantation and recurrent laryngeal monitoring), and reduction of medical liability. Every member of this dynamic division deserves accolades for their continued commitment, energy, and enthusiasm with which they pursue their clinical subspecialty and research interests.

Preoperative Screening Unit

The Preoperative Screening Unit (POSU) is a joint venture of the hospital and the departments of surgery and anesthesiology. It is here that patients scheduled for surgery at Duke undergo a comprehensive evaluation by nurse practitioners, physician assistants, and nurses. Clerical and technical staff assist with investigations and coordination of care. Medical management and consultations are initiated and coordinated as indicated. Patients are educated on the perioperative experience, anesthesia consent is obtained, and anesthesiologists are consulted and informed regarding special needs that may arise. All this is documented in an electronic medical record which is available online and is contiguous with the intraoperative record.

The medical care is supervised by physicians from the GVT division. Drs David Wright and Ron Olson are the Medical Co-Directors.

A syllabus with pdf files of current statements, guidelines, and journal articles in the Perioperative Medicine field are available here.

Training Program

Resident, fellow, medical student and student CRNA education are top priorities for the entire faculty in this division. Our faculty are consistently rated by the residents as highly effective teachers in the OR, as well as during didactic lectures and oral board preparation. Our weekly divisional CME accredited lecture series has continued to grow in popularity. The residents are asked to prepare a case presentation with learning objectives, while faculty share their research, lectures, and clinical experiences with discussion and comments encouraged from the participants. In addition, invited guest lecturers share their expertise and novel insites targeting a variety of clinical and basic science topics. The overriding goal is to establish “best practice” guidelines and continuing excellence in patient care.

Research Program

The research potential of the division continues to grow through recruitment of new faculty and diligent efforts to acquire funding through industry sponsorship or grant support. Quarterly evaluation of our publications record, faculty mentorship, personal diligence and a mutually supportive environment have been the keys to maintaining our consistently high level of productivity.

TJ Gan, MD, is a Professor of Anesthesiology and Medical Director of Clinical Anesthesia Research Endeavor (CARE), a clinical research organization for the department. He is an acknowledged world expert in antiemetic drug therapies, hetastarch solutions for volume resuscitation and acupuncture techniques to reduce postoperative nausea and vomiting. He is currently conducting numerous industry and organization funded clinical research projects in antiemetic therapy, analgesics and intraoperative fluids. Dr. Gan is the driving force behind the departmental objective to establish a comprehensive postoperative database to measure perioperative outcomes and ultimately establish “best practice” directives for patient care. Dr. Gan is a member of the editorial board of Anesthesia and Analgesia, and serves as secretary of the Society of Ambulatory Anesthesia (SAMBA) and treasurer of the International Society of Anesthetic Pharmacology (ISAP). He also serves on the Board of Directors of both organizations and numerous ASA committees. Dr. Gan is pursuing his Master’s Degree of Health Sciences in Clinical Research.

Eugene Moretti, MD, is a Duke anesthesia graduate who has recently completed formal studies and defended his thesis toward a Master’s Degree of Health Sciences in Clinical Research. He has also been awarded a FAER grant where he is studying “Genetic Polymorphisms and Susceptibility to Sepsis in the Elective Surgical Population.” As a requirement for the grant he is spending a significant portion of his bench research time in the laboratory of his mentor Dr. Debrah Schwinn. In the laboratory he is learning various molecular biology techniques that will enable him to complete his FAER project. In addition, Dr. Moretti’s continuing commitment to patient care finds him in the Duke North OR, as an intensivist in the surgical intensive care unit, and as an active participant on the liver transplant team.

In addition to his participation in the GVTCCM division, Richard Moon, MD, serves as Medical Director of the Center for Hyperbaric Medicine and Environmental Physiology. During 2004, one of the many projects Dr. Moon worked on was entitled, Effect of Altitude Acclimatization on Lung Nitric Oxide and Carbon Monoxide Concentration and Vascular Tone in Humans. He is also working on the fractal properties of the breathing pattern.

The Preoperative Screening Unit under the leadership of Medical Director, Dr. Ronald Olson, continues to serve as the focal point for preoperative assessment and optimization of patients scheduled for elective surgery at Duke. The staff perform a complete history and physical examination, order appropriate consultations and studies, as well as educate patients about the perioperative experience. Where appropriate, medical conditions are managed in cooperation with the patient’s local physicians, consultants, and the surgeon. Consistency in high quality care and education of the patients is maintained through continual feedback from anesthesiologists and surgeons. Our goal is that on the morning of surgery, the patient will have been assessed, optimized and educated with the documentation complete and available. The coming year will see further progress toward making the record an electronic one, which will be available throughout the hospital system and provide a research database. The option of telephone screening of low risk patients will be cautiously expanded. As we increasingly provide services which are over and above the standard preoperative assessment, appropriate compensation for those services will be optimized.

David R. Wright, BM, FRCA, has a very active clinical role within our division, as well as on the liver transplantation team. He has an interest in evoked potential monitoring which he uses in the OR to monitor the integrity of the recurrent laryngeal nerve during thyroidectomy. He is also involved in a clinical study investigating the potential usefulness of the long latency auditory evoked P300 response as a measurement of neurocognitive performance in patients undergoing knee replacement under general or regional anesthesia. Dr. Wright is responsible for organizing the divisional CME weekly conference, which is a useful educational forum for CRNAs, residents, and faculty.

Catherine K. Lineberger, MD, has been a member of the division since its creation. Her clinical interests revolve principally in the vascular anesthesia domain. Apart from her clinical work, Dr. Lineberger’s major administrative activities are predominantly involved with the residency training program in her capacity as Residency Program Director. Dr. Lineberger has participated at the ASA as a problem-based learning discussion moderator for the past ten years and was elected to the PBLD Committee of the ASA in 2001. She is currently the President of the Society for Education in Anesthesia (SEA). She is a faculty member in the annual SEA Teaching Workshop, a week-long intensive course designed to teach a variety of clinical, administrative, and educational theory topics to practicing anesthesia faculty members. This year Dr. Lineberger assisted the Residency Review Committee of the Accreditation Council on Graduate Medical Education as a Specialist Site Visitor. In addition, she was nominated for and selected as a Fellow in the Executive Leadership in Academic Medicine program at Drexel University.

Tony Roche, MD, from Cape Town, South Africa, was trained in anesthesiology at University College London, UK. He is a member of the Perioperative Leaders Group for Duke North Perioperative Service, and is a consulting physician for the Center for Blood Conservation at DUMC. He has been asked to serve on the Society for the Advancement of Blood Management Nominating Committee, and was recently the recipient of an IARS Clinical Scholar Award for his research into perioperative changes in coagulation and endothelial function. Dr. Roche’s other research interests include coagulation and hemostasis, intravenous fluid therapy and volume resuscitation, and blood conservation.

Lewis Hodgins, MD, returns to Duke University Medical Center and joins our division after an extensive career at the VAMC. His interests include clinical teaching of the residents and CRNA faculty and mastery of the topic of volatile anesthetic agents in clinical practice.

Goals

• Demonstrate excellence in patient care, research, teaching, and administrative endeavors;
• Through attendance and participation, support a weekly divisional CME for continuing education and development of best practice management guidelines;
• Optimize perioperative care of surgical patients with faculty leadership roles in the Preoperative Screening Clinic, operational management of the OR, PACU, and the SICU;
• Continue to improve workplace satisfaction: efficiency in OR operations, safety, infection control, OR design, and function;
• Continue to improve the resident teaching curriculum and provide subspecialty anesthetic care of adult and pediatric patients for liver transplantation and living-related donation; participate in establishing national policy for donation after cardiac death and transplantation and liaison between UNOS, Surgery and the American Society of Anesthesiologists;
• Support new monitoring techniques (point-of-care coagulation and RLN monitoring) and surgical innovations (robotic laparoscopic prostatectomy and living-related donation for pediatric liver transplantation);
• Continue to support efforts in integrating existing data collecting systems into a comprehensive DUHS network, develop perioperative database for outcomes assessment, formulate clinical templates reflecting best practice guidelines;
• Encourage individual faculty research interests: postoperative nausea and vomiting (PONV), hetastarch solutions and fluid management, perioperative coagulation monitoring, Human Pharmacology Laboratory (PK and PD studies), sleep studies and auditory evoked potential monitoring, hyperbaric medicine, multisystem organ dysfunction after major surgery and the potential roles of gut ischemia, endotoxin, systemic inflammation, immunity to endotoxin, and the coagulation system and resident teaching in the simulator laboratory; and
• Continue efforts to remain fiscally accountable divisionally.

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Richard E. Moon, MD, CM, M.Sc., FRCPC, FACP, FCCP
Interm Chief, Division of GVTCCM Anesthesia
Medical Director, Center for Hyperbaric Medicine and Environmental Physiology
Professor of Anesthesiology
Associate Professor of Medicine
Office: (919) 681-5805
E-mail: moon0002@mc.duke.edu

Faculty
Elliott Bennett-Guerrero, MD
Tong Joo Gan, BB, BS, FRCA
Lewis Hodgins, MD
Catherine K. Lineberger, MD
Timothy E. Miller, MB ChB, FRCA
Richard E. Moon, MD, CM, MSc, FRCP(C), FACP, FCCP
Tony Roche, MD
Kerri M. Wahl, MD, FRCP(C)

Surgical Intensive Care Unit
Nancy W. Knudsen, MD
Eugene W. Moretti, MD
Christopher C. Young, MD

Preoperative Screening Clinic
Ronald P. Olson, MD, CCFP
David R. Wright, MB, ChB

CRNA Clinical Lead
Meredith L. Muncy, CRNA, MS

CRNA Staff
Carleen Bagnall, CRNA
Leslie Cline, CRNA, MSN
Evelyn M. DeRoche, CRNA
Deborah J. Ferrero-Conover, CRNA, MSN
David R. Marion, CRNA
Debra S. Clements, CRNA, MSA
Donald R. Moede, CRNA, MS
Gayle P. Moyer, CRNA, BSN, MS
Grace Simpson, CRNA, MSN, MHS-CL
G. Lynn Stockbridge, CRNA
Donald K. Thomas, CRNA
Helen B. Walston, CRNA

Staff Support
Victoria Grossman
Christopher Keith
Thomas Pafford
Carrie Lind
Angela Rogers