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Otolaryngology,
Head, Neck/Neuroanesthesiology
OHN/Airway: Bret Stolp, MD, PhD, Section Chief
Clinical Program
The Otolaryngology, Head, and Neck (OHN) airway group provides anesthetic care for adults undergoing procedures such as complex head and neck surgery, airway laser surgery, and translabyrinthine acoustic surgery. In addition, this group focuses on developing, maintaining, and providing equipment and expertise for managing difficult airways in the OR and hospital environment.
Training Program
The OHN airway group continues to develop the anesthesia airway management laboratory. This laboratory is located in the vicinity of the Duke North ORs and is used on a daily basis for instruction in airway management techniques to residents, SRNAs, CRNAs, and faculty. It consists of a reference and video library, multiple difficult airway mannequins, task trainers and intubation equipment, and the AirMan difficult airway simulation mannequin. We are continuing to develop scenarios for use with the AirMan in conjunction with our Web-based airway management course, as well as with courses taught at the Human Simulation and Patient Safety Center. Residents, SRNAs, CRNAs, and students will be tracked throughout their training at Duke for their participation in each of the teaching blocks in the hopes of providing a more complete and consistent education in airway management techniques. It has already been very useful in helping residents refresh skills just prior to their application to patient care.
We have developed unique airway management curricula for ICU fellows and residents, respiratory therapists, and life flight nurses for use at both the airway management laboratory as well as the simulation center.
The fiberoptic carts have all been redesigned and upgraded with the addition of new video systems and ancillary airway management equipment. New pediatric and adult Bullard laryngoscopes have been acquired for both OR use and use in the airway management laboratory.
A final accomplishment this year includes the expansion and upgrading of the special anesthesia emergency airway packs located on code carts throughout the OR, PACU, and all anesthetizing sites throughout Duke North. We have also been instrumental in standardizing the anesthesia carts used at Duke North.
ECT, Radiology, and Off-Site Anesthesia: Bret Stolp MD, PhD, Section Chief
Clinical Program
Anesthesia is provided in a variety of off-site locations for over 2,000 cases per year by members of this 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.
Case load for radiofrequency ablation of abdominal tumors and in the interventional neuroradiology facility continues to increase. We are developing anesthetic techniques to improve patient safety during coiling and embolization procedures. These procedures require general anesthesia, hemodynamic monitoring, and the potential need for acute lowering or raising of blood pressure. Dr. Willem Lombard has been investigating new methods of monitoring coagulation status during these procedures in an attempt to prevent postoperative thromboembolic complications. Anesthesia support from within the division has been called on to develop emergency staffing and management protocols for this challenging group of patients. We continue to work with the hospital administration to get all patients evaluated in the preoperative screening clinic prior to their procedure date. New off-site anesthesia machines and monitors have been installed at Duke North off-site locations. The Saturn data acquisition system has been installed at ECT, and we are awaiting the installation of similar systems at the remainder of the off-site locations. An upgraded MRI anesthesia machine and monitor have been placed this year. Off-site GI cases are now performed in the endoscopy suite in the sub-basement of Duke North. We are expanding our coverage of off-site cases and will continue to do so as soon as the hospital approves the hiring of budgeted CRNA staff. Finally, we are developing a hospital-wide initiative for training and implementing expanded conscious sedation services.
Training Program
Our group organized a month-long section of grand rounds and resident lectures to provide inservice and education to the residents, faculty, and CRNAs on the special demands of off-site anesthesia.
Neuroanesthesia: John Keifer, MD, Section Chief
Clinical Program
Group members provide anesthesia for adults undergoing brain and spinal cord surgery. Anesthesiologists provide management for specialized neuroanesthesia care such as the following: patients in sitting position, cerebral aneurysm clipping, aneurysm clipping under circulatory arrest, awake craniotomy, seizure surgery, and infratentorial surgery.
Training Program
The group continues to provide daily education in the delivery of anesthesia care to a variety of neurosurgical patients. Craniotomy (for tumor or for vascular lesions) and back surgery comprise the majority of patients. Anesthetic strategy is tailored to meet the surgical requirements of the following: (1) lengthy procedure; (2) no muscle relaxant (to identify nerve tracts); (3) “deep” anesthesia (to ensure immobility); (4) rapid and crisp emergence (to monitor nervous system function in the postoperative period); and (5) control of cardiovascular and respiratory function (to ensure maintenance of nervous system function). The residents and CRNAs who deliver anesthesia in the group are therefore exposed to the pharmacodynamics and pharmacokinetics of anesthetic, analgesic, and vasoactive drugs to meet these needs.
The goals for the coming year include developing a neuroanesthesia Web page and developing a case scenario addressing the “wake up” craniotomy for use in the anesthesia simulator.
Research Program
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 prospectively to evaluate anesthetic techniques for managing these patients.
Aesthetic Office Anesthesia: Dianne L. Scott, MD, Section Chief
Clinical Program
The Duke Center for Aesthetic Services functions as a part of the OHN 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 ORs and a postanesthesia care unit onsite. 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 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 1,200 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.
Training Program
The goal of this rotation is to introduce residents to the issues related to managing an office-based practice. Emphasis and instruction is focused on clinical assessment management and rapid discharge of ambulatory patients undergoing general anesthesia for cosmetic surgery. Issues related to complications that can occur in this population are addressed through review of current literature. Facility and operational issues are also addressed.
Research Program
Clinical research is considered to focus on ways to facilitate successful and safe execution of clinical care. Efforts to collaborate with plastic surgery are underway.
Neurointensive Care (NICU): Cecil O. Borel, MD, Medical Director
Clinical Program
The NICU serves as the most advanced treatment unit in the area for the care of patients with life-threatening neurological illness. Four critical care nurse practitioners and six faculty intensivists compose the multidisciplinary critical care team.
Training Program
The goal of the division over the next several years is to develop collaborative clinical and basic neuroscience research involving divisions of neurology and neurosurgery.
Research Program
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.
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Cecil O. Borel, MD
Chief, Division of Otolaryngology, Head, Neck/Neuroanesthesiology (OHN)
Associate Professor of Anesthesiology
Associate Professor of Surgery (Neurosurgery)
Office: (919) 681-2150
E-mail: borel001@mc.duke.edu
Faculty
John C. Keifer, MD
Frederick Willem Lombard, MB, ChB
Ziaur Rahman , MB , BS
Dianne L. Scott, MD
Alan Shang, MD
Bryant W. Stolp, MD, PhD
Jeffrey M. Taekman, MD
David S. Warner, MD
Wade A. Weigel, MD
CRNA Staff
John Pierce, Lead CRNA
Laura Booth, CRNA
Jennifer Burd, CRNA
Russell Giesler, CRNA
Michele Moody, CRNA
James Temo, CRNA
Katharine Vivian, CRNA
Support Staff
Laraine Tuck
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