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Women’s
Anesthesia and Critical Care Medicine
Clinical Program
The Division of Women’s Anesthesia (DWA) is responsible for obstetric and gynecologic anesthesia and provides continuous in-house faculty coverage of obstetrics. We provide a full range of anesthetic services to cover the approximately 3,000 deliveries a year we see on labor and deliver (L & D).
The DWA provides all major modalities of labor analgesia including neuraxial narcotics, combined spinal-epidural analgesia (CSE), and patient-controlled epidural analgesia (PCEA). We offer an on-demand consult service, which has been very busy this year. On the obstetric service, we continue to enjoy great relationships with our Maternal Fetal Medicine (MFM) group under the direction of Dr. Philip Heine and Duke Women’s Health Associates. Through the efforts of Elizabeth Remsberg-Bell, nursing manager of the L & D unit, we have maintained a full nursing compliment; this has allowed for an improvement in care delivery. In addition to our work in Duke North, we also provided services at the Ambulatory Surgery Center for outpatient gynecologic surgery and recently for the Eye Center.
The expansion of the neonatal intensive care unit and the recruitment of additional MFM faculty have lead to an increase in our high-risk patient population. We are continually faced with interesting and challenging clinical problems.
We continue to appreciate the contributions made to the group by Drs. Terry Breen, Peter Dwane, Ashraf Habib, Yemi Olufolabi, Moeen Panni, Hector Lacassie and John Schultz. All of our clinical efforts are supported by a strong team of nurse anesthetists (CRNAs). This year we have continued to see more of our divisional CRNAs venture up to the obstetric service. We welcome the opportunity to provide growth for our CRNA pool in this area. We continue to be indebted to the clinical and administrative efforts of our charge CRNAs, Tede Spahn (obstetrics) and Deb Clements (gynecology and urology).
Training Program
Resident education is a major mission of the division. We have two first-year residents rotating on obstetrical anesthesia at all times. With a good balance of high-risk and normal pregnancies, we are confident that our residents get an education in obstetrical and gynecological anesthesia that is second-to-none. We continue to see increasing interest in CA-3 and advanced clinical track rotations on the obstetric service.
We offer one to two fellowship positions per year in obstetrical anesthesia. These fellows undertake clinical care and teaching as well as participate in clinical and laboratory research. Dr. Olufolabi is the director of the fellowship program. Our program has been well subscribed and we have enjoyed working with our fellow, Dr. Abbie Melnick.
Dr. Dwane, in his capacity as coordinator of the fourth-year clinical elective, facilitates the introduction of numerous medical students to the field of anesthesia, including our own services, women’s and obstetric anesthesia.
Research Program
Dr. Breen has had a busy tenure in his role as the coordinator for implementing electronic recordkeeping on L & D. Through much hard work we have introduced the Saturn system in a novel application with mobile units on the labor ward.
In addition to his role as fellowship director, Dr. Olufolabi has been busy in research. In collaboration with Dr. T.J. Gan, he has been busy with a project evaluating two formulations of propofol. Dr. Habib continues to work as a collaborator with Dr. Gan with his interest in postoperative nausea and vomiting. He has a number of clinical projects on both the obstetric and gynecology service investigating this area. He is also collaborating with Dr. Holly Muir and a project funded by a departmental research grant looking at the effects of ethnicity on pain perception. Dr. Habib was also the recipient of one of the departmental research grants for his project entitled “Transdermal nicotine for analgesia following retropubic prostatectomy.”
The obstetrical anesthesia research laboratory, headed by James Reynolds, PhD, continues to function as the basic science arm of the division and as a resource for clinical investigators. Over the past year, with the help of NIH funding, several significant projects were initiated. These included an investigation of how regional and general anesthesia during pregnancy can affect fetal cerebral oxygenation and a series of studies on how to improve tissue and fetal perfusion during maternal laparoscopic surgery. The research group has expanded considerably to include undergraduate and medical students, fellows, and various collaborative faculties both at Duke and other institutions.
The annual meeting of the Society for Obstetric Anesthesia and Perinatology(SOAP), held in Ft. Myers, Florida, was once again a highlight of the year. Through the hard work of Dr. Schultz as the coordinator for resident research for the division, we once again had a number of residents submit abstracts at the meeting, which resulted in very strong representation from Duke.
In July we had one fellow join the division: Duke graduate Dr. Abigail. She has added significantly to our division.
The Obstetric Anesthesia Research Laboratory is the basic science arm of the Division of Women’s Anesthesia. The majority of lab members conduct in vivo and in vitro experiments that are designed to mimic different clinical scenarios related to maternal/fetal medicine. Specific ongoing studies include: the use of Near Infrared Spectroscopy to measure changes in fetal cerebral oxygen levels caused by drugs of abuse, volatile anesthetics, or pneumoperitoneum; monitoring the hemodynamic and tissue blood flow changes produced by insufflation; and conducting outcome investigations and postnatal animal behavioral assessments following surgery during pregnancy. Similar studies aimed at understanding the physiologic response to minimally-invasive surgery are being conduced in the non-pregnant setting. The lab also functions as a resource for clinical investigations. Throughout the past year, the group continued to strengthen its ties with the Duke Neonatal Perinatal Research Institute and the Duke Endosurgery Center, as well as continuing its active collaborations with other Duke faculty including Drs. Jonathan Stamler (Pulmonary Medicine), Cynthia Kuhn (Pharmacology and Cancer Biology), and Tom Cummings (Pathology), and with researchers outside of Duke: Dr. Marjorie Grafe (Pathology, Oregon Health Sciences Center), Dr. Steve Eubanks, University of Missouri, and Dr. Paul Benni (CAS Medical).
As in past years, some people arrived and others moved on. After a two-year stint, Ms. Becca McClaine resumed her medical studies and she is looking forward to spring 2005 graduation. As well, Dr. Kenichiro “Ken” Uemura returned to Japan to accept a faculty position in the Department of Surgery at Hiroshima University. In his place, Dr. Kazufumi Shimazutsu, a surgeon from Hiroshima University joined us for a two-year research fellowship. Janet Williams moved on to become Dr. Laura Niklason’s fulltime aide-de-comp, but we were very fortunate to have Robin Hicks-Dickerson move over from payroll to the Division to fill Janet’s position. We also welcomed medical students Dana Cairo and Molly Boyce, who will be completing their 3 rd year research projects in the lab, and Ms. Jessica Lash, a recent college graduate who wanted some hands-on laboratory experience. Lucky for us, Deb McClaine put off graduate school for at least one more year; she remains a valued member of the research group. Additional technical services continued to be provided by Mr. Kurt Campbell. Finally, Ms. Megha Shah, a Duke undergraduate, moved from an assistant to heading up her own research project as she chose to complete a year of independent study as part of her honor’s curriculum.
Overall, it was a successful year with respect to publications and funding. In addition, work from the lab was selected for presentations at the upcoming meetings of SAGES, the Pediatric Academic Societies, and the American College of Surgeons, as well as being named a finalist for best paper at the 2004 SOAP meeting. It is the hope of all lab members that the accomplishments in the coming year will meet or exceed those of 2004.
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Holly A. Muir, MD, FRCP(C)
Chief, Division of Women’s Anesthesia
Vice Chair Clinical Operations
Director of Perioperative Leaders Group, DN OR
Assistant Professor of Anesthesia
Associate of Obstetrics and Gynecology
Office: (919) 668-6266
E-mail: muir0005@mc.duke.edu
Faculty
Peter D. Dwane, MD
Ashraf Habib , MB , ChB, MSc, FRCA
Cathleen Peterson-Layne, MD
Abigail Melnick, MD
Adeyemi J. Olufolabi, MB, BS, DCH, FRCA
James D. Reynolds, PhD
Amy Rice, MD
John R. Schultz, MD
CRNA Staff
Maurice Begin, CRNA
Cindy Black, CRNA
Deb Clements, CRNA
Julie T. Fritz, CRNA, MSN
Sarah O. Jinwright, CRNA
Jan Margeson, CRNA
Dave Marion, CRNA
Tede E. Spahn, CRNA
Yolanda G. Wright, CRNA
Support Staff
Janice Rogers
Robin Hicks-Dickerson
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