Clinical Program

The responsibilities of the GVTCCM division encompass the complete perioperative experience, including the Preoperative Screening Unit, the operating room and PACU and the Surgical Intensive Care Unit.

GVTCCM 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). Procedures include robotic laparoscopic prostatectomies and living-related donor hepatectomy for pediatric liver transplantation. Anesthesia will be provided for bowel transplantation as the program develops.

The development of automated anesthesia information systems (Innovian™) and outcomes databases has been crucial in facilitating perioperative outcomes research directed towards organ protection and the establishment of “best practices.”

Faculty members are involved in several key activities in addition to their clinical duties.

Dr. Bennett-Guerrero serves as Director of Perioperative Clinical Research at the Duke Clinical Research Institute (DCRI). He Chairs the Department of Anesthesiology Research Advisory Board.

Dr. Gan is Vice Chair for Clinical Research for the department. He 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. He is a member of the editorial boards of Anesthesia and Analgesia and Acute Pain and serves as President of the Society of Ambulatory Anesthesia (SAMBA) and Immediate Past President of the International Society of Anesthetic Pharmacology (ISAP). He also serves on the Board of Directors of both organizations and numerous ASA committees.

Dr. Knudsen is Co-Director of the Duke Surgical Intensive Care Unit. She is a member of the following Duke School of Medicine committees: Curriculum, Promotions, Clinical Core Task Force, Capstone Task Force. She teaches in the PRACTICE Course (a weekly 4-hour course for 8 medical students) and the Capstone Course. She serves on the OPTN/UNOS Operations Committee and the Association of Organ Procurement Organizations Medical Directors’ Committee.

Dr. Kuhn is Director of Residency Education and President of the Society for Education in Anesthesia (SEA). She is also a Fellow in the Executive Leadership in Academic Medicine program at Drexel University. She works with the Accreditation Council on Graduate Medical Education as a Specialist Site Visitor.

Dr. Moon chairs a Hospital committee that investigates perioperative opioid and sedative-related complications.

Dr. Moretti is Group leader Principles in Pharmacology Seminar Series taught to first year medical students. He is the Anesthesiology Representative on the Multidisciplinary Trauma Peer Review Committee and member of the Fundamentals of Critical Care Support Committee.

Dr. Roche is a consulting physician for the Center for Blood Conservation at DUMC and on the Society for the Advancement of Blood Management Nominating Committee. He has organized the international CME event “Great Atlantic Fluid Debate” and is heavily involved in the Duke Global Health effort in Uganda.

Dr. Wahl is involved in development of national policy for donation after cardiac death and liaison between UNOS, Surgery and the American Society of Anesthesiologists.

Dr. Young is Director of the Fellowship in Critical Care Medicine, from which distinguished graduates include Drs. Bennett-Guerrero, Knudsen and Moretti. As a Fellow in the American College of Critical Care Medicine, he has been a contributor for the written board exam. He is a member of the American Society of Critical Care Medicine, and has served as Chair of several committees over that time. His clinical research interests are primarily in the ICU, where he continues to investigate sedative agents, delirium and palliative care.

Liver and Intestinal Transplantation

In 1984, Duke University Medical Center performed the first liver transplant in the Southeast US. Program landmarks include approval as a Medicare facility in 1994, the first center world-wide offering an ex-vivo transgenic pig liver perfusion system for fulminant hepatic failure, initiation of the living-related program for children in 1997, live donor right hepatectomy for adult recipients in 1999, and small bowel transplantation in 2009.

The Duke Liver and Intestinal Transplant team consists of three abdominal transplant surgeons and five anesthesia faculty members providing 24-hour clinical coverage for 40 to 50 adult liver cases per year, Table 1(total 690 adults from 1988 to 2008).  Dr. Wahl has served as Director of Liver Transplant Anesthesia at Duke since 1994. Her expertise includes two years of Fellowship training in Liver Transplant Anesthesia and 15 years as an active participant on the liver transplant team.  Our group is represented at the ILTS (International Liver Transplant Society), UNOS Liver and Intestinal Transplant Committee and the ASA Transplant Committee meetings. Research interests include: selective use of VVB, perioperative fluid resuscitation, hyponatremia, care of the cadaveric, living and DCD liver adult donor, optimum care of the pediatric donor, and establishing  best practice guidelines for the perioperative care of the liver transplant recipient.

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 elective surgery at Duke North and the Ambulatory Surgery Center, for outpatient procedures requiring anesthesia, and some organ transplant candidates undergo a comprehensive evaluation. The team of nurse practitioners, physician assistants, nurses, clerical, and technical staff educate, evaluate, and then arrange investigations, consultations, and coordination of care as indicated. Anesthesia consent is obtained and anesthesiologists and surgeons 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 connected to the intraoperative record. Patients with limited, stable medical conditions are assessed by telephone, with the creation of a similar electronic record, which is finalized by the attending anesthesiologist doing a brief physical exam on the morning of surgery. These records, in conjunction with a clinic note from the surgeon, serve as the admission history and physical document. Consent for research is often conducted in this clinic. Anesthesiology and family medicine residents all do a rotation in the clinic. 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 is available for review.

Training Program

Resident, fellow, medical student and student CRNA education are top priorities. The overriding goal is to impart excellence in patient care using “best practice” guidelines.

Research Program

The research program of the division includes outcome studies in acute pain, nausea and vomiting, blood storage and administration and fluid optimization. Work is ongoing to develop new monitoring techniques based on fractal analysis of respiratory pattern.

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Richard E. Moon, MD, CM, M.Sc., FRCPC, FACP, FCCP

Chief, Division of GVTCCM AnesthesiaMedical Director, Center for Hyperbaric Medicine and Environmental Physiology
Professor of Anesthesiology
Associate Professor of Medicine

Faculty

Elliott Bennett-Guerrero, MD
Tong Joo Gan, BB, BS, FRCA
Catherine M. Kuhn, 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, MHSc
Christopher C. Young, MD

Preoperative Screening Clinic

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

Support Staff

Victoria Grossman
Christopher Keith
Thomas Pafford
Carrie Hines
Angela Rogers