Faculty of Duke Anesthesiology’s General, Vascular, and Transplant (GVT) Anesthesia Division are experts in the management of patients undergoing high-risk non-cardiac surgery. They provide world-class anesthesia care for patients undergoing colorectal surgery, liver and pancreatobiliary surgery, major vascular, urology, and endocrine surgery, as well as kidney, liver, pancreas and small bowel transplantation.
The GVT Division has attracted multitalented individuals since its inception in 2000. David Lubarsky, MD, MBA, the inaugural division chief, first described the GVT Division in the 2000 annual report as “a seasoned and productive group that has a variety of clinical and research interests.” This is still certainly the case today, as the division has continued to grow and expand under the past leadership of Kerri Wahl, MD, FRCP(C), and Richard Moon, MD, CM, MSc, FRCP(C), FACP, FCCP.
The division is currently led by Timothy Miller, MB ChB, FRCA, who serves as the director of the Duke Perioperative Medicine Fellowship, as well as the vice-president of the American Society for Enhanced Recovery. Duke Anesthesiology was among the first departments in the country to implement an enhanced recovery program, and the GVT division has achieved national and international prominence as leaders in improving outcomes for patients undergoing major abdominal surgery.
Through close collaborations with the Department of Surgery and the rest of the perioperative team, patient outcomes and length of stay have continued to improve for those undergoing major non-cardiac surgery. The GVT Division has developed enhanced recovery pathways for colorectal surgery, hepatobiliary surgery, liver resections, cystectomy, and living donor kidney transplantation. These pathways include both regional and multimodal analgesia, as well as individualized fluid management to enable early DRinking, EAting and Mobilizing after major surgery (known as DrEaMing or “living the DrEaM”).
The Duke Enhanced Recovery Pathway for colorectal surgery has halved the median length of stay for colorectal surgery over the last eight years, as well as reducing costs, complications and readmissions. The non-epidural colorectal enhanced recovery pathway has enabled many patients to be discharged on postoperative day one or two after colorectal resections. Similar improvements have been seen for other enhanced recovery programs.
Whilst anesthesia complications per se are rare, patients undergoing major abdominal surgery can suffer significant morbidity. Duke Anesthesiology believes that perioperative medicine is the “practice of patient-centered, multidisciplinary and integrated medical care of patients from the moment of contemplation of surgery until full recovery.” Many patients undergoing major abdominal and vascular surgery will benefit from perioperative optimization programs which have been developed by Duke Anesthesiology, including its preoperative anemia clinic, preoperative diabetes clinic, and perioperative nutrition service.
The GVT Division has also developed opioid-free and opioid-sparing pathways for patients undergoing more minor surgery, such as laparoscopic cholecystectomy. The opioid free laparoscopic cholecystectomy pathway, developed by Michael Manning, MD, PhD, has enabled many patients to leave the hospital on the same day of surgery without receiving or requesting any opioids.
Under the leadership of Dr. Miller, proficiency in perioperative care of liver transplant patients at Duke has grown to national prominence. Aside from access to highly skilled and experienced physicians, liver transplant patients at Duke benefit from shorter wait times and significantly higher survival rates than the national average. The GVT Division also provides care to patients undergoing kidney and pancreas transplants and has recently expanded its services to include small bowel transplantation. The transplant team includes Timothy Miller, MB ChB, FRCA; Brian Colin, MD; Jonathan Dunkman, MD; Michael Manning, MD, PhD; Quintin Quinones, MD, PhD; Arturo Suarez, MD and Ankeet Udani, MD.
GVT faculty members are also adept at managing multiple hospital-wide leadership positions. Examples include Dr. Richard Moon who serves as medical director of Duke Anesthesiology’s Center for Hyperbaric Medicine and Environmental Physiology, Elizabeth Malinzak, MD, who serves as clinical coordinator at the Duke Eye Center, and Dr. Kerri Wahl, MD, who is the director of anesthesia services at the Duke Endoscopy Clinic. Many GVT faculty also work in the Critical Care Division and are highly skilled at managing patients with critical illness.
A major strength of the GVT Division is education. Faculty members in this division provide world-class education to medical students, residents and fellows, and consistently receive outstanding teaching accolades. Many members of the division also have prominent roles in graduate education at a local, national and international level.
Dr. Catherine Kuhn serves as Duke’s Graduate Medical Education Designated Institutional Official (DIO). She was the first anesthesiologist in the nation to receive the Parker J. Palmer Courage to Teach Award from the Accreditation Council for Graduate Medical Education (ACGME) in 2004. Dr. Kuhn has worked with several other division members to advance academic anesthesiology both at home and abroad through involvement in various overseas medical missions. She has also been named as a North Carolina Best Doctor.
Drs. Brian Colin and Ankeet Udani are Duke Anesthesiology’s assistant residency program directors and have been instrumental in helping maintain the residency program as one of the top in the country. Dr Udani is also assistant director of Duke’s Human Simulation and Patient Safety Center. Dr. Udani has expertise in simulation-based medical education and research, and is interested in studying innovation and implementation techniques to improve medical education. He has received extramural grant funding from the Foundation for Anesthesia Education and Research, American Geriatrics Society and the Anesthesia Patient Safety Foundation.
In 2017, Duke Anesthesiology will launch the Perioperative Medicine Fellowship in collaboration with University College London (UCL). Dr. Miller is the director of the fellowship. Dr. Manning has been integral in designing the fellowship and will serve as research mentors for the fellows.
The GVT Division is also a highly productive research division with interests in clinical, translational, education and basic science research. Dr. Moon is a world expert in respiratory physiology, hyperbaric medicine and environmental physiology. He is a superb and passionate teacher of physiology and anesthesiology, and a dedicated and gifted researcher. These qualities make Dr. Moon an inspiring mentor. He was recently awarded the Leonard Palumbo, Jr., MD, Faculty Achievement Award for compassionate patient care, and excellence in the teaching and mentoring of young physicians. This annual award recognizes an outstanding contribution to the teaching and mentoring of young physicians at Duke University Medical Center.
In other examples of ongoing research, Dr. Miller is investigating the impact of an enhanced recovery pathway on cystectomy. Dr. Manning additionally has expertise in cardiothoracic anesthesia and investigates the role of renin-angiotensin systems. Chris Young, MD, and Gene Moretti, MD, MHSc, are developing more effective methods to monitor tissue oxygenation. Jonathan Dunkman, MD, who joined the division in 2016 after finishing his fellowship in cardiothoracic anesthesiology here at Duke, has research interests in perioperative transfusion and resuscitation.
Balancing multiple leadership positions, research initiatives, and educational responsibilities, while continuing to provide world-class care to a high-acuity patient population is no easy feat. Each and every day, the faculty within the GVT Division accomplishes this juggling act with aplomb, maintaining a level of poise and grace worthy of applause.