Duke Neuroanesthesiology Over the Decades
In the early days of Duke Anesthesiology, Bruno Urban, MD, was primarily responsible for neuroanesthesia procedures. His principal interest, however, was pain management. Consequently, in the mid-1980s, he passed the torch to one of his former fellows, Ziaur Rahman, MD, who served as the first official Division Chief of Neuroanesthesia at Duke. By the early 1990s, the Department decided that Neuroanesthesia would be better supported as a section within the Division of General Services Anesthesia. Even with this new direction, the program still lacked adequate staff and training necessary to excel in complex neuroanesthesia procedures.
In 1993, Department Chair Joseph “Jerry” Reves, MD, recruited the highly qualified Dr. Cecil Borel from Johns Hopkins University to lead and enhance neuroanesthesia at Duke. Dr. Borel is a pioneer in the field of Neurocritical Care. He is credited with establishing the third Neuroscience Critical Care Unit in the world at Johns Hopkins University. Dr. Reves recognized that it was impossible to grow a successful clinical enterprise without creating an equally strong research component. Consequently, in 1993, he recruited David S. Warner, MD, from the University of Iowa to develop a robust neuroanesthesia research program.
For the next several years, Dr. Borel worked to establish an esteemed neuroanesthesia program and a world-class Neuro-ICU at Duke. “This was no easy task,” says Dr. Warner. “The departments of neurology, neurosurgery, and anesthesiology were not accustomed to working together,” he recalls, “but Cecil worked tirelessly to ensure that everyone’s needs were met and that everyone understood they were working toward a common goal—a better experience for our patients.” Dr. Borel was assisted in his effort by Duke neurosurgeon Allan Friedman, MD, and neurointensivist Carmelo Graffagnino, MD.
A major challenge in the mid-1990s was the lack of continuous staff coverage in the Neurointensive Care Unit. This was imperative to the successful care of the neurosurgical patient. Dr. Borel recruited and trained a new group of physician faculty and mid-level providers to maintain the critical care unit. Together with Joanne Hickey, PhD, RN, Dr. Borel established one of the earliest Acute Care Nurse Practitioner (ACNP) programs in the country—if not the world—with a focus on neurocritical care.
The Otolaryngology, Head & Neck, and Neuroanesthesia (OHN) Division was separated from the Division of General Services Anesthesia in 1997. While Dr. Borel focused on building the foundations of the Neuroanesthesia Program during his tenure as Chief, his mentee & successor, Dr. David McDonagh, has directed his energy toward fine-tuning one of the most mature Neuroanesthesia Programs in the Country. Dr. McDonagh is board-certified in both Neurology & Anesthesiology and Fellowship Trained in Neurocritical Care. He led the Duke Neurocritical Care Fellowship Program from 2005–12, establishing it as one of the preeminent Programs in the Nation and one of the earliest to receive national accreditation through the United Council of Neurologic Subspecialties. Dr. McDonagh established a formal Neuroanesthesia Fellowship in 2010 and has since trained many subspecialists who have gone on to academic careers in Neurosurgical Anesthesiology.
The Division consists of 12 faculty members. Clinical responsibilities of the division today include intracranial procedures (such as awake craniotomy and aneurysm clipping), endovascular treatment of intracranial vascular abnormalities, electroconvulsive therapy, complex spine surgery with instrumentation, and radical head and neck surgery. Intraoperative MRI & CT technologies, advanced neuromonitoring, and functional & minimally invasive neurosurgery require highly specialized anesthesia care. Along with excellence in clinical care, the Division is known for pioneering innovative approaches to patient safety and education. Division member Bryant “Bret” Stolp, MD, PhD, director of Airway Emergency Services, is responsible for the creation of specialized emergency airway packs to be kept on all code carts in the operating rooms and other anesthetizing sites throughout the medical center. In addition, the Division is heavily involved in medical simulation under the direction of Jeffrey “Jeff” Taekman, MD, Assistant Dean for Educational Technology at Duke. Dr. Nicole Guinn, having combined training in cardiac & neuroanesthesia, leads the Duke Center for Blood Conservation—a tremendous resource for the Jehovah’s Witness patient population. Dr. Grace McCarthy cares for both neurosurgical and cardiac surgical patients, with a particular interest in perioperative transesophageal echocardiograpy. Dr. Leonard Talbot enjoys resident education and the challenges of a multifaceted clinical neuroanesthesia practice. Dr. John Keifer focuses his efforts on anesthesia for electoconvulsive therapy and the understanding of complex pain syndromes. Dr. Jason Guercio, recent graduate of the Duke Management & Leadership Pathway Program is a clinical anesthesiologist while simultaneously exploring new ways to forge the future of academic anesthesiology. When not at work in the neurosurgical or pediatric surgical operating rooms, Dr. Andrew Peery devotes his effort to resident education as well as the medical humanities.
Furthermore, the division engages in a number of research initiatives aimed at transforming care in neuroanesthesia and critical care. In the clinical realm, significant headway has been made in reducing postoperative nausea and vomiting following craniotomy. More recently, the Division championed the use of adenosine-induced transient asystole for intracranial aneurysm surgery. Current studies focus on mechanisms underlying anesthetic effects on the central nervous system, and optimizing analgesia after spine surgery. The basic science endeavors are led by Dr. David Warner, renowned neuroprotection expert and 2011 recipient of the SNACC Distinguished Service Award for his extensive contributions to the subspecialty of Neuroanesthesia. Dr. Warner is Vice Chair for Research and has an active laboratory investigating novel approaches to neuroprotection in a variety of animal models. Dr. Michael “Luke” James, neuroanesthesiologist & neurointensivist, is pursuing basic and translational research into intracerebral hemorrhage, a common and devastating stroke syndrome. Dr. Miles Berger is attempting to decipher the mechanism underlying perioperative neurologic injury and recently received a 2014 IARS Mentored Research Award.
The Division is committed to the belief that no matter how good we are at something, we can always become better. Looking to the future, we seek to support growth and ever-increasing clinical excellence in neurosurgery, otolaryngology, interventional radiology, and interventional psychiatry. We will continue to train subspecialty leaders in this arena and, through research, to produce insights into the pathophysiology and treatment of complex neurologic syndromes. At the core of our mission is the recognition that our future success will come from our ability to effectively train & inspire resident physicians & fellows, develop our junior faculty, provide world-class clinical care, and advance our field through cutting-edge research.