Clinical Program

The Division of Women’s Anesthesia (DWA) is responsible for obstetric and gynecologic anesthesia and provides continuous in-house faculty coverage for obstetrics. We provide a full range of anesthetic services to cover the approximately 3,000 deliveries a year.

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 and maintain great relationships with our Maternal Fetal Medicine (MFM) group and Duke Women’s Health Associates contributing to our excellent patient care. Through the efforts of the nursing staff in 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.

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.

Along with our clinical faculty in women’s services, our clinical efforts are supported by a strong team of nurse anesthetists (CRNAs). We welcome the opportunity to provide growth for our CRNA group in this area.

Training Program

Resident education is an important 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. An increasing interest in CA-3 and advanced clinical track rotations on the obstetric service allows us to model our training to fit the needs of our residents.

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.

Research Program

Many of our faculty in the division have roles in research. One clinician coordinates the implementation of the 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.

The Women’s division has research endeavors that involve evaluating two formulations of propofol and the affects it has on postoperative nausea and vomiting, the effects of ethnicity on pain perception, as well as transdermal nicotine for analgesia following retropubic prostatectomy.

The obstetrical anesthesia research laboratory serves 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 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 in pulmonary medicine, pharmacology and cancer biology, and pathology, as well as with researchers outside of Duke (Oregon Health Sciences Center, University of Missouri, and CAS Medical).

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 for the division. The division submitted a number of abstracts at the meeting, which resulted in very strong representation from Duke.

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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

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

Bridget White