A First-Place Tie for Pie in the Face

Drs. Adeyemi Olufolabi, Gavin Martin, and Stephen Parrillo

Drs. Adeyemi Olufolabi, Gavin Martin, and Stephen Parrillo

For the first time since the launch of Duke Anesthesiology’s Pie in the Face event, there was a tie for first place in fundraising! Departmental members gathered in the courtyard outside of the Trent Semans Center on November 30 to watch the winners, Drs. Adeyemi Olufolabi and Stephen Parrillo, graciously accept a celebratory pie in the face, hand-delivered by Drs. Erin Manning and Ashraf Habib.

This year’s three “competitors,” who arrived to the event in coordinating outfits, raised a total of $4,185 which goes toward departmental residents’ travel expenses for their global health missions. Drs. Olufolabi and Parrillo both raised $1,590. The runner-up, Dr. Gavin Martin, raised $1,005. Dr. Ellen Flanagan did the honors and surprised him with a pie in the face as well. We thank all of the donors for their generosity and the contestants for participating in this year’s fourth annual global health fundraiser!

Previous Pie in the Face winners include Duke Anesthesiology’s chairman, Dr. Joseph Mathew, along with Drs. Solomon Aronson and Eddie Sanders. Anesthesia plays a critical role in global health care and there is a great need for anesthesiologists abroad. In response, Duke Anesthesiology continues to take steps to encourage its global presence in countries that need it the most. Click here to learn more and/or make a gift to the department’s Global Health Program.

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Chris KeithA First-Place Tie for Pie in the Face
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Botulinum Toxin for Atrial Fibrillation? Maybe, But More Study is Needed

Dr. Waldron presenting his research at the American Heart Association’s Scientific Sessions on November 15.

From temporarily softening wrinkles to easing migraines, botulinum toxin has become a versatile medical remedy because of its ability to block nerve signals that can become bothersome or risky.

But could the toxin also quell heart flutter, known as atrial fibrillation, after cardiac surgery? That question was at the root of a study led by Duke University researchers, who report today at the Scientific Sessions of the American Heart Association meeting that the answer is … maybe.

Researchers in Duke’s Department of Anesthesiology and the Duke Clinical Research Institute launched their inquiry after a study from Russian scientists reported a 70-percent drop in atrial fibrillation episodes among a small cohort of heart surgery patients who were treated with strategic injections of botulinum toxin (commonly marketed as Botox).

Bouts of irregular heartbeat are a common complication after cardiac surgery, affecting up to 40 percent of patients and increasing the risk of stroke and death.

“The results from Russia were very interesting, but needed to be replicated on a larger and more medically complex group of patients,” said lead author and Duke anesthesiologist Nathan Waldron, M.D.

Waldron and colleagues enrolled 130 patients who were slated to undergo a coronary artery bypass grafting procedure, valve surgery, or both. During their surgeries, roughly half the patients were randomly assigned to receive shots of botulinum toxin in the fat pads around their heart — where the fibrillation is known to arise; the other half received harmless saline. The medical teams did not know which injection the patients received.

Afterward, the patients were monitored continuously by electrocardiogram to pick up signs of atrial fibrillation. Among the patients who received injections of botulism toxin, 36.5 percent had atrial fibrillation, compared to 47.8 percent of those who had the saline placebo.

Dr. Waldron presenting his research at the American Heart Association’s Scientific Sessions on November 15.

Dr. Waldron is the first anesthesia fellow to present in the Innovative Therapies and Novel Applications Late Breaking Trials session.

The researchers also found that patients who received the botulinum toxin had shorter initial bouts of atrial fibrillation, but there were no significant differences in the length of hospital stays or post-operative complications.

“Unfortunately, while there was a numerically lower risk of atrial fibrillation among the Botox patients, it did not meet statistical significance,” said Jonathan P. Piccini, M.D., a member of DCRI and senior author of the study. “What we observed was a modest positive effect on preventing atrial fibrillation, so a larger trial is something that is needed to provide a clearer picture.”

The study received funding from the American Heart Association and the Foundation for Anesthesia Education and Research.

In addition to Waldron and Piccini, study authors include Mary Cooter, John C. Haney, Jacob N. Schroder, Carmelo A. Milano and Joseph P. Mathew.

Source: Duke Health News and Communications press release (Durham, N.C. – November 15, 2017)

View additional coverage of Dr. Waldron’s research by American Heart Association News and Medical Xpress, along with a video discussion produced by MedPage Today and the American College of Cardiology.

Chris KeithBotulinum Toxin for Atrial Fibrillation? Maybe, But More Study is Needed
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That’s a Wrap! Highlights from ASA 2017

That’s a Wrap! Highlights from ASA 2017We would like to thank all members of our department who helped make this year’s American Society of Anesthesiologists (ASA) meeting in Boston a huge success! Duke Anesthesiology made a big impression at this year’s event with 51 faculty and trainees participating in the conference, including 84 lectures, workshops, panel discussions, presentations, and more. Please join us in congratulating our team of authors who received the 2017 Anesthesia Patient Safety Foundation Resident Quality Improvement Recognition Award at the ASA for their video, titled “A Bedside Tool to Improve Safety and Efficiency of Cardiothoracic ICU Patient Transport: The Duke ICU Transition to OR (DITTO) Checklist.” Authors include: Suraj Yalamuri, MD, and Michael Plakke, MD (team leaders); John Haney, MD, AB, MPH; Brad Taicher, DO, MBA; Madhav Swaminathan, MD, FASE, FAHA; Cory Maxwell, MD (mentors); Hassan Amhaz, MD; Vinca Chow, MD; Heather Pena; Joseph Deblasio; Mollie Kettle; Jhaymie Cappiello; Jessica Lumbard; Rachel Gambino; Courtney Thurman.

During the conference, we hosted Duke Anesthesiology’s 29th Annual ASA Alumni Event at The Roof at Taj Boston. Nearly 200 guests (including departmental faculty, trainees, staff, alumni, donors and friends) joined us atop the 17th floor of Boston’s most iconic hotel, surrounded by panoramic views of the city’s Back Bay and skyline for a night of live jazz music, culinary cuisine and celebration. Guests enhanced their evening by bidding on 13 silent auction items (graciously donated by the department, faculty and staff) to benefit our Global Health Program. This year’s winning bidders raised nearly $2,500 which will help fund our residents’ travel expenses for their global health missions.

Two of the most anticipated highlights of the evening were: 1) the announcement of the Mark F. Newman Professorship in which we shared this inspirational video. Donors who generously endow this new professorship are not only ensuring the progress of medicine, research and academic excellence, they are giving a gift for future generations to come. Please consider donating to preserve Dr. Newman’s legacy. 2) the reveal of the 2018 DREAM Innovation Grant (DIG) recipients.

Qing Ma, MD

“The Role of Sirtuin-3 in Neuroinflammation and Perioperative Cerebral Injury”

Jamie Privratsky, MD, PhD

“The Role of Dendritic Cells in Acute Kidney Injury and Renal Healing”

DIGs are part of the Duke DREAM Campaign which was launched in 2007. These grants support innovative high-risk and potentially high-reward investigations to accelerate anesthesia and pain management research. Each DIG recipient can receive up to $30,000 in seed money for their pilot study which ultimately helps them apply for and obtain extramural funding. To date, $662,900 has been funded by DIGs which has led to nearly $8 million in extramural funding. We would like to express our appreciation to the DIG Application Review Committee and the donors who continue to support our research programs and initiatives, ultimately helping us transform the future of patient care.

It was also another successful fundraiser at the 8th Annual ASA Sponsored Run For The Warriors 5k race, dedicated to the men and women wounded during service, their families and families of the fallen. We’re proud to announce that for the seventh year in a row, the Duke Anesthesiology team won first place for fundraisinga total of $11,895! All proceeds from the race benefit wounded warriors and their families through the many Hope For The Warriors® programs. Thank you to the 42 race participants and donors who raised money for this nonprofit veteran service organization. A special congratulations goes to Dr. Atilio Barbeito (faculty), his son, Jose, and Dr. Stephanie Jones (fellow) who medaled for having one of the top three race times in their division (gender/age group). Dr. Barbeito placed 2nd in his division and 7th overall. Jose placed 2nd in his division and 5th overall. Dr. Jones placed 3rd in her division.

We sincerely appreciate your continued support of Duke Anesthesiology and your commitment to our mission of providing extraordinary care through a unique culture of innovation, education, research and professional growth. We are particularly grateful to those who worked in the operating rooms during the ASA so that others on our team could attend. Here’s to a successful 2018 and we look forward to celebrating at our ASA alumni event next October in San Francisco!

Chris KeithThat’s a Wrap! Highlights from ASA 2017
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Duke Anesthesiology Surges to Win First Place for Fundraising

2017 Run for the Warriors

Duke Anesthesiology rallied until the last minute on Saturday, October 21 to secure their title of “top fundraising team” for the seventh consecutive year at the 8th Annual ASA Sponsored Run For The Warriors race at the Boston Common!

Congratulations to Duke Anesthesiology for reaching their fundraising goal and raising more funds than any other team at this year’s event – a total of $11, 895 ($4,490 more than last year). All funds raised will benefit the men and women wounded during service, their families, and families of the fallen through the many Hope For The Warriors® programs.

Thank you to the 42 Duke Anesthesiology race participants (listed below) and donors who raised money for this nonprofit veteran service organization. A special congratulations goes to Drs. Atilio Barbeito (faculty), his son, Jose, and Stephanie Jones (fellow) who medaled for having one of the top three race times in their division (gender/age group)! Dr. Barbeito placed 2nd in his division and 7th overall. Jose placed 2nd in his division and 5th overall. Dr. Jones placed 3rd in her division.

Wads Ames
Atilio Barbeito
José Maria Barbeito
Luz María Barbeito
Miles Berger
Brandi Bottiger
Chad Burkhart
Jessica Burkhart
Eric Cole
Sarah Cotter
Theresa Crowgey
Jonathan Dunkman
Dave Falcinelli
Jenna Falcinelli

Michael Fierro
Kyle Fletke
John Gamble
Mike Grocott
Stacey Hilton
Alina Hulsey
Courtney James
Luke James
Stephanie Jones
Catherine Kuhn
Annabelle Levine
Matthew Levine
Angela Li
Ying Low

Kelly Machovec
David MacLeod
Jonathan Mark
Joseph Mathew
Rachael Mintz-Cole
Richard Moon
Alina Nicoara
Kendall Smith
Kelsey Steller
Alena Suarez
Arturo Suarez
Annemarie Thompson
Bryn Van Hoomissen
Julie Westover

Chris KeithDuke Anesthesiology Surges to Win First Place for Fundraising
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2018 DIG Recipients Revealed

2018 DREAM Innovation Grant Recipients

The much anticipated 2018 DREAM Innovation Grant (DIG) recipients were announced at Duke Anesthesiology’s 29th Annual ASA Alumni Event at The Roof at Taj Boston on Saturday, October 21.

Congratulations to the 2018 DIG winners:

Qing Ma, MD

“The Role of Sirtuin-3 in Neuroinflammation and Perioperative Cerebral Injury”

Jamie Privratsky, MD, PhD

“The Role of Dendritic Cells in Acute Kidney Injury and Renal Healing”

DIGs support innovative high-risk and potentially high-reward investigations to accelerate anesthesia and pain management research. Each year, Duke Anesthesiology junior and senior faculty members compete for a DIG by submitting their most innovative research ideas to the DIG Application Review Committee. Dr. William Maixner, vice chair for research, announces the DIG recipients at the department’s annual ASA alumni event.

Each DIG recipient can receive up to $30,000 in seed money which supports their pilot study for one year and ultimately helps them apply for and obtain extramural funding. These grants are funded through a combination of private donors, private companies, alumni, faculty and executive board members. To date, $662,900 has been funded by DIGs which has led to nearly $8 million in extramural funding to further investigate the role of Alzheimer’s pathways, therapies to improve stroke outcomes, ways to prevent cognitive decline after surgery, sleep apnea during pregnancy, strategies to decrease bleeding after cardiac surgery and transplantation, blood cell rejuvenation, and more. Click here to view the 2011-2017 DIG recipients and learn more about their projects.

The DIG is part of the Duke DREAM Campaign which launched in 2007 to support Duke Anesthesiology’s research programs and initiatives. These grants create an avenue for healthy competition among faculty, inspire ingenuity, promote the careers of young physician investigators, enhance donor communication, and further the department’s academic mission. DIGs help to bridge the gap between training and progression to independent investigator status. Please consider making an online gift to the Duke DREAM Campaign to support our department’s research initiatives focused on improving patient care.

Chris Keith2018 DIG Recipients Revealed
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Extreme Everest 2017: Reflections From a Scientific Expedition

Extreme Everest 2017: Reflections From a Scientific ExpeditionOn March 30, we (members of Duke Anesthesiology) left Durham to participate in Extreme Everest 2017, a scientific expedition to the Everest base camp and Kala Patthar in the Himalayas. This had been organized by a British team, including Professors Monty Mythen and Mike Grocott, who had summited Mount Everest and performed numerous groundbreaking studies in 2007 and 2013. In the current expedition, we headed for Nepal for the second time, this time joined by a Duke Undersea and Hyperbaric Medicine (UHM) fellow, Dr. Chris Martin, and former Duke UHM fellow, Dr. Nicole Harlan, along with Dr. Joe Wiater and Fran Cullen, a financial advisor in Durham. The aim was to trek from Lukla to Everest base camp over 11 days, while measuring pulse oximetry continuously in a cohort of 14 individuals.

Why do this? What can be achieved from an observational study during the field expedition? The answer is that no one knows the lower limits of acceptability on blood oxygenation. While tens of thousands of individuals have trekked to Everest base camp without a problem, their oxygen saturation values have largely been unknown. Several studies have incorporated spot measurement of SpO2 but no published studies thus far have measured it continuously. In 2013, we obtained some data using wrist oximeters; the plan this year was to extend those studies.

Our team flew to Kathmandu, arriving on March 31. Among the 46 members of the group, several were doing research projects. These included an investigation of the microbiome and echocardiography at three different altitudes. Another investigation was looking for antigens that might explain the ubiquitous ‘Khumbu cough’ as due to inhalation of aerosolized yak dung particles. For our study, we signed up a number of the trekkers and obtained overnight baseline measurements. On April 3, we made our way to Kathmandu airport for the 40-minute flight in a Twin Otter aircraft to Lukla, altitude 9,317 feet. The Tenzing-Hillary airport at Lukla is reported to be the most dangerous airport in the world because its unique runway is positioned between two cliffs which leaves no room for error on landing. However, we landed safely and after gathering in a coffee shop for a brief refreshment, we headed up the mountain toward Monjo. Hiking in North Carolina can be challenging, but it is nothing like this. Unacclimatized as we initially were, dyspnea was a constant accompaniment. After several hours of hard trekking, we reached Monjo in the dark, and the next day to Namche (altitude 11,283ft), where we spent three days. Glancing periodically at our pulse oximeters revealed measurements that were consistently in the 70s. Apart from the shortness of breath, we felt fine and were able to carry on up the trail. Namche is a small town and would be the last ‘comfort stop’ on the way to base camp: there were coffee shops, lattes and just about anything you might need to buy for the remainder of the trip. The guest house where we stayed was owned by a man who was completely deaf due to meningitis as a child. However, he was a brilliant lip reader and an even more brilliant photographer. He plans to use proceeds from the sale of his photographs to fund a museum.

After our mandatory acclimatization, we headed up the trail toward Debouche (altitude 12,369 ft) and then Pheriche (14,010 ft), where we spent three nights, again to acclimatize. Pheriche is the site of the Himalayan Rescue Association, a bare bones facility but regularly and effectively staffed by doctors from around the world. Although most of us felt okay, medical problems started to occur. The first was one of our co-trekkers who abruptly lost consciousness while sitting outside a teahouse waiting for lunch. A couple of days later someone on another trek was visibly ataxic as he walked along the trail. The diagnosis: high altitude cerebral edema – HACE. Dr. Chris Imray, one of the British medical leaders, administered dexamethasone, walked with him to a helipad and escorted him back to Kathmandu by helicopter. Later, two of our group members would suffer HACE themselves. Fortunately, in all instances, dexamethasone and descent did the trick.

Extreme Everest 2017: Reflections From a Scientific Expedition

Gorak Shep (altitude 17,126 ft), the original base camp for the Hillary-Tenzing expedition in 1953, was our last stop. The day after our arrival there, most of the group trekked on to the current base camp at about the same altitude. The two of us, along with four other trekkers, including Chris Imray and Jeet Sherpa, hiked up Kala Patthar (altitude 18,519 ft). The prize on this mountain is a spectacular view of four peaks: Everest, Pumori, Lhotse and Nuptse. Although we didn’t quite make the summit due to incoming inclement weather, we did get the view and a backdrop for the Duke Anesthesiology banner. The climb nevertheless was tough, and my pulse oximeter was reading its lowest value of the trek: in the low 60s.

The next morning was the planned start of the descent. Before heading down, several of the trekkers set out at 5 a.m. to climb Kala Patthar. We and the British medical leaders had waited until their return before setting out. Unfortunately, as it turned out, one of our trekkers returned with a case of HACE. It would have been impossible to evacuate by helicopter as it was snowing, so she was given dexamethasone and allowed to sleep. The cure was miraculous: a few hours later she and her doctor, Dan Martin, zoomed past us on their way to the next stop at Loboche.

The downhill trek seemed uneventful until we were a few hours past Dingboche. As we walked through a small village, we were debating whether to stop for coffee when we spotted a few of our fellow trekkers. In the end, we decided to sit down with them to enjoy a few minutes of rest, but a few minutes later we heard someone yelling for help. Both of us, along with Aine Burns, a London nephrologist, and her daughter Brid, a medical student, rushed up the trail as fast as we were capable, where we found a man lying on the ground. The sherpa who had been accompanying him reported that he had not felt well earlier in the morning and had been advised to hike slowly. Abruptly, he had fallen down, unconscious. Fortunately, Nima (our Sherpa) had the medical kit with which we were able to check the man’s glucose to exclude hypoglycemia and then administer IV dexamethasone for presumed HACE. The stars had lined up for this man as a Nepali Army platoon was hiking through the village and was able to request a helicopter and carry the man up the hill for evacuation.

That night was spent at Tengboche, then we headed to Namche and then Lukla followed by the short hop back to Kathmandu.

What about our study? The data is being analyzed, but we had clearly observed that normal hikers trekked at altitude for long periods of time at SpO2 values, which if seen in any of our hospital patients would elicit panic. However, it was great to get back to normoxia where we could climb stairs and walk up hills with relative ease. We hope that the eventual publication, which might be entitled, “Oxygen saturation: How low can you go?” will elicit conversations as to alternative strategies for treating hypoxia in patients.

By Drs. Richard Moon and Eugene Moretti

Chris KeithExtreme Everest 2017: Reflections From a Scientific Expedition
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