Dr. Swaminathan Appointed Vice Chair Position

We are pleased to announce that Madhav Swaminathan, MD, FASE, FAHA, has been appointed as the vice chair for faculty development at Duke Anesthesiology, effective January 1, 2018. In his new role, Dr. Swaminathan will be responsible for nurturing our faculty with the vision, mentorship, opportunities and infrastructure they need to be leaders in “changing the face of anesthesiology.”

“It is an honor and privilege to serve the department in any capacity. This particular position is important as it helps faculty at all levels achieve their professional goals while advancing the mission of the department,” says Dr. Swaminathan.

Dr. Swaminathan’s short-term goals are to 1) develop robust methods to assess faculty needs, 2) make institutional resources for developing professional skills, such as writing, public speaking and collaborative research opportunities, readily available to departmental faculty, 3) streamline mentorship pathways for mentees and mentors, 4) simplify the pathway for navigating the appointments, promotions and tenure process, and 5) establish new programs for wellness, inclusion, leadership and skills development.

Dr. Swaminathan, professor of anesthesiology, arrived at Duke in 2000 as a cardiothoracic anesthesiology fellow. Two years later, he joined the department as faculty and developed his research interests in kidney outcomes after cardiac surgery. In 2004, he assumed a leadership role as the director of perioperative echocardiography at Duke. And in 2013, he was appointed as clinical director of cardiothoracic anesthesiology. During his time at Duke, Dr. Swaminathan has notably earned two historic appointments. In 2015, he was named the 16th Feigenbaum Lecturer at the scientific sessions of the American Society of Echocardiography (ASE), marking the first time a cardiac anesthesiologist was given this honor. This year, he was appointed vice president of the ASE, and in 2019, he is slated to become the first anesthesiologist to hold the position of president in the organization’s 44-year history.

“I am fortunate to have giants in this field as my mentors and have learned and benefited from their commitment to faculty development. During that process, I have successfully mentored junior faculty into leadership roles and have gained a deeper understanding of what makes a faculty member a successful professional in our field,” says Dr. Swaminathan. “I would like all faculty members to not only develop their own careers, but also mentor junior members along the way and ultimately advance the department’s vision. I look forward to working with our faculty to develop innovative methods for enhancing personal and professional growth.”

Please join us in extending congratulations to Dr. Swaminathan on his new position.

Chris KeithDr. Swaminathan Appointed Vice Chair Position
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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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Neural Discovery at Duke is the Newest Cover of Nature

New research from two Duke University labs in the departments of anesthesiology and cell biology finds that astrocytes and their unique architecture play a significant role in regulating the development and function of synapses in the brain. The manuscript, titled “Astrocytic neuroligins control astrocyte morphogenesis and synaptogenesis,” was published in the November 9, 2017 issue of Nature and featured as the journal’s cover story. Duke Anesthesiology authors include Dr. Ru-Rong Ji, chief of pain research, Dr. Yong-Ho Kim and Di Liu.

An astrocyte (blue) grown in a dish with neurons forms an intricate, star-shaped structure. Neurons’ synaptic proteins appear in green and purple. Overlapping proteins represent the locations of synapses. Credit: Jeff Stogsdill, Duke University

An astrocyte (blue) grown in a dish with neurons forms an intricate, star-shaped structure. Neurons’ synaptic proteins appear in green and purple. Overlapping proteins represent the locations of synapses. Credit: Jeff Stogsdill, Duke University

According to the article, titled “Star-Shaped Brain Cells Orchestrate Neural Connections,” published by Duke TODAY and featured on Duke University’s Med School Blog, this study highlights that the dysfunction of intricate astrocyte cells may underlie devastating diseases such as autism, schizophrenia and epilepsy. The article goes on to state that the Duke team identified a family of three proteins that control the web-like structure of each astrocyte as it grows and encases neuronal structures such as synapses. Switching off one of these proteins not only limited the complexity of the astrocytes, but also altered the nature of the synapses between neurons they touched, shifting the delicate balance between excitatory and inhibitory neural connections.

Dr. Cagla Eroglu, co-author and associate professor of cell biology and neurology at Duke adds that, “We found that astrocytes’ shape and their interactions with synapses are fundamentally important for brain function and can be linked to diseases in a way that people have neglected until now.”

A 3-D-printed model of a single astrocyte from a mouse brain shows the sponge-like structure of these cells. Photo credit: Katherine King, Duke University.

A 3-D-printed model of a single astrocyte from a mouse brain shows the sponge-like structure of these cells. Photo credit: Katherine King, Duke University.

Ben Barres, a professor of neurobiology at Stanford University, who was not involved with the study, praised the findings as “a profoundly important, revolutionary advance” for understanding how interactions between neurons and astrocytes can affect synapse formation.

Dr. Ji is a distinguished professor of anesthesiology in the Duke University School of Medicine, co-director of Duke Anesthesiology’s Center for Translational Pain Medicine and a member of the Duke Institute for Brain Sciences. His Sensory Plasticity and Pain Research Laboratory focuses on identifying molecular and cellular mechanisms that underlie the genesis of chronic pain and developing novel pain therapies that can target those mechanisms.

Chris KeithNeural Discovery at Duke is the Newest Cover of Nature
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