In the early days of Duke Anesthesiology, Dr. Bruno Urban 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, Dr. Ziaur Rahman, who served as the first official chief of the Neuroanesthesiology Division 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 lacked adequate staff and training necessary to excel in complex neuroanesthesia procedures.

In 1993, Dr. Joseph “Jerry” Reves, then department chair, recruited Dr. Cecil Borel from Johns Hopkins University to lead and enhance neuroanesthesia at Duke. 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. Reves recognized that it was impossible to grow a successful clinical enterprise without creating an equally strong research component. Consequently, in 1993, he recruited Dr. David S. Warner from the University of Iowa to develop a robust neuroanesthesia research program.

For the next several years, Borel worked to establish an esteemed neuroanesthesia program and a world-class Neuro-ICU at Duke. “This was no easy task,” says 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.” Borel was assisted in his effort by Duke neurosurgeon Dr. Allan Friedman and Duke neurointensivist Dr. Carmelo Graffagnino.

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. Borel recruited and trained a new group of physician faculty and mid-level providers to maintain the Critical Care Unit. Together with Dr. Joanne Hickey, Borel established one of the earliest Acute Care Nurse Practitioner 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 Borel focused on building the foundations of the neuroanesthesia program during his tenure as chief, his mentee and successor, Dr. David McDonagh, directed his energy toward fine-tuning one of the most mature neuroanesthesia programs in the country. McDonagh led the Duke Neurocritical Care Fellowship Program from 2005–2012, 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. McDonagh established a formal neuroanesthesia fellowship in 2010 and trained numerous subspecialists who have gone on to academic careers in neurosurgical anesthesiology.

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, the division seeks to support growth and ever-increasing clinical excellence in neurosurgery, otolaryngology, interventional radiology, and interventional psychiatry. It 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 the division’s mission is the recognition that future success will come from the ability to effectively train and inspire resident physicians and fellows, develop junior faculty, provide world-class clinical care, and advance the field through cutting-edge research.