General, Vascular and Transplant Anesthesiology Division

The General, Vascular and Transplant Anesthesiology (GVT) Division has attracted multitalented individuals since its inception in 2000. Dr. David Lubarsky, the inaugural division chief, first described the GVT Division as “a seasoned and productive group that has a variety of clinical and research interests.” This is still the case today, as the division has continued to grow and expand under the past leadership of  Drs. Kerri Wahl and Richard Moon. The division is currently led by Dr. Timothy Miller, who also serves as the the vice-president of the American Society for Enhanced Recovery. Many GVT faculty also serve Duke Anesthesiology’s Critical Care Medicine Division and are highly-skilled at managing patients with critical illness.

Duke Anesthesiology is among the first departments in the country to implement an Enhanced Recovery After Surgery (ERAS) program. Through close collaborations with Duke Surgery and the rest of the perioperative team, patient outcomes and length of stay have continued to improve for those undergoing major non-cardiac surgery. The GVT Division has developed enhanced recovery pathways for colorectal surgery, hepatobiliary surgery, liver resections, cystectomy, and living donor kidney transplantation. These pathways include both regional and multimodal analgesia, as well as individualized fluid management to enable early DRinking, EAting and Mobilizing after major surgery (known as DrEaMing or “living the DrEaM”). The Duke enhanced recovery pathway for colorectal surgery has halved the median length of stay for colorectal surgery over the last eight years, as well as reduced costs, complications and readmissions. The non-epidural colorectal enhanced recovery pathway has enabled many patients to be discharged on postoperative day one or two after colorectal resections. Similar improvements have been seen for other enhanced recovery programs.

While anesthesia complications per se are rare, patients undergoing major abdominal surgery can suffer significant morbidity. Duke Anesthesiology believes that perioperative medicine is the “practice of patient-centered, multidisciplinary and integrated medical care of patients from the moment of contemplation of surgery until full recovery.” Many patients undergoing major abdominal and vascular surgery will benefit from perioperative optimization programs which have been developed by Duke Anesthesiology, including its preoperative anemia clinic, preoperative diabetes clinic and perioperative nutrition service.

The GVT Division has also developed opioid-free and opioid-sparing pathways for patients undergoing more minor surgery, such as laparoscopic cholecystectomy. The opioid-free laparoscopic cholecystectomy pathway, developed by Dr. Michael Manning, has enabled many patients to leave the hospital on the same day of surgery without receiving or requesting any opioids.

Under the leadership of Dr. Timothy Miller, proficiency in perioperative care of liver transplant patients at Duke has grown to national prominence. Aside from access to highly skilled and experienced physicians, liver transplant patients at Duke benefit from shorter wait times and significantly higher survival rates than the national average. The GVT Division also provides care to patients undergoing kidney and pancreas transplants, and has expanded its services to include small bowel transplantation. The liver transplant team includes Drs. Timothy Miller, Sandy An, Brian Colin, Jonathan Dunkman, Sarada Eleswarpu, Michael Manning, Arturo Suarez, Ankeet Udani, and David Williams.

Perioperative Medicine Fellowship

Perioperative medicine is an emerging specialty that emphasizes the care of patients from the time surgery is contemplated until full recovery. Anesthesiologists are uniquely positioned to touch each phase of this new pathway of care. The Duke Perioperative Medicine Fellowship is a collaboration between Duke Anesthesiology and University College London (UCL) that provides a unique opportunity for anesthesia trainees who have the ambition of reaching outside of the operating room to gain academic, clinical and research expertise in perioperative medicine. The role of an anesthesiologist is being redefined and with that comes the need for new skill sets and training in perioperative medicine. Fellows will participate in rotations at high-risk surgical pre-operative clinics and intensive care units, learn point of care ultrasound techniques, deliver specialized care in the Post-Anesthesia Care Unit (PACU), and collaborate on research projects with Duke’s Perioperative Enhancement Team (POET). Other unique opportunities include enrollment into a masters program in perioperative medicine at UCL as well as the opportunity for international collaboration with a core rotation in London.

In 2017, Duke Anesthesiology launched the Perioperative Medicine Fellowship in collaboration with University College London. Dr. Jeanna Blitz is the director of the fellowship. Dr. Michael Manning was integral in designing the fellowship and serves as research mentors for the fellows.

Faculty members in the GVT Division provide world-class education to medical students, residents and fellows, and consistently receive outstanding teaching accolades. Many members of the division also have prominent roles in graduate education at a local, national and international level. Dr. Catherine Kuhn serves as Duke’s Graduate Medical Education designated institutional official (DIO). She was the first anesthesiologist in the nation to receive the Parker J. Palmer Courage to Teach Award from the Accreditation Council for Graduate Medical Education in 2004. Dr. Kuhn has worked with several other division members to advance academic anesthesiology, both at home and abroad, through involvement in various overseas medical missions. She has also been named as a North Carolina Best Doctor.

Drs. Brian Colin is Duke Anesthesiology’s associate residency program director and has been instrumental in helping maintain the Duke Anesthesiology Residency Program as one of the top in the country. Dr Udani is the director of Duke’s Human Simulation and Patient Safety Center. Dr. Udani has expertise in simulation-based medical education and research, and is interested in studying innovation and implementation techniques to improve medical education. He has received extramural grant funding from the Foundation for Anesthesia Education and Research, American Geriatrics Society and the Anesthesia Patient Safety Foundation.

Dr. Richard Moon is an expert in respiratory physiology, hyperbaric medicine and environmental physiology. He currently serves as medical director of the Duke Center for Hyperbaric Medicine and Environmental Physiology. Dr. Moon was awarded the Leonard Palumbo, Jr., MD, Faculty Achievement Award – an annual award that recognizes an outstanding contribution to the teaching and mentoring of young physicians at Duke University Medical Center.

The GVT Division is a highly-productive research division with interests in clinical, translational, education, and basic science research. Current research studies include:

• The role of long-acting opioids on postoperative recovery
• Opioid-free anesthesia for laparoscopic and robotic procedures
• Closed-loop decision support systems for hemodynamic optimization
• The role of exercise prehabilitation to optimize fitness before major surgery
• The impact of poor nutritional status on surgical outcomes in the broad surgical population by specific surgery type, and across different socio-economic groups
• The use of emergency manuals to improve crisis management and patient safety
• Respiratory control and prevention of opioid-induced respiratory depression after surgery
• Enhanced recovery pathways to improve outcomes after major surgery

View the department’s competitive and non-competitive research grant awards by calendar year.

Duke Surgery – we work very closely with our surgical and other colleagues to achieve the best possible outcomes for our patients. Perioperative care involves a multidisciplinary team effort to optimize patients before surgery, help them recover from surgery as quickly as possible and return to their normal quality of life.

Perioperative Anesthesia and Surgery Screening (PASS) clinic – many of our faculty also work in the PASS clinic. It is designed to help patients improve their overall well-being as they prepare for surgery, in order to positively impact their surgical experience and long-term health outcomes.

Acute Pain Service (APS) – we use multimodal and regional anesthesia techniques to minimize postoperative pain, and work closely with our colleagues in the APS to provide a seamless transition in pain management from the operating rooms to the postoperative wards.

UK Universities – we collaborate closely with University College London and University of Southampton. Together, we launched the Morpheus Consortium on June 8, 2016. It is the branding of three universities with one shared goal – to be leaders in perioperative medicine and enhanced recovery after surgery, ultimately improving the patient’s journey from the moment their surgery is contemplated to full recovery.

Please contact the GVT Division’s staff assistant, Christopher Keith, at 919-613-8881 or chris.keith@duke.edu with inquiries.