Neuroanesthesiology, Otolaryngology and Offsite Anesthesiology Division

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.

Clinical responsibilities of the Neuroanesthesiology, Otolaryngology and Offsite Anesthesiology Division include intracranial procedures (such as awake craniotomy and aneurysm clipping), endovascular treatment of intracranial vascular abnormalities, electroconvulsive therapy, complex spine surgery with instrumentation, and radical head and neck surgery. Intraoperative MRI and CT technologies, advanced neuromonitoring, and functional and minimally invasive neurosurgery require highly specialized anesthesia care.

Neurosurgical Anesthesiology Fellowship

Colleen M. Naglee, MD
Fellowship Director

The Neurosurgical Anesthesiology Fellowship aims to supply highly-trained physicians to care for a fragile and growing neurosurgical patient population.

The overall goal of this one-year training program is to transform the general anesthesiologist into a subspecialist in neurosurgical anesthesiology. This is the beginning of a lifelong learning process and is accomplished through multidisciplinary training in all aspects of the perioperative care of the neurosurgical patient. These aspects of care include neurosurgical anesthesiology, neurocritical care (neuro-ICU), neuroradiology, neurosonology, and neurophysiologic monitoring.

A two-year program option will be offered for fellows interested in a dedicated research year to prepare for an academic career.

The Neuroanesthesiology, Otolaryngology and Offsite Anesthesiology Division is known for pioneering innovative approaches to patient safety and education. Dr. Bryant “Bret” Stolp, director of Airway Emergency Services, is responsible for the creation of specialized emergency airway packs to be kept on all code carts in the operating rooms and other anesthetizing sites throughout the medical center. In addition, the division is heavily involved in medical simulation. Dr. Nicole Guinn, having combined training in cardiac and neuroanesthesia, leads the Duke Center for Blood Conservation—a tremendous resource for the Jehovah’s Witness patient population. Dr. Grace McCarthy cares for both neurosurgical and cardiac surgical patients, with a particular interest in perioperative transesophageal echocardiograpy. When not at work in the neurosurgical or pediatric surgical operating rooms, Dr. Andrew Peery devotes his effort to resident education as well as the medical humanities.

The Neuroanesthesiology, Otolaryngology and Offsite Anesthesiology Division engages in a number of research initiatives aimed at transforming care in neuroanesthesia and critical care. In the clinical realm, significant headway has been made in reducing postoperative nausea and vomiting following craniotomy. The division notably championed the use of adenosine-induced transient asystole for intracranial aneurysm surgery. Recent studies focus on mechanisms underlying anesthetic effects on the central nervous system, and optimizing analgesia after spine surgery. The basic science endeavors are led by Dr. David Warner, renowned neuroprotection expert and 2011 recipient of the SNACC Distinguished Service Award for his extensive contributions to the subspecialty of neuroanesthesia. Warner’s laboratory investigates novel approaches to neuroprotection in a variety of animal models. Dr. Michael “Luke” James, neuroanesthesiologist and neurointensivist, is pursuing basic and translational research into intracerebral hemorrhage, a common and devastating stroke syndrome. Dr. Miles Berger is attempting to decipher the mechanism underlying perioperative neurologic injury.

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

Please contact the Neuroanesthesiology, Otolaryngology and Offsite Anesthesiology Division’s staff assistant, Angela Rogers, at 919 681 2470 or angela.j.rogers@duke.edu with inquiries.