Perioperative fluid and hemodynamic management within an enhanced recovery pathway.

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Goal-directed fluid therapy (GDFT) seeks to improve outcomes through individualized optimization of oxygen delivery using IV fluid and vasoactive infusions. Trials of GDFT show clinical benefits over traditional liberal fluid administration, but fail to demonstrate benefits when compared to a restrictive strategy within an optimized enhanced recovery protocol. The ideal monitors, hemodynamic goals, and fluid administration strategy are not well established but may be less important than rational application of thoughtful fluid management strategies.





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Manning, Michael W, William Jonathan Dunkman and Timothy E Miller (2017). Perioperative fluid and hemodynamic management within an enhanced recovery pathway. Journal of surgical oncology, 116(5). pp. 592–600. 10.1002/jso.24828 Retrieved from

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Michael Wayne Manning

Associate Professor of Anesthesiology

Dr. Michael W. Manning, MD, Ph.D., is an Associate Professor at Duke University Medical Center, within the Divisions of Cardiothoracic and General, Vascular, and Transplant anesthesia. He serves as the director of Enhanced Recovery after Surgery programs and the director of research for the Perioperative Medicine Fellowship at Duke. His clinical practice focuses on high-risk cardiac surgery, Heart, Lung, and Liver transplantation.

Dr. Manning earned a Ph.D. in cardiovascular physiology from the University of Kentucky, where he studied the role of Angiotensin II-mediated inflammation in the development of abdominal aortic aneurysms. After graduate school, Dr. Manning remained at the University of Kentucky, earning his MD degree. He completed a year of general surgery residency before switching to anesthesia. Following residency, Dr. 
Manning continued his clinical training at Duke University with a one-year clinical fellowship in Adult Cardiothoracic Anesthesiology and a 2-year research fellowship. He joined the Duke faculty in 2014. 

His current research interests are ERAS centered, specifically in the role of opioid-free anesthesia and goal-directed fluid therapy in cardiac surgery on renal outcomes.


Jonathan Dunkman

Assistant Professor of Anesthesiology

I enjoy providing anesthesia for and taking care of a wide variety of complex patients in Duke University Hospital's main operating room and off site locations.  After finishing residency at The University of Pennsylvania, I worked in private practice outside Philadelphia and completed a fellowship in cardiothoracic anesthesia here at Duke, all of which prepared me for the variety of complex surgeries and patients we care for in the operating rooms here at Duke.  I also enjoy the research and education opportunities that come with working in this environment.  I have specifically worked on our enhanced recovery after surgery (ERAS) programs and am currently the Director of Liver Transplant Anesthesia.  I am engaged with a number of other operational roles including the Patient Safety and QI Committee, the Equipment Selection Committee and the Perioperative Leadership Group.


Timothy Ellis Miller

Professor of Anesthesiology

Clinical and research interests are Enhanced Recovery and Perioperative Medicine; with particular interests in fluid management, and perioperative optimization of the high-risk non-cardiac surgery patient.

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