Scholars@Duke
Eugene William Moretti

Eugene William Moretti

Professor of Anesthesiology
Anesthesiology, General, Vascular, High Risk Transplant & Critical Care
moret002@mc.duke.edu
Box 3094 Med Ctr, Durham, NC
2301 Erwin Road, 5673 Hafs Building, Durham, NC 27710

Selected Publications

The Role of Sleep Apnea in Postoperative Neurocognitive Disorders Among Older Noncardiac Surgery Patients: A Prospective Cohort Study.

Journal Article Anesth Analg · January 1, 2025 BACKGROUND: Obstructive sleep apnea is associated with increased dementia risk, yet its role in postoperative neurocognitive disorders is unclear. Here, we studied whether the severity of untreated obstructive sleep apnea is associated with the severity of ... Full text Link to item Cite

Cognitive and Cerebrospinal Fluid Alzheimer's Disease-related Biomarker Trajectories in Older Surgical Patients and Matched Nonsurgical Controls.

Conference Anesthesiology · May 1, 2024 BACKGROUND: Anesthesia and/or surgery accelerate Alzheimer's disease pathology and cause memory deficits in animal models, yet there is a lack of prospective data comparing cerebrospinal fluid (CSF) Alzheimer's disease-related biomarker and cognitive traje ... Full text Link to item Cite

Preoperative electroencephalographic alpha-power changes with eyes opening are associated with postoperative attention impairment and inattention-related delirium severity.

Journal Article Br J Anaesth · January 2024 BACKGROUND: In the eyes-closed, awake condition, EEG oscillatory power in the alpha band (7-13 Hz) dominates human spectral activity. With eyes open, however, EEG alpha power substantially decreases. Less alpha attenuation with eyes opening has been associ ... Full text Link to item Cite

Perioperative changes in neurocognitive and Alzheimer's disease-related cerebrospinal fluid biomarkers in older patients randomised to isoflurane or propofol for anaesthetic maintenance.

Journal Article Br J Anaesth · August 2023 BACKGROUND: Animal studies have shown that isoflurane and propofol have differential effects on Alzheimer's disease (AD) pathology and memory, although it is unclear whether this occurs in humans. METHODS: This was a nested randomised controlled trial with ... Full text Link to item Cite

Postoperative changes in cognition and cerebrospinal fluid neurodegenerative disease biomarkers.

Journal Article Ann Clin Transl Neurol · February 2022 OBJECTIVE: Numerous investigators have theorized that postoperative changes in Alzheimer's disease neuropathology may underlie postoperative neurocognitive disorders. Thus, we determined the relationship between postoperative changes in cognition and cereb ... Full text Open Access Link to item Cite

Relationship Between Depression/Anxiety and Cognitive Function Before and 6 Weeks After Major Non-Cardiac Surgery in Older Adults.

Journal Article J Geriatr Psychiatry Neurol · January 2022 OBJECTIVE: To determine the relationship between affective measures and cognition before and after non-cardiac surgery in older adults. METHODS: Observational prospective cohort study in 103 surgical patients age ≥ 60 years old. All participants underwent ... Full text Link to item Cite

Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study.

Journal Article Br J Anaesth · December 2021 BACKGROUND: Cognitive dysfunction after surgery is a major issue in older adults. Here, we determined the effect of APOE4 on perioperative neurocognitive function in older patients. METHODS: We enrolled 140 English-speaking patients ≥60 yr old scheduled fo ... Full text Open Access Link to item Cite

Immunomodulatory lipid mediator profiling of cerebrospinal fluid following surgery in older adults.

Journal Article Sci Rep · February 4, 2021 Arachidonic acid (AA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) derived lipids play key roles in initiating and resolving inflammation. Neuro-inflammation is thought to play a causal role in perioperative neurocognitive disorders, yet th ... Full text Open Access Link to item Cite

Cerebrospinal Fluid Proteome Changes in Older Non-Cardiac Surgical Patients with Postoperative Cognitive Dysfunction.

Journal Article J Alzheimers Dis · 2021 BACKGROUND: Postoperative cognitive dysfunction (POCD), a syndrome of cognitive deficits occurring 1-12 months after surgery primarily in older patients, is associated with poor postoperative outcomes. POCD is hypothesized to result from neuroinflammation; ... Full text Open Access Link to item Cite

Endocrine and Electrolyte Disorders

Chapter · January 1, 2021 This chapter discusses a variety of common endocrine and metabolic challenges that occur in the perioperative period. Guidance on the perioperative management of several conditions is presented including diabetes, obesity, obstructive sleep apnea, and thyr ... Full text Cite

A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.

Journal Article J Neurol · July 2020 OBJECTIVE: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort st ... Full text Link to item Cite

The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.

Journal Article J Alzheimers Dis · 2020 BACKGROUND: Perioperative neurocognitive disorders (PND) are common complications in older adults associated with increased 1-year mortality and long-term cognitive decline. One risk factor for worsened long-term postoperative cognitive trajectory is the A ... Full text Open Access Link to item Cite

Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in Patients With Postoperative Cognitive Dysfunction: A Pilot Study.

Journal Article Anesth Analg · November 2019 Animal models suggest postoperative cognitive dysfunction may be caused by brain monocyte influx. To study this in humans, we developed a flow cytometry panel to profile cerebrospinal fluid (CSF) samples collected before and after major noncardiac surgery ... Full text Open Access Link to item Cite

The INTUIT Study: Investigating Neuroinflammation Underlying Postoperative Cognitive Dysfunction.

Journal Article J Am Geriatr Soc · April 2019 BACKGROUND/OBJECTIVES: Every year, up to 40% of the more than 16 million older Americans who undergo anesthesia/surgery develop postoperative cognitive dysfunction (POCD) or delirium. Each of these distinct syndromes is associated with decreased quality of ... Full text Open Access Link to item Cite

Approaching the Design of an Information Display to Support Critical Care

Conference Proceedings - 2017 IEEE International Conference on Healthcare Informatics, ICHI 2017 · September 8, 2017 Well into the electronic health record (EHR) era, interface design issues remain unresolved. When developing EHR displays, human-centered design techniques are often ignored; this results in a cognitive burden on users. Critical care is demanding. Clinicia ... Full text Cite

Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults.

Journal Article Front Syst Neurosci · 2017 Each year over 16 million older Americans undergo general anesthesia for surgery, and up to 40% develop postoperative delirium and/or cognitive dysfunction (POCD). Delirium and POCD are each associated with decreased quality of life, early retirement, incr ... Full text Open Access Link to item Cite

Toward Designing Information Display to Support Critical Care. A Qualitative Contextual Evaluation and Visioning Effort.

Journal Article Appl Clin Inform · October 5, 2016 OBJECTIVES: Electronic health information overload makes it difficult for providers to quickly find and interpret information to support care decisions. The purpose of this study was to better understand how clinicians use information in critical care to s ... Full text Link to item Cite

The accuracy of a near-infrared spectroscopy cerebral oximetry device and its potential value for estimating jugular venous oxygen saturation.

Journal Article Anesth Analg · December 2014 BACKGROUND: An intriguing potential clinical use of cerebral oximeter measurements (SctO2) is the ability to noninvasively estimate jugular bulb venous oxygen saturation (SjvO2). Our purpose in this study was to determine the accuracy of the FORE-SIGHT(®) ... Full text Link to item Cite

Age-related differences in biomarkers of acute inflammation during hospitalization for sepsis.

Journal Article Shock · August 2014 The authors aimed to evaluate age-related differences in inflammation biomarkers during the first 72 h of hospitalization for sepsis. This was a secondary analysis of a prospective observational cohort of adult patients (n = 855) from 10 urban academic eme ... Full text Link to item Cite

Exploring the impact of augmenting sedation assessment with physiologic monitors.

Journal Article Aust Crit Care · August 2014 BACKGROUND: Pharmacological sedation is a necessary tool in the management of critically ill, mechanically ventilated patients. The intensive care unit (ICU) sedation strategy is to use the least amount of medication to meet safety and comfort goals. Titra ... Full text Link to item Cite

Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.

Journal Article Anesth Analg · May 2014 BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and co ... Full text Open Access Link to item Cite

Vein anesthesia

Chapter · January 1, 2014 Local anesthesia and tumescent anesthesia play a key role in the success of phlebology procedures. This chapter reviews key principles of these procedures. Local anesthetics have been used for decades by physicians to provide pain relief during simple surg ... Full text Cite

The use of recombinant human activated protein C (drotrecogin alpha) in solid organ transplant recipients: case series and review of the literature.

Journal Article Transpl Infect Dis · December 2011 Septic shock occurs frequently in solid organ transplant (SOT) recipients. Standard therapy includes fluid resuscitation, the administration of antimicrobials, and source control of the infection. Adjunctive therapy with recombinant human activated protein ... Full text Link to item Cite

Relationship between B-type natriuretic peptide and adverse outcome in patients with clinical evidence of sepsis presenting to the emergency department.

Journal Article Acad Emerg Med · February 2011 OBJECTIVES: Myocardial dysfunction is an important aspect of sepsis pathophysiology. B-type natriuretic peptide (BNP) is a neurohormone released from the ventricles in response to myocardial stretch and volume overload. The authors hypothesized that an ele ... Full text Link to item Cite

The diagnostic accuracy of plasma neutrophil gelatinase-associated lipocalin in the prediction of acute kidney injury in emergency department patients with suspected sepsis.

Journal Article Ann Emerg Med · July 2010 STUDY OBJECTIVE: We assess the diagnostic accuracy of plasma neutrophil gelatinase-associated lipocalin (NGAL) to predict acute kidney injury in emergency department (ED) patients with suspected sepsis. METHODS: We conducted a secondary analysis of a prosp ... Full text Link to item Cite

In response

Journal Article Anesthesia and Analgesia · January 1, 2010 Full text Cite

Noninvasive monitoring of tissue hemoglobin using UV-VIS diffuse reflectance spectroscopy: a pilot study.

Journal Article Opt Express · December 21, 2009 We conducted a pilot study on 10 patients undergoing general surgery to test the feasibility of diffuse reflectance spectroscopy in the visible wavelength range as a noninvasive monitoring tool for blood loss during surgery. Ratios of raw diffuse reflectan ... Full text Open Access Link to item Cite

Minimally invasive cardiac output monitoring in the perioperative setting.

Journal Article Anesth Analg · March 2009 With advancing age and increased co-morbidities in patients, the need for monitoring devices during the perioperative period that allow clinicians to track physiologic variables, such as cardiac output (CO), fluid responsiveness and tissue perfusion, is in ... Full text Link to item Cite

A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis.

Journal Article Crit Care Med · January 2009 OBJECTIVE: To define a biomarker panel to predict organ dysfunction, shock, and in-hospital mortality in emergency department (ED) patients with suspected sepsis. DESIGN: Prospective observational study. SETTING: EDs of ten academic medical centers. PATIEN ... Full text Link to item Cite

A brief report: the use of high-frequency oscillatory ventilation for severe pulmonary contusion.

Journal Article J Trauma · August 2008 BACKGROUND: Severe pulmonary contusions are a common cause of acute respiratory distress syndrome (ARDS) and are associated with significant morbidity. High frequency oscillatory ventilation (HFOV) is a ventilatory mode that employs a lung protective strat ... Full text Link to item Cite

A brief report: the use of high-frequency oscillatory ventilation for severe pulmonary contusion.

Journal Article The Journal of trauma · August 1, 2008 BACKGROUND: Severe pulmonary contusions are a common cause of acute respiratory distress syndrome (ARDS) and are associated with significant morbidity. High frequency oscillatory ventilation (HFOV) is a ventilatory mode that employs a lung protective strat ... Cite

Effects of decreased preoperative endotoxin core antibody levels on long-term mortality after coronary artery bypass graft surgery.

Journal Article Arch Surg · July 2006 Featured Publication HYPOTHESIS: Decreased preoperative levels of antiendotoxin core antibody (EndoCAb) in patients undergoing cardiac surgery with cardiopulmonary bypass are associated with increased long-term mortality. DESIGN: Observational study. SETTING: Academic medical ... Full text Link to item Cite

APOE polymorphism is associated with risk of severe sepsis in surgical patients.

Journal Article Crit Care Med · November 2005 Featured Publication OBJECTIVE: To test for an association between apolipoprotein E (APOE) genotypes and the occurrence of severe sepsis in an elective surgical cohort. DESIGN: Prospective, observational, single cohort study. SETTING: Sixteen-bed surgical intensive care unit ( ... Full text Link to item Cite

Impact of central venous catheter type and methods on catheter-related colonization and bacteraemia.

Journal Article J Hosp Infect · October 2005 Featured Publication A prospective, randomized, controlled, multi-centre clinical trial was performed to test the effectiveness of an antimicrobial central venous catheter (CVC) made of polyurethane integrated with silver, platinum and carbon black (Vantex). Adults expected to ... Full text Link to item Cite

Changes in hematocrit based on incremental blood sampling: mathematical models perform poorly.

Journal Article Can J Anaesth · April 2005 Featured Publication PURPOSE: Excessive blood sampling, with its inherent risks, is of growing concern among clinicians. We performed this study to measure the changes in hematocrit (Hct) during a laboratory investigation where multiple blood samples are collected. The perform ... Full text Link to item Cite

The desaturation response time of finger pulse oximeters during mild hypothermia.

Journal Article Anaesthesia · January 2005 Featured Publication Pulse oximeters may delay displaying the correct oxygen saturation during the onset of hypoxia. We investigated the desaturation response times of pulse oximeter sensors (forehead, ear and finger) during vasoconstriction due to mild hypothermia and vasodil ... Full text Link to item Cite

Dexmedetomidine pharmacodynamics: Part II: Crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers.

Journal Article Anesthesiology · November 2004 BACKGROUND: Dexmedetomidine is a highly selective alpha2-adrenoceptor agonist used for short-term sedation of mechanically ventilated patients. The analgesic profile of dexmedetomidine has not been fully characterized in humans. METHODS: This study was des ... Full text Link to item Cite

Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers.

Journal Article Anesthesiology · November 2004 BACKGROUND: Dexmedetomidine, a highly selective alpha2-adrenoceptor agonist used for short-term sedation of mechanically ventilated patients, has minimal effect on ventilation. METHODS: This study compared the respiratory effect of dexmedetomidine to that ... Full text Link to item Cite

The relationship between ionized and total serum magnesium concentrations during abdominal surgery.

Journal Article J Clin Anesth · June 2003 STUDY OBJECTIVE: To determine the necessity for ionized magnesium (iMg) assay by evaluating the effect of abdominal surgery without massive transfusion on total magnesium (Mg) and iMg concentrations. DESIGN: Prospective, observational study. SETTING: Opera ... Full text Link to item Cite

Intraoperative colloid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration.

Journal Article Anesth Analg · February 2003 The debate over colloid versus crystalloid as the best solution for intraoperative fluid resuscitation is not resolved. Published studies have shown that mortality is not related to the specific fluid used for resuscitation. In addition, the quality of pos ... Full text Link to item Cite

Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery.

Journal Article Anesthesiology · October 2002 BACKGROUND: Intraoperative hypovolemia is common and is a potential cause of organ dysfunction, increased postoperative morbidity, length of hospital stay, and death. The objective of this prospective, randomized study was to assess the effect of goal-dire ... Full text Link to item Cite

Orthotopic liver transplant patients require less postoperative morphine than do patients undergoing hepatic resection.

Journal Article J Clin Anesth · September 2002 STUDY OBJECTIVE: To compare postoperative morphine use, analgesic efficacy, and side effect profiles in patients following orthotopic liver transplantation (OLTx) and liver resection (LR). DESIGN: Retrospective study. SETTING: Liver transplant and liver re ... Full text Link to item Cite

Malnutrition in liver transplant patients: preoperative subjective global assessment is predictive of outcome after liver transplantation.

Journal Article Transplantation · August 27, 2001 BACKGROUND: Malnutrition is a common complication of end-stage liver disease. It is frequently not a priority of treatment before liver transplantation. The purpose of this study was to examine whether prospective preoperative nutritional assessment could ... Full text Link to item Cite