Inquisitive anesthesiologist leaves 30-year legacy

The veterinary anesthesiologist’s goal during her stay in the former east German city was to help curb the number of horses that died after surgery in the Universität Leipzig’s large animal clinic.

The problem was post-anesthetic myopathy, a muscle disease that could be prevented by properly controlling blood pressure and providing fluid therapy during anesthesia to ensure the patient’s muscles continued to receive oxygen. Without proper treatment, horses faced a difficult recovery and were often euthanized.

“The young anesthetists out there now will hopefully never see problems like this in equine anesthesia because we know how to prevent them now,” says Duke-Novakovski.

She published her research on the topic, and since then, the case report summarizing eight months of observations has become a key source for veterinary anesthesiologists.

“If you’re a researcher, there are some landmark papers everybody knows. Not all of us will publish such a paper,” says Dr. Barbara Ambros, a veterinary anesthesiologist and professor at the veterinary college. Duke-Novakovski was Ambros’s supervisor during her residency and graduate program at the WCVM.

“That [paper] made a change from that moment forward in how we dealt with equine anesthesia.”

The paper was just one of many published by Duke-Novakovski, a prolific and highly collaborative researcher, who worked with various veterinarians and specialists to solve many problems. Her CV includes collaboration with the WCVM’s wide range of faculty members, from wildlife to livestock to horses and companion animals.

Duke-Novakovski recently retired after more than 30 years at the college. Originally from the U.K., she made her first visit to North America for her job interview after completing an anesthesia residency at the University of Liverpool.

She smiles as she remarks on the massive changes to her specialty since the 1990s. She and her colleagues have explored new techniques, drugs and technologies that have helped outcomes for veterinary patients.

“Over my career it’s been a time of great change within the anesthesia world,” she says.

Duke-Novakovski’s work spanned species and specialties. Almost every veterinary procedure requires the support of the anesthesia team, whether it’s a routine X-ray or a complex surgery.

Working on horses always presents a unique challenge as they respond differently to anesthesia than other animals.

“It is a much riskier thing to do for a horse than it is for a dog or a cat,” says Duke-Novakovski. Unique complications can develop due to the horse’s immense body weight and their unnatural position — lying on their back or sides — during surgical procedures.

Much of Duke-Novakovski’s research work dovetailed with advances in surgical techniques as surgeons tried new procedures that have since become routine. A shift to minimally invasive surgeries in the 1990s led to a corresponding need for new anesthesia techniques as well as research to determine best practices in small and large animal patients.

Because of the complexity of equine anesthesia, anesthesiologists typically stay in the room throughout the entire procedure. These circumstances presented a lot of opportunity for Duke-Novakovski to observeand to ask more questions, which inevitably led to further research studies.

“We would quite often piggyback on projects for several reasons. It made financial sense, but she was also quite good at thinking around certain problems and coming up with research questions,” says Dr. James Carmalt, an equine surgeon and professor at the WCVM.

Carmalt worked with Duke-Novakovski on many projects including his PhD work. His research involved passing a catheter through a network of blood vessels into the base of a horse’s brain to retrieve hormone samples from the pituitary gland.

Carmalt always appreciated Duke-Novakovski’s organizational abilities and her “unflappable” attitude: “Clinically, that was very important.”

Duke-Novakovski believes one of most important projects she worked on in equine medicine was research into whether thoracoscopy — a procedure where surgeons use an endoscope to look inside the chest cavity — could be performed on horses lying on their backs by collapsing the lung on the operative side with insufflated carbon dioxide.

She had worked on using ventilation of one lung in dogs with special endotracheal tubes, but direct ventilation of one lung cannot easily be done in horses. In horses, the alternative technique of collapsing the lung with a gas was evaluated, but the study’s results did not support its safe use when horses are recumbent.

“It’s a question that had to be answered because some people were doing this,” she says.

Duke-Novakovski also worked to explore new drugs and dosages. Her research was instrumental to bringing the anesthestic drugs propofol and alfaxalone into routine veterinary use (in Canada), says Dr. Christine Egger, a WCVM graduate and veterinary anesthesiologist. Egger was Duke-Novakovski’s first graduate student trainee and went on to serve as a faculty member at several veterinary colleges in the United States.

“I think she’s contributed a ton in terms of her research — she’s a big collaborator — so she’s certainly influenced the careers of many people at all levels. But she’s also put the University of Saskatchewan and WCVM on the map in terms of veterinary anesthesia research,” says Egger. “Her research is extremely well thought of, and she’s really brought a lot of credibility to the research program in anesthesia here.”

With funding from the Townsend Equine Health Research Fund (TEHRF), Duke-Novakovski recently completed the first study of remifentanil use in horses — work prompted because equine patients could become excited after receiving the opioid fentanyl. It is also expensive. Remifentanil, while also costly, offers a short-acting alternative without the possibility of adverse reactions during recovery.

All along, Duke-Novakovski was driven by the desire to make the information she gleaned from clinical practice available to colleagues around the world through publishing.

Her mentorship of students has also had an impact on generations of WCVM graduates.

“I think the standard of anesthesia in the last two decades has definitely improved, and I think she played a big role in that,” says Ambros. She points out that Duke-Novakovski always taught the highest standard of care to her students, who then went out to implement their knowledge in private practice.

“You can only do that if you’re passionate about it, and she is somebody who loved her field of expertise and it definitely showed with students. Students loved to come through anesthesia, and she was a big part of that.”