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Services

Regular Anaesthesia Services were provided to the following operation theatres:

Operation theatres

No. of theatres

Main Operation Theatre Complex

Seventeen operating  rooms (n=17)

Advanced Cardiac Centre

Four operating  rooms (n=4)

Renal Transplant Unit

Two operating  rooms (n=2)

Advanced Paediatric Centre

Two operating  rooms (n=2)

Advanced Eye Centre

Three operating  rooms (n=3)

Trauma 22

Two operatingrooms (n=2)

Robotic Surgery

Two operating  rooms (n=2)

Day Care Centre

One operating room (n=1)

Total

33 operating theatres

 

 

A 24x7 emergency anaesthesia services were provided for Emergency operations in:

New Emergency Operation Theatre Complex

Six operating  rooms (n=6)

Advanced Trauma Centre

Five operating  rooms (n=5)

Clean Labour Room

One operating  room (n=1)

Advanced Paediatric Centre

One operating  room (n=1)

Advanced Eye Centre

One operating  room (n=1)

Advanced Cardiac Centre

One operating  room & one cath lab (n=2)

DSA Room                  

One operating room (n=1)

Total

17 operating theatres

 

A 24x7 Intensive care services were provided to the following units:

Main ICU

12 bedded

High Dependency Unit(Main ICU)

4 bedded

CTVS ICU

12 bedded

High Dependency Unit(Cardiac)

13 bedded

Trauma ICU

17 bedded

Post-anaesthesia Care Unit

20 bedded

 

Anaesthesia services in peripheral locations

  • Paediatric CT sedation 
  • Dental Sedation
  • Electroconvulsive Therapy
  • Radiotherapy
  • Whole body DSA
  • Neuro DSA
  • ERCP
  • In vitro fertilization
  • Peripheral resuscitation and central line cannulation 

 

Additional services

  • Pre-anaesthetic evaluation clinic: PAC clinic set up in the New OPD block runs on all working days of the week to assess and evaluate surgical patients preoperatively.
  • Pain clinic: Twice a week Pain Clinic service was offered to treat patients with Acute or Chronic pain in the New OPD block.
  • Pain OT: Interventional procedures for relief of chronic pain were performed under fluoroscopy guidance in the operation theatre.
  • Labour analgesia services: They were provided to parturient in the labour room.

 

Additional Operating rooms started in last one year:

  • Day Care OT= 300 days
  • Trauma OT= 100 days
  • Robotic OT= 25 days.

 

The Details of the clinical services provided in the last three years are as follows:

ANESTHESIA SERVICES

2017-18

2016-2017

2015-16

Operating Room:

Patients receiving anaesthesia

42773+3403

=46176

40,232

38,151

 

Anaesthesia for Organ retrieval

34

30

 

Cadaveric Renal transplant

69

60

 

Cadaveric Liver transplant

11

12

 

Cadaveric Heart transplant

1

1

 

Cadaveric Pancreas transplant

2

6

 

Patients admitted overnight in PACU

1674

1326

1243

Intensive Care:

 

 

 

Patients in Main ICU

525

431

410

Patients in Trauma ICU

461

538

396

PAC clinic

53285

29591

34,096

Pain Services:

 

 

 

Patients examined in Pain clinic

3889

3893

4621

Pain procedures performed in pain clinic

240

92

566

Pain procedures performed in OT

590

526

658

Parturient received labour analgesia

16

17

16

Outside OR

 

 

 

Pediatric Dental sedation

100

76

90

Cardiac Catheterization Lab: anaesthesia/sedation/MAC

82/47/238=367

76/67/174=317

123/98/213=434

Radiology

 

 

 

  1. Pediatric CT Imaging

 

683

958

  1. ECT

2835

1656

1727

  1. DSA

1350

1654

349

Resuscitation  calls

764+92+263

=1119

1369

498

Arterial Blood Gases

 

 

 

  1.  Main ICU  lab

141100

151368

1,40,389

  1.  Main OT lab

3774

3623

3282

  1. Advanced Trauma Centre Lab

40971

28817

25,855

 

Training

This year 96 residents are undergoing training for the course of MD Anaesthesia, 7 for DM, Cardiac Anaesthesia and 14 for DM, Neuroanaesthesia. Four candidates enrolled for Ph.D program in Neuroanaesthesia and 1 candidate enrolled for Ph.D in Cardiac Anaesthesia during this time period. Thirty one residents received the MD Anaesthesia degree in the year 2017 – 18. This year 8 students are being trained for three-year B.Sc. Medical Technology Operation Theatre degree course. Three students received the B.Sc degree during the year 2017 – 18. The faculty of the department conducted 4 Courses on Cardiopulmonary Resuscitation – Basic Life Support for all the junior residents who joined the Institute in January and July 2017. The courses included lectures, hands-on training on manikins followed by evaluation for each resident. One candidate enrolled in Paediatric Anaesthesia Fellowship.

 

In 2009, the Advanced Cardiac centre was inaugurated by the then Hon’ble Prime Minister of India, Dr.Manmohan Singh in the presence of Hon’ble minister for health and family welfare Shri Ghulam Nabi Azad . The number of outpatients and inpatients with heart disease being treated at the institute has more than doubled since then. The cardiac anaesthesia department has been delivering anaesthesia care to an increasing number of patients. We have been delivering care to patients undergoing minimally invasive cardiac surgery, complex paediatric cardiac disease patients , heart and lung transplant patients and ECMO patients in the cardiac operating room and intensive care unit, anaesthesia support for multi vessel and high risk PCI patients, endovacular graft placement and complex paediatric cardiac patients in the cath lab which includes neonates with high risk lesions in the cath lab and in the cardiac care unit .


Transesophageal echocardiography is the cornerstone of cardiac anesthesia. The cardiac anaesthesia department of PGIMER has been a pioneer in TEE. At the helm of the Society for Transesophgeal echo(STE) , we have organised annual preoperative and critical care transesophgeal echocardiography workshop, which has now reached its 13th edition. The highlights of the workshop are the presence of nationally and internationally renowned faculty, which includes cardiac anaesthesiologists and echocardiography directors. Participants from all over the country get to see live demonstrations of TEE from the OT. The didactic lectures are structured and distributed over three days, and participants learn about the niche field of pediatric transesophageal echo on the third day. Porcine heart dissection in the wet lab to learn the anatomy of the heart is the brain child of PGI, in India. Interested participants also attend a week long hands on workshop in the OT. The STE also gives away young research scholarship award and handsome prizes to meritorious participants. 
STE also has a peer reviewed journal ‘ Journal of Perioperative Echocardiography’, which is dedicated to publications related to tranesophgeal, trans thoracic and epicardial echo in the perioeprative period. As a biannual journal launched in 2013, it has 84 published articles till 2017.As an offshoot of the TEE workshop, the cardiac anaesthesia department of PGI conducts trans thoracic echo workshop every october. Transthoracic echocardiography is an essential skill for all anaesthesiologists and may soon become a requirement for certification. This is a completely hands on workshop right from the first hour. The faculty leave no stone unturned in making sure that the anaesthesiologists are equipped with this valuable skill at the end of the workshop.The cardiac anaesthesia team is also proactively involved in echo workshops conducted in national and international conferences and were the mentors in the echo conference conducted as part of Indian society of anesthesiologists annual conference held at Ludhiana in 2016.


On the sidelines of the TEE workshop is the workshop on nerve blocks mentored by renowned international faculty. Colloboration with the anatomy department of PGI also makes demonstration on cadavers possible in this workshop.


CMEs have been held at regular intervals at the Advanced Cardiac centre. The CMEs involve horizontal integration among the paediatrics, cardiology, cardiac surgery, pathology and immunology departments and include CMEs on ECMO,CPR in cardiac surgery and paediatric cardiac surgical intensive care. Notable among them is the Heart transplant update held in February 2014, which saw experts from all over the country dealing on the crucial subject of transplantation care.
The cardiac anesthesia team of PGIMER, with tremendous help from surgeons, transplant coordinators, pathologists, perfusionists, technicians and staff nurses performed the country’s first ex vivo lung perfusion with locally available components on a brain dead organ donor’s lungs in 2016. We followed it up with EVLP of four more pairs of lungs. By preserving the lungs for four hours duration, we were able to demonstrate the remarkable potential for this technique in expanding donor lung availability and shortening the waiting list for transplant.


The Advanced Cardiac Centre has served as a launchpad for the region’s first automated drug delivery system ‘ Closed loop anesthesia delivery system’, shortly known as CLADS. It is an automated feedback controlled drug delivery system which also has the additional functionality of electronic record keeping. Its development was sponsored by the Department of Electronics and Information Technology. PGI’s collaboration with Clarity Medicals Pvt Ltd has now resulted in possibility for revenue realisation from this well published, patented, indigenous technology. It has been presented in numerous forums and was awarded the Excellence in healthcare award of FICCI in 2014. The innovation continues with the development of automated pressure control system (CLAPS). Another notable innovation emanating from the advanced cardiac centre is the IV alert, a compact volume measuring device which protects the patient against volume overload. Again, we were awarded the FICCI healthcare excellence award in 2017 for this innovation.


We have remained at the forefront of technology and an MoU with Infosys resulted in the efficient and economical anesthesia information management system. This system collects data from multiple monitoring and drug administration devices in the operation theatre. Launched in June 2018, the system allows real time data visualisation; it can be linked to the hospital information system and can be programmed to assist in auditing the cases.


Residents from PGI have won numerous awards at anesthesia as well as multidiscpilnary conferences based on their research done during their time at the advanced cardiac centre.The best paper award in the cardiac anesthesia category for the previous two consecutive years were bagged by residents of PGI, Dr.S. Sruthi (2016) and Dr.Avneet Singh (2017) under the expert guidance of Dr.Banashree Mandal for their work on sedation during TEE and lung ultrasound in cardiac surgical patients respectively at the Indian society of Anesthesiologists’ annual national conference. Residents from PGI, Dr.Sheenam Walia and Dr. D.Srinath were the recipients of best paper award in 2017 and best presentation award in 2018 respectively at the multidisciplinary Paediatric cardiac society of India annual conference, which is attended and chaired by stalwarts of cardiac surgery. Dr.Ganesh Kumar from cardiac anesthesia, PGI won best paper award at ISACON -Uttarakhand 2018 from among numerous participants for his presentation on dynamic right ventricular outflow obstruction.
The ACC has been at the centre of multiple international collaborations. The surgeons , staff nurse and the perfusionists from PGI underwent mentorship programs at the Boston Children’s hospital, USA. The institute is also in constant touch with Children’s heart link, an international collaboration for improvement in paediatric cardiac care. Regular visits and conduction of simulation exercises by their team are directed at improving paediatric cardiac care at the institute. Prof.V.K.Arya is also a visiting professor at University of Manitoba, Canada. Student exchange program with University of Manitoba, Canada has resulted in mutual benefits for the institutes. As a part of the colloboration, the editorial team of Canadian journal of Anesthesia conducted a scientific writing workshop at the Advanced Cardiac centre. Conjunctionally, the two institutes are among the few centres in the world practicing high spinal anesthesia in cardiac surgery.  Prof. Bhupesh Kumar and Dr. Banashree Mandal have received training in Paediatric cardiac anaesthesia at Boston Children’s Hospital and in heart transplant from Pittsburg,USA respectively. The residents, Dr. Rajarajan G., Col. Dr. Alok Kumar and Dr. D. Srinath have also presented their research work done at the advanced cardiac centre in international conferences. In addition, Dr. Sethumadhavan and Col.Dr.Alok Kumar received training at University of Manitoba and Boston Children’s hospital respectively. 


As of 2018, 12 candidates have completed their DM cardiac anesthesia at the institute. All of them are working at premier government or private institutes in India or abroad. Notably, the excellent transesophgeal echocardiography training provided at the institute has resulted in many of them passing the benchmark advanced perioperative echocardiography certification exam conducted by national board of echocardiography, USA.   


The perioperative care of patients is only expected to further improve when the pediatric cardiac surgical intensive care unit in 2nd floor of advanced cardiac centre starts to function.