DEPARTMENT OF ANAESTHESIOLOGY, CRITICAL CARE AND PAIN

As anesthesiologists we are responsible for the safety and well-being of patients before, during and after surgery. This includes placing patients in a state of controlled unconsciousness called “general anesthesia”, the provision of “regional anesthetics” where only a portion of the body is made numb, or administering ‘sedation’ when indicated for the relief of pain or anxiety.

The role of the anaesthesiologist extends beyond the operating room. It starts from preoperative assessment of the patient, which is an evaluation process that carefully considers both the patient’s current state of health and the planned surgical procedure that allows anaesthesiologists to make judgments about the safest anesthesia plan for each individual patient. The anaesthesia care extends to postoperative period while the patient emerges from the effects of anaesthesia.

Critical Care Medicine (CCM) is a specialty that involves the management of patients with life threatening, frequently complex medical and surgical illnesses in a specialized Intensive Care Unit (ICU) or similar facility. A modern ICU represents the pinnacle of any hospital’s approach to highly technological & sophisticated in-patient care. The critical care consultant has the expertise in the evaluation and management of these critically ill patients, who may have dysfunction or failure of one or more organ systems including the cardiac, pulmonary, neurologic, liver, kidney or gastrointestinal systems.

The department also provides acute pain services in the hospital and pain management for chronic cancer related pain on both as outpatient as well as in-patient basis.

ABOUT THE DEPARTMENT

The mission of the Department of Anesthesiology, Critical Care and Pain in Tata Medical Center is to provide state-of-the art anaesthesia services, perioperative care, pain management and life-support for cancer patients in intensive care. The primary objective is centered on patient safety and satisfaction.

The Department of Anesthesiology, Critical Care and Pain has successfully completed five years of existence and is an integral part of the institute that has contributed immensely to the growth of the hospital. Our Department has set up its own high standards in patient care, education and research. The Department boasts of a pool of 11 consultants, 4 clinical associates, 5 postgraduate fellows, 9 medical officers and 13 technologists. The Department provides anaesthesia services for seven onco-surgical sub-specialties. Recently, we have added advanced robotic-anaesthesia into our armamentarium. Our Department provides round-the-clock consultant-based anaesthesia services for emergency surgical patients. We also have a robust ‘Pain Management Unit’ that covers for acute postoperative pain services and outpatient clinics for elective pain management.

STATE-OF–THE-ART- TECHNIQUES

The Department of Anaesthesiology, Critical Care and Pain looks forward and into newer/emerging techniques that propose to improve patient management. The unit is equipped with latest advanced technology/aids to boost up routine clinical anaesthesia management including modern anaesthesia machines, advanced gadgets for difficult airway management, patient safety monitors: specific hemodynamic monitoring for fluid administration, optimization during critical/long surgery (stroke-volume variation), anesthesia-depth monitoring (Bispectral-Index); ventilators, ultrasound etc. amongst many others. Pain medicine: radio-frequency ablation, ultrasound-aided nerve-blocks, alcohol/neurolysis etc.

The Department of Anaesthesiology, Critical and Pain, offers host of clinical services, academic-training and research. Apart from the provision of routine clinical anesthesia, we impart fellowship in Onco-Anesthesia, Critical Care and Cancer Pain management accredited by Indian College of Anaesthesiologists. The process of accreditation for IDCCM and DNB is going on.

KEY SERVICE

Clinical Anesthesia

The presence of a collective anaesthesia practice system in the department has facilitated to undertake 250-300 cancer surgeries in various sub-specialties along with active teaching (operation-theatre technologists, visiting fellows/observers in Anesthesiology, etc.) and related investigator-driven clinical research. All the anesthetic episodes are fully controlled and covered by designated consultants and fellows only. We provide anesthesia care delivery (clinical anesthesia, perioperative intensive care, intensive care to other critically sick patients) to several surgical sub-specialty-areas (GI-onco, gynaec-onco, head-neck, uro-onco, plastic & microvascular, thoracic-onco, breast, paediatric and robotic etc.) for scheduled/emergent surgical intervention.

Intensive Care

Critical care unit presently comprised of 16 beds. It is divided into medical ICU (5 beds), surgical ICU (6 beds) and High Dependency Unit (5 beds). All the medical beds are isolated unit to prevent cross infection. ICU beds are electronically controlled so that head or foot end of the bed can be positioned appropriately as per patient requirement for better patient management. Each bed is associated with an advanced multichannel monitor capable of monitoring patient’s pulse, ECG rhythm, blood pressure (both continuous and intermittent basis), central venous pressure, respiratory rate and pattern etc. The unit is equipped with advanced ventilators containing different modes to support patient’s lung function in different scenario. Besides, the unit is also equipped with advanced haemodynamic monitors, airway adjuncts including fibreoptic bronchoscope, haemodialysis machine etc.  We have dedicated radiology, microbiology and pathology team helping us for better patient management. All the patient related data including laboratory and radiology reports, doctor’s assessment record, and old treatment document (both inpatient and outpatient) are available in our electronic hospital management system (HMS), so that investigation reports are available to the treating doctors without any unnecessary delay, all the data can be accessed from any place inside the hospital and no old data are lost during the treatment course.

Acute Pain Services

The Department of Anesthesiology, Pain and Perioperative Medicine has an active Acute Pain Service (APS) program that caters to all the surgical patients in the postoperative period. A multidisciplinary, nurse (acute pain Nurse) based, anaesthesiologist (consultant & fellows) supervised/ led model of APS (Acute Pain Service), involving all ward nurses (through an organized team approach) provide postoperative analgesia, regardless of the technique used. Acute pain team uses protocol-based management, which involves use of multimodal analgesia including thoracic epidural analgesia (TEA), patient-controlled analgesia (PCA), patient controlled epidural analgesia (PCEA) etc.

Chronic Pain Management

The Department runs a pain clinic for cancer patients. It facilitates evaluation, initial counseling for possible prospective methods of pain-relief, which include pharmacological, non-pharmacological or interventional. This pain may be due to direct tumour invasion of local tissues, metastatic bone pain, visceral obstruction, nerve compression and plexus invasion, ischaemia and inflammatory pain. The post pain-intervention care is responsibly supervised 24×7 by our APS-team.

Non-Operating Room Anaesthesia Services

Nonoperating room anesthaesia (NORA) refers to administration of sedation/anesthaesia outside the operating room to patients undergoing painful or uncomfortable procedures. Common procedures include diagnostic/ thearapeutic procedures in radiology i.e. MRI, CT, PET CT etc, gastrointestinal endoscopic procedures, radiotherapy, interventional radiological procedures in cath lab etc. Anaesthesiologists are frequently asked to provide NORA in these remote locations. We have state-of-the-art facility with anaesthesia machine and monitoring in every area (including MRI compatible machine & monitors) to provide safe anaesthesia to patients.

SPECIALTY CLINIC

We run dedicated anesthesia care delivery clinics with sub-specialty area experts. The following clinics serve the patients in the respective core areas:

1.Pre-Anaesthesia Checkup Clinic (PAC clinic):  Daily PAC Clinic goes on from 09:00 to 17:00 (08:00 hrs) keeping up to the timings of concurrently running surgical OPDs. Here all patients scheduled for surgery are assessed, optimized, counseled, preoperative advise given and consent is taken after thorough explanation and discussion regarding the perioperative plan.

2.Pain Clinic: We actively cater to the chronic pain patients on Saturdays and other days on SOS basis.

OBJECTIVES AND VISION

Overall, we aim to follow a set of serial-objectives that are intricately linked and have a prospective stepladder orientated growth projection. Current objectives are:

1. Patient-oriented anesthesia services
2. Newer approaches to consider and address difficult case-scenarios
3. Bring down internal case-cancellation rate
4. Active record keeping (anaesthesia-related morbidity, successfully managed critical cases)

The collective efforts towards objectives (as above) are likely to yield solid, inclusive and comprehensive sustainable mechanisms of anaesthesia-specific health care delivery. We aim to deliver consistently on clinical services as well remain sensitive to immediate/long-term need of surgical patient population coming to TMC Kolkata.

RESEARCH-RELATED ENDEAVORS

The Department of Anaesthesia, Critical Care & Pain in TMC has an inclusive clinical research development plan in place. Intensive clinical practice, thesis-oriented research, morbidity meets, active audit system and consultant-based innovative practices have formed the very basis from which research have emanated. In addition, our consultants get actively involved in subspecialty anaesthesiology conferences (National/International) as delegates/presenters (platform, poster)/invited faculty/ lectures).

The unit runs a successful postgraduate TMC fellowship program of 2 years’ duration, Indian College of Anaesthesia (ICA) accredited fellowship program for 1 year duration in onco-anaesthesia, critical care & pain, 1 year postgraduate TMC fellowship program in critical care.  Our Department also administers structured training OR-technicians, observers (anaesthesia, pain-relief services) and guest observes/fellows.

Our Department trains all senior and junior doctors of the hospital on “simulation-based Basic Life support training methods” Importantly, we also have orientation-program for disaster preparedness, infection control and handling mass-casualty situations.

Fellowship programs in Anaesthesia, Critical care & Pain

• 2 year TMC fellowship in Oncoanaesthesia, Critical Care & Pain
• 1 year ICA accredited fellowship in Oncoanaesthesia, Critical Care & Pain
• 1 year TMC fellowship in Onco Critical Care