Sir Ganga Ram Hospital, New Delhi, India

Anaesthesia

DEPARTMENT OF ANAESTHESIOLOGY, PAIN AND PERIOPERATIVE MEDICINE

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. These anesthetics provide continuous pain relief and sustain patients’ critical life functions as they are affected throughout surgical, obstetrical or other medical procedures.

The role of the anesthesiologist extends beyond the operating room. The anesthesiologist is responsible for the preoperative assessment of the patient, an evaluation process that carefully considers both the patient’s current state of health and the planned surgical procedure that allows anesthesiologists to make judgments about the safest anesthesia plan for each individual patient. The anesthesiologist is also responsible for the well being of the patient postoperatively while the patient emerges from the effects of anesthesia. They are often involved in the management of acute postoperative pain, as well as chronic and cancer pain. 

ABOUT THE DEPARTMENT

The Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital (SGRH), has successfully completed over three decades of existence. Over the period of time, it has seen significant technological, human-resource, functional and clinical evolution. Our Department has consistently maintained its position as a state-of-the-art essential clinical services provider. The Department boasts of a pool of 35-consultants, 2-clinical assistants and 12-residents (postgraduate trainees, senior residents) over and above the rotating interns, guest clinical-observers (liver/kidney transplant anesthesia, general anesthesia) and fellows (pain clinics). Clinical anesthesia services, academics, research, charitable activity and community outreach are integral central-facets of the Department. The Department sustains anaesthesia services for over fifteen surgical sub-specialties. Recently, we have added advanced Robotic-anaesthesia into our armamentarium and have facilitated over 300-major ROBOT-aided surgeries. Our Department provides round-the-clock consultant-based anaesthesia services for incoming elective/ emergency surgical patients that run into over 25000-patients annually. We also have a robust ‘Pain Relief Unit’ that covers for acute postoperative pain services and outpatient clinics for elective pain management.

STATE-OF–THE-ART- TECHNIQUES

The Department of Anaesthesiology, Pain and Perioperative Medicine looks forward and into newer/emerging techniques that propose to lead improvement in patient management. We have inculcated many advanced technology/aids to bolster routine clinical anaesthesia management, including; patient safety monitors: specific hemodynamic monitoring for fluid administration, optimization during critical/long surgery (stroke-volume variation), noninvasive cardiac-output management (Lidco-Plus), anesthesia-depth monitoring (Bispectral-Index); Pain medicine: electromyography-guided transforaminal injections for low backache, radio-frequency ablation,  and ultrasound-aided nerve-blocks, alcohol/neurolysis and Ozone-nucleolysis. We also have developed new functional innovative techniques, such as, airway management; ‘neo-fulcrum’ for dental-protection during airway management; ‘guided tactile-probing’ and ‘rigid endoscope-assisted’ difficult airway management; and radiograph-assisted first-attempt (RFA) neuraxial access in difficult spine in the elderly, etc. We are also the front-runners in chronic pain-management techniques.

FACILITIES OFFERED

The Department of Anaesthesiology, Pain and Perioperative Medicine, offers host of clinical services, academic-training and research. Apart from the provision of routine clinical anesthesia, we impart DNB-postgraduate Training (Anesthesiology), Fellowship (pain relief services, liver-transplant anaesthesia), Observership (general anesthesia, liver-transplant anesthesia, pain management) and opportunity for new MBBS-graduates under the Compulsory Rotatory Internship programme.

KEY SERVICE

Clinical Anesthesia

The presence of a collective anaesthesia practice system in our Department has facilitated the experts/consultants (n=35) to undertake 80-100 operations-a-day along with active teaching (3-year postgraduate DNB training, operation-theatre technologists/scrub-nurse training, visiting fellows/observers in Anesthesiology, etc.) and related investigator-driven clinical research. All the anesthetic episodes are fully controlled and covered by designated consultants only. We provide anesthesia care delivery (Clinical Anesthesia, Postoperative Intensive Care) to over fifteen surgical specialty-areas (liver/kidney transplantation, major knee/hip replacements, neurosurgery, pediatric surgery, robotic thoracic/urologic/minimal access interventions, etc.) for scheduled/emergent surgical intervention. Over the last couple of decades, we have been pioneers in Anesthesiology service-provision in the surgical sub-specialty area, including but not restricted to, thoracic, bariatric, laparoscopic/robotic, organ transplant, neurosurgical and pediatric anesthesia, etc. Anesthesia services are rolled out from the dedicated operation rooms (ORs, n=28), a day-care system and an intensive care back-up. All the operation theatres are modular and are fully-equipped with advanced laparoscopy armamentarium

Intensive Care

The intensive care service to perioperative patients is vital and occupies essential transition period between the surgery and a discharge-fit patient. We have a robust intensive-care system covering generic (immediate-postoperative care recovery rooms 6th/7th floor, post-anesthesia intensive care, [PACU]) as well as specific intervention-oriented (Liver & Kidney Transplant Intensive Care Units) surgical patients. We have the privilege of having to offer intensive care to around 10% of surgical patients everyday. In addition, an intricate and well-structured intensive care patient transfer procedure is operational for intra-hospital transfer of critically-ill patients.

Acute Pain Services

The Department of Anesthesiology, Pain and Perioperative Medicine has the distinction of being the first in the country to initiate an Acute Pain Service (APS) program that caters to all the surgical patients in the postoperative period. While it helps all the patients in receipt of anaesthesia to get pain alleviation, it has a definitive positive impact on the post-surgical patient outcome. It has been, for sometime now, a much-needed fillip to completeness of clinical anesthesia services and consequential patient satisfaction with the healthcare delivery.

Chronic Pain Management

In conjunction with APS-system, the chronic pain management simultaneously took-off as an additional provision. Interestingly, since it involved non-surgical patients whose care demanded preoperative evaluation, OR-based intervention, and postoperative care, a day-case-patient-floor-system is evolved to ensure comprehensive pain relief services. A Pain Relief Clinic is set-up to allow preoperative evaluation and initial counseling for possible prospective pain-relief related technical intervention. The post pain-intervention care is responsibly supervised 24x7 by our APS-team.

Daycare Anesthesia Services

A state-of-the-art 18-bedded daycare facility awaits the patients who are electively scheduled for short-duration minor surgical procedures. With the societal changes, especially those emanating out of increasing formation of nuclear family units, the daycare anesthesia care delivery of our department expects to and is geared-up to receive greater number of patients who require day-surgery other than pure surgical reasons. The facility is ably manned by anesthesia-oriented patient safety monitors and experts controlling them. The nursing care (1:4) and expert medical cover is available around-the-clock to entertain routine patient inflow and any unanticipated exigency.

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 Evaluation Clinic: situated in 5th floor SSRB block patient reception area. The Pre-anaesthesia Evaluation Clinic starts early (07:00 Hrs) for the incoming daycare patients. After the initial surge, it settles with the routine flow of impatient as well as outpatients who are posted for afternoon surgery. It closes late in the evening (20:00Hrs) keeping up to the timings of concurrently running surgical OPDs.

2. Pain Relief Clinic: We actively cater to the chronic pain patients through the Pain Relief Clinic functional during 08:00-18:00 hrs. In addition, we undertake a 2-hour free-clinic in the SGRH general-OPD on Monday and Friday (10:30-12:00 Hrs). A private outpatient clinic is also run by the pain specialists of our department.

3. Labor Counseling/Analgesia Clinic: A Labor Analgesia Clinic is also open and services, including, labor pain relief prior to and during the normal delivery process, patient/attendant information about the labor-epidural intervention, counseling for proactive obstetric plan, and the role of anesthesiology experts to the patient with active labor pain is provided throughout the day and also in the emergency hours.

4. Patient Counseling Clinic: is operational for those patients who wish to be apprised of anesthesia intervention process, which they would be subjected to in course of the planned surgery. This helps in allaying anxiety, nurturing confidence, counseling the relatives/attendants and facilitating informed consent process for surgery and overall, it adds to the preoperative patient satisfaction.

5. The Palliative Care Clinic: provides a multidisciplinary clinical consultation in palliative medicine to all patients with chronic or life-limiting condition in need of counseling. The General OPD is held on Monday & Thursday, from 10:00 am in Room No. F-24.

OUR ACHIEVEMENTS

With the changing scenario and recent developments in anesthesia sciences having a positive impact on the anesthesia care delivery in terms of infrastructural and operational systems, the Department of Anesthesiology, Pain and Perioperative Medicine, has been all the way up there with concurrent advances/innovations that are taking place in-around the world. We have the pride in initiating and sustaining dedicated sub-specialty anesthesia care in major surgical areas, including, Organ Transplant Surgery (Kidney [1987], Liver [1996]), Plastic & Reconstructive Micro-Surgery, Laparoscopic Surgery (1994), Joint Arthroplasty (1996) Thoracic Surgery (2000), Bariatric & Metabolic Surgery (2004), Robotic Surgery (2011) to name a few. We have to pleasure of initiating the country’s first fully-functional Acute Pain Service (APS) unit. We are also the first to introduce an Audit system for clinical anesthesia and a Quality Assurance Cell within our department (2006). We successfully look forward to and have always embraced new technology on the anvil, including, newer monitoring systems (BIS, advanced cardiac monitoring [invasive, non-invasive], neuromuscular monitoring, airway dynamics assessment, etc], interventions [ultrasound-guided initial venous access/nerve blocks, radiofrequency ablation, ozone-therapy] and maintenance profile [Bair-Hugger warming system, Flowtron-SCI mechanical anti-DVT system, rapid fluid-infusion system, thromboelastography, etc.] Above stated advantages and a proactive stance has helped us with the opportunity of extending anesthesia care to the Honorable President of India.

ADVANCED ANESTHESIA/RESUSCITOLOGY SIMULATION CENTER

In the year 2007, in conjunction with the initiation of Surgical Laparoscopy Simulation Center, our department came up with Advanced Anesthesia & Cardio-pulmonary Resuscitation Simulation Center. It helps in facilitating technical-training to our postgraduate students and the dedicated support staff, before they actually start working in consultant-supervised system in the real-patient anesthesia case scenarios. This facilitates patient safety and also brings down undue morbidity purely due to suboptimal training.

OBJECTIVES AND VISION

The Department of Anaesthesiology, Pain and Perioperative Medicine has been constantly following a ‘review®renew’ agenda for over five-years now. Based on the above, we have set internal standards in the form of system-operating-procedures (SOPs), random policy introduction and application, learning from morbid / critical study cases, and teaching / training of younger members (DNB postgraduates, senior residents, clinical associates, junior consultants). The primary objective is centered on patient safety and satisfaction. We intend to further broaden the scope of diverse procedures, which specifically targets enhancement of current patient care both in terms of content (technical adequacy) and quality (patient-satisfaction). Overall, we aim to follow a set of serial-objectives that are intricately linked and have a prospective step-ladder orientated growth projection. Current objectives are:

i) Patient-oriented anesthesia services

ii) Newer approaches to consider and address difficult case-scenarios

iii) Bring down internal case-cancellation rate

iv) Enhance external referrals

v) Active record-keeping (anaesthesia-related morbidity, successfully-managed critical cases)

vi) Structured patient follow-up mechanism with particular attention to high-risk cases, women, children and the elderly

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 SGRH, New Delhi.

RESEARCH-RELATED ENDEAVORS

The Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital has an inclusive clinical research development (CRD) plan in place since 2003. Intensive clinical practice, thesis/dissertation-oriented research, morbidity meets, active audit system and consultant-based innovative practices have formed the very basis from which research and consequent publications have emanated. In addition, our consultants get actively involved in subspecialty anaesthesiology conferences (National/International) as delegates/presenters (platform, poster)/invited faculty/oration-lectures).Most importantly, our consultants have been very aware of contemporaneous research and time-and-again have critically responded to the concurrent contentious publications.

We have a robust academic programme, which centers on DNB postgraduate training. Our Department also administers structured training to nurses, OR-technicians, observers (anaesthesia, pain-relief services, organ-transplant, laparoscopic surgery) and guest observes/fellows. The outreach academic endeavors of our Department includes: Annual SGRH Anaesthesiology Updates (since 2003), Postgraduate Assembly (since 2010), monthly ISA-Clinical Meets (Delhi Chapter) and, Faculty-lectures.

AMENDING THE CURRENT, LOOKING INTO THE FUTURE

The Department of Anaesthesiology, Pain and Perioperative Medicine has continuously put endeavors for a forward-looking, proactive, flexible and patient-oriented developmental outlook. Furthermore, we are sensitive to identification of ‘new’ problem-areas related to clinical services and/or quality enhancement relating to existing practices. Our Department continually frames new policy(s) based on the objective need to enhance anesthesia health care delivery. In the future, we plan to introduce as a part of routine practice, objective anesthesia techniques, preoperative forums (critical case discussion, patient counseling), structured postoperative patient follow-up, and e-record system that archives the above. In addition, we have a focused stance on patient rights, good ethical practices and study of socio-economic implications that may arise from anaesthesia health care delivery process. Our Department trains the post-graduates trainees on “simulation-based training methods” that covers broader/essential anesthesia domain (major vascular access, neuraxial block, airway access techniques). Importantly, we also have orientation-programme for disaster preparedness, and handling mass-casualty situations. We critically look forward to prioritization in terms of ‘case down-time’, type of cases, collective consultant approach to emergency patients and overall care-plan (postoperative ventilation/observation).

The Department of Anaesthesiology, Pain & Perioperative Medicine has 35 consultants, in addition to senior residents and postgraduate students.  There are 21 state of the art operation theatres with modern anaesthesia machines and advance patient monitoring devices.We conduct on an average of 80-100 operations every day of various surgical specialties.

Our department is actively involve in imparting training to candidates pursuing postgraduate training in anaesthesia (DNB). Research and further improvement of the art of Anesthesiology is our endeavor.

We provide anaesthesia services for a wide variety of specialties:

  • Robotic Surgery
  • Advanced Laparoscopic Surgery
  • Neurosurgery
  • Pediatric Surgery
  • Thoracic and Vascular Surgery
  • Transplant Surgery (Liver and Kidney)
  • GI Surgery
  • Urology
  • oint Replacement
  • Plastic & Cosmetic / Maxiofacial Surgery
  • ENT / Ophthalmology
  • Obst. & Gynae surgery / Labour Analgesia
  • Pain Management Service
  • Anesthesia outside Operating theater- interventional radiology, neurointervention, vascular intervention, MRI, PET scan, CT scan, Endoscopy

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.  These anesthetics provide continuous pain relief and sustain patients’ critical life functions as they are affected throughout surgical, obstetrical or other medical procedures.

The role of the anesthesiologist extends beyond the operating room. The anesthesiologist is responsible for the preoperative assessment of the patient, an evaluation process that carefully considers both the patient’s current state of health and the planned surgical procedure that allows anesthesiologists to make judgments about the safest anesthesia plan for each individual patient. The anesthesiologist is also responsible for the well being of the patient postoperatively while the patient emerges from the effects of anesthesia. They are often involved in the management of acute postoperative pain, as well as chronic and cancer pain.

Post Doctoral Certificate Course in Pain Management