Anaesthesiology, Critical Care & Pain Clinic
The Department of Anesthesiology and critical care at BHMRC provides expert care in the Operation Theaters (OT), Post Anesthesia Care Unit (PACU), Surgical Intensive Care Unit (SICU), Pre Anesthetic Checkup Clinic (PAC), Pain Clinic and the Casualty. The department consists of over 12 consultants and 20 residents.
The 15 OTs are extremely spacious and well planned with laminar flow air conditioning and Hepa filters to maintain absolute sterility. Each OT is equipped with the latest generation low flow anesthetic workstations with built-in ventilators. Our department was the first and still one of the very few in the country to acquire a Target Controlled Infusion (TCI) system for computer controlled delivery of IV anesthetic agents Modern modular monitors are used for continuous monitoring of Pulse, Blood pressure, ECG, temperature, invasive pressures, end tidal CO2 and anesthetic gases, depth of anesthesia etc. There are dedicated OTs for Cardiac Surgery, Neurosurgery, Renal transplant, Joint replacement, Laparoscopic, Hysteroscopic, Urology, Thoracic and Vascular surgery etc. The most complex and diverse type of surgeries are performed here on many critically ill patients varying in age from premature babies to centenarians. The OT’s function during office hours for elective surgeries; and round the clock for emergency surgeries.
For post- operative care of patients, the two PACUs (12 and 8 bedded) have piped gases and multi-parameter monitors on each bed. For critically ill surgical patients, the 16 bedded SICU (including 2 reverse barrier nursing suites) has modern ventilators, non invasive ventilation systems and modular monitors. A dedicated and motivated team of doctors, nurses, physiotherapists, technicians etc. provide round the clock care of these patients.
The Department runs an Acute pain service for post operative patients and pregnant patients in labour who are offered various modalities of pain relief including patient controlled analgesia; IV and epidural infusions of analgesic agents and other drugs to relieve their discomfort. The department also runs a Pain Clinic for patients with chronic pain (e.g. cancer pain etc); and a Pre Anaesthetic Checkup (PAC) clinic for evaluating patients coming for surgery. These clinics are run Mon - Sat between 9am - 5pm.
To keep abreast of the latest, the members of the department organize and regularly attend various scientific meetings where they present research papers and deliver lectures.
The department conducts a post graduate residency programme accredited by the National Board of Examinations for awarding the degree of DNB which is recognized in India and abroad. Presently there are 15 post graduate students enrolled in the residency programme.
A dedicated Code Blue team is on call 24x7 to attend to any Life Threatening emergency within the premises of hospital.
A well equipped emergency department (general casualty) equipped with minor operations theatre runs 24x7 and is manned by a casualty medical officer (CMO) with his team from anesthesia department.
Post Operative Pain Clinic
Pain, arguably is the single most distressing symptom which leads patients to consult a doctor. Post operative pain is unique in that it results from a treatment planned for the patient’s good. However, often it is the single most worrisome thing on a patient’s mind as he prepares himself for surgery. Earlier pain was considered an integral part of the comprehensive post operative experience. However, now it has been scientifically demonstrated that adequate post operative pain relief besides improving patient comfort, results in improved outcomes and faster recovery and discharge. Good post operative analgesia is of paramount importance in patients undergoing surgery in the chest and upper abdomen.
Present day management of post operative pain includes using a combination of Paracetamol, non steroidal anti-inflammatory drugs (NSAIDS), narcotics (e.g.; morphine, fentanyl etc), occasionally certain adjuvants and local anaesthetic infiltration and nerve blocks. This is called Multi modal analgesia which combines more than one type of pain killers to achieve good pain relief with lower doses and hence fewer side effects.
Earlier the pain killers (narcotics) were given intermittently. However that resulted in unsatisfactory pain relief because of fluctuating drug levels in patient’s blood. Therefore present day treatment of postoperative pain includes use of IV infusion which results in continuous delivery of adequate amounts of pain killers either through a mechanized syringe pump or through elastomeric infusers. These infusers are light weight, relatively inexpensive and provide uniform pain relief while the patient is mobile.
Another advance in the delivery of pain killers to patients has been the development of Patient controlled analgesia (PCA). At the push of a button, the patient activates a mechanism to deliver a predetermined dose of analgesic (painkiller). This has been shown to give greater patient satisfaction, as they can control the analgesic delivery according to their requirements without having to call a nurse. To prevent over dosage, there is a built in ‘lockout’ period in which no drug will be delivered even if patient presses the button. The PCA devices are available as mechanized microprocessor based pumps or small disposable devices which allow patients to move around.
A tremendous advance in pain management has been the use of epidural catheter. This is a very fine tubing inserted in the back and left close to the nerves carrying the pain sensation. A mixture of local anaesthetics and narcotics is then administered through this catheter. This results in very good pain relief without the drowsiness seen with intravenous narcotics. This is very helpful in patients undergoing painful operation in the chest, abdomen and lower limbs. Patient controlled analgesia can be used with epidural catheter also. Epidural catheters have also been used for ‘Painless labour’ in expectant mothers.
The Anesthesiology department at Batra Hospital has an ‘Acute Pain Service’ which provides all these facilities to patients undergoing surgeries, or those involved in accidents and having pain due to fractures etc. We also look after patients in labour and provide epidural analgesia for painless labour. We strive to make the perioperative period a relatively pain free and pleasant experience for the patient.