Speciality Department

Anaesthesiology and Critical Care Medicine

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The Department of Anaesthesiology and Critical Care Medicine offers consultation in all areas of anaesthesia and critical care as well as chronic and acute pain management.

Critical Care Medicine

The Division of Critical Care Medicine runs a 29 bedded medical intensive care unit (MICU). All medical cases needing intensive care are admitted here. These include endocrinology, gastroenterology, internal medicine, nephrology, neurology, oncology, pulmonology, paedatrics, rheumatology, skin & infectious diseases. Some surgical patients are also admitted here including general surgery, gynaecology, neurosurgery, orthopaedics, and trauma. The total number of patients admitted annually is approximately 1500.

All beds have individual multi-parameter patient monitors that have ECG, invasive pressures that include blood pressure, CVP, ICP, PAP etc., respiratory monitoring, temperature with features for storing data over a 24 hour period. The various mechanical ventilators that are available have all modes including SIMV, PRVC, PS, etc. Ventilators also provide ventilator waveforms and loops that help the intensivist in better titration and fine tuning of ventilatory management. Other ventilators like noninvasive ventilators and transport ventilators are also available.

Other facilities that are available at the bedside include various diagnostic procedures like ultrasound,ECG, ECHO, X-ray, EEG, ABG and various therapeutic procedures like haemodialysis, plamapheresis, fibreoptic bronchoscopy, percutaneous tracheostomy, minitracheostomy, ultrasound guided paracentesis and other therapeutic procedures, USG guided arterial and central venous cannulation etc. The special features of staffing include one:one nurse patient ratio, 24 hour availability of physiotherapists and respiratory therapists.

We have two critical care training programme here. We have the fellowship programme of the National Board of Examinations, New Delhi and also the Diploma (IDCCM) of the Indian Society of Critical Care Medicine (ISCCM). The trainees are trained to do various procedures like insertion of invasive lines, intercostal drainage, various airway management techniques, percutaneous tracheostomy and advanced cardiac life support. Teaching programme are in place for the fellowship candidates. Journal clubs with articles from the recent journals are discussed.

Anaesthesiology

Services Offered :

Cardiovascular Anaesthesiology

The department of Cardiac Anaesthesia & Intensive care is imparting anaesthesia services to all types of cardiac surgical procedures (routine & emergency). We conduct beating heart as well as bypass surgeries for CABGs, complex aneurysm repair, emergency aortic dissection repair as well as valvular surgical cases. Thoracic cases like pneumonectomy, lobectomy, and thoracoscopic cases are frequently done. We provide training in one lung ventilation, bronchoscopy, and difficult airway management too. Annually we administer anaesthesia to 1350 adult adult cases and 300 pediatric cardiac cases. Ours being a tertiary centre we get referrals from distant hospitals pertaining to complex redo cardiac pediatric as well as adult surgeries. The pediatric cardiac anaesthesia section caters to anaesthesia for a varying kind of surgeries from ASDs and palliative surgeries like Glenn shunt to complex taxing surgeries like Norwood. Ours is a well equipped, state of art 5 cardiac theatres and 12 adult ICU beds and 12 pediatric ICU beds. Both the ICUs are well equipped with state of art, latest ICU ventilators & central monitoring system with facilities of monitoring vital signs & various other invasive & non invasive parameters including Arterial blood analysis.

We provide training to postgraduate students as well as anaesthesia technicians and respiratory therapy students. We encourage research and pioneering spirit in the department. Our endeavor is to create leads in the field of anaesthesia and we have been successful in this as many from this institute are well placed in various centers in and outside India

Anaesthesia for Neurosurgery and Orthopaedic surgery

Division of Neuroanaesthesia and Orthopaedic anaesthesia caters to a wide variety of neurosurgical and orthopaedic patients. The department deals with high risk patients including ASA PS 3 and 4.

The division anaesthetizes neurosurgical procedures (for adults and children) including, intracranial and skull base tumour surgeries, intracranial vascular surgeries including aneurysm clipping, cranial and craniofacial reconstructive procedures (combined with maxillofacial surgeons), seizure surgeries, awake craniotomy, stereotactic procedures, trans-nasal trans-sphenoidal pituitary surgery, CSF rhinorrhoea repair, varied shunt procedures, neuroendoscopy, anomaly correction in new-borns and trauma surgery.

The spine division of neurosurgery performs surgeries on both adults and children, including lumbar and cervical disc surgeries, spine decompression for trauma, complex spinal canal tumour surgery, and correction of degenerative disease of the spine, and different spine stabilization procedures including occipito – cervical, and repair of myelomeningocele in the neonatal population.

Other procedures for which patients are anaesthetized include repair of brachial plexus injury in adults and children, surgery for stroke including carotid endarterectomy, and interventional neuroradiology for aneurysm coiling, intracranial stent placement, and AVM embolization.

The Orthopaedic department also requires us to anaesthetize a wide spectrum of patients, ranging from simple trauma related cases, paediatric orthopaedics, correction of complex spinal deformities, arthroscopic surgeries and reconstructions, knee, hip, shoulder and spine arthroplasties, and surgery for bony malignancies.

In addition to anaesthetic care of patients, the division also renders expertise in stabilization and management of critically ill orthopaedic and neurosurgical patients in the neuro-intensive care unit. Airway management in patients with unstable cervical spine is facilitated by familiarity with intubation aids including flexible fiberoptic bronchoscopy (adults and children), ILMA, and Airtraq. Regional anaesthesia is practiced extensively to minimise patient discomfort. Continuous nerve block techniques are employed when indicated. The division uses ultrasonography and nerve stimulation as a routine to enhance success during procedures. The number of USG guided procedures exceeds 500 per year, and training of both faculty and postgraduates in ultrasound guided regional anaesthesia is undertaken.

GI, Transplant (Liver & Kidney) & Urology

Gastrointestinal (Transplant, Minimal access surgery) & Vascular Anesthesia. A team of more than 10 senior anaesthesiologists are available to provide both preoperative evaluation, optimisation and operative and postoperative care to the patients for transplantations both liver and kidney. Amrita Hospital hold the coveted position for being the largest centre for liver transplants in South India. More than 140 liver transplants have been successfully performed; the majority of the transplantations are done from living donors. In addition, newer techniques like auxiliary liver transplantation and ABO incompatible transplantation have been successfully performed. Amrita Hospital have also performed 19 transplants in children. The anesthesiologists are trained in the usage of the latest hemodynamic monitoring devices and coagulation monitoring in these patients.

Amrita Hospital is also a major centre for renal transplantation largely from living related donors.

The gastro surgical unit is one of largest referral centers in South India and has specialized in the treatment of gastrointestinal & hepatobiliary disorders. The anaesthesiologists provide expert care in major surgeries with advanced hemodynamic monitoring including management of pain with thoracic or lumbar epidural analgesia. They are also trained to provide blocks under ultrasound guidance if needed.

The teams of anaesthesiologists also provide anaesthesia for vascular surgery both for abdominal aortic surgery and peripheral vascular diseases. A large number of procedures for vascular disorders are done under ultrasound guided limb blocks.

The team also provides anesthesia for a large number of laparoscopic surgeries including bariatric surgeries. The team is trained in fibreoptic intubations and airway management in difficult intubations. Specialized operating tables and equipment is available for this group of patients.

Paediatric Anaesthesia

The anesthesiologists also provide services for pediatric surgical patients. A large number of neonatal surgeries are successfully performed and the patients are looked after in NICU which is equipped with state of the art ventilators and monitoring equipments. A numbers of laparoscopic surgeries including thoracoscopic procedures are performed and the anesthesiologists are trained in the intra and postoperative ventilatory management of these patients.

Urology

The department of urology performs a large number of surgeries and serves as a tertiary referral centre. The centre besides routine prostatic surgery and percutaneous nephrolithotomies handles a large number of renal malignancies and receives a number of referrals for endocrine related surgeries. The anesthesiologists are trained to handle these patients involving laparoscopic procedures for adrenal tumors including pheochromocytomas.

Anaesthesia for Head and Neck/Plastic and Reconstructive Surgery

Section of Anaesthesia for Head and Neck surgery, onco-surgery, Plastic and reconstructive surgery, podiatry and maxillofacial surgery caters to a wide range of cases.

The cases taken care of under the maxillofacial section consist of major facial trauma, cranio-facial surgeries (usually combined with neurosurgery), reconstructive and cosmetic surgery in the syndromic patients (neoanate to adults), cleft palate, cleft lip and pure cosmetic procedures in adults (Orthogranthic surgery).

Major head and neck surgeries include surgeries for major cancers of the head and neck region with reconstruction, craniofacial cancer surgeries and major vascular malformations of the had and neck region. This center has the reputation of doing the largest number of free flap reconstruction in all of India.

The plastic surgery section does major cosmetic surgeries, re-implantation of traumatic amputation, truncal reconstructions, abdominoplasty, major liposuction, brachial plexus surgery and reconstruction following cancer resection as well as traumatic tissue loss.

The Anaesthesiolgists managing this section are highly skilled in managing difficult airway situations, taking care of patients requiring long duration of anaesthesia as well as the post-operative ICU care of the major surgical and trauma patients. Specialized airway equipments like Flexible bronchoscope suited for neonate, children and adult are part of their armamentarium in addition to the other special airway management equipments. They are also skilled in providing ultrasound guided regional anaesthesia for major limb surgeries in patients with high risk factors. A major number of patients coming to the podiatry section belong to ASA grade II and above (the high risk group).

Obstetrics

This is a tertiary referral center that provides a full range of obstetric – related care. Obstetric anaesthesia services are provided round-the-clock, seven days a week with three operating rooms with state-of-the-art facilities dedicated exclusively for obstetrics and gynecology. 20 to 25 surgeries are performed every day which includes laparoscopic and gynecology cases also. Around 100 patients receive labour analgesia every month. We provide care for a full range of obstetric – related surgical conditions. Commonly encountered pregnancy – related problems include pre – eclampsia, complex cardiac maternal conditions, prematurity and multiple gestations. The patients are approached by an interdisciplinary team that includes perinatologists, neonatologists, anaesthesiologists and other medical and surgical consultants as needed. The anaesthesiologists give intra operative and post- operative intensive care to the patients.

CONTACT US

Email: anaesthesia@aims.amrita.edu