विभाग

Anesthesia Service

The Anesthesia service is involved with the peri-operative management of patients undergoing cancer surgery in the operation theatre complex for routine and emergency procedures, as well as in peripheral areas including paediatric radiotherapy, brachytherapy, endoscopy and radiology.

Our operating rooms are arranged geographically by surgical subspecialty and include 11 theatres for major and 2 for minor surgical procedures including laser surgery. Excellence in clinical care has always been an essential mission of our service. A work environment of mutual trust, respect, understanding and appreciation of each others needs, between surgeons and anaesthetists is encouraged. In the year 2005, we administered anesthetics to over 6047 patients and this volume of patient care has continued.

Major surgeries at our center include pulmonary, oesophageal and mediastinal tumour surgery, liver resections, pancreatectomy, adrenalectomy, radical cystectomy and renal surgery. Hemipelvectomy and limb salvage surgery are the major orthopaedic surgeries performed. Major head and neck surgeries include laryngectomy, laryngopharygectomy with gastric transposition, composite resections and skull base surgery. Airway surgery includes laser surgery for laryngeal / bronchial lesions and tracheal resections. Complex micro vascular reconstructive surgeries are also undertaken and a growing number of minimally invasive procedures like laparoscopic APR, laparoscopic Wertheim's hysterectomy, laparoscopic nephrectomy / cystectomy, VATS (Video Assisted Thoracoscopic Surgery) etc. are being performed.

The anesthetic management of patients undergoing extensive cancer surgery offers challenging problems including the management of difficult airway, acute hemorrhage, massive blood transfusion, anesthesia for emergency surgery in patients with severe sepsis and hemorrhage. The immense clinical experience gained in administering anesthesia to these patients, monitored anesthesia care, performing invasive procedures and experience in invasive haemodynamic monitoring attracts qualified anesthetists from around the country to undergo specialisation training in anaesthesia at our center.

Recovery Room

(24 hour service) All patients after major or minor surgical procedures are shifted to the recovery room for observation before being transferred home or to the ward. During this period they are monitored by a team of anaesthetists and nurses, who perform an initial post-operative evaluation, pain management, manage any acute post-operative event and also decide when the patient is ready for transfer.

Pre-operative Clinic

The department runs a clinic to conduct pre-operative anaesthetic evaluation of patients planned for surgery. A team of anaesthetists evaluate the patient's medical condition and formulate an anaesthetic plan, taking into account the patient's physical condition. This is then discussed with the patient, including the risks involved and details of any procedures likely to be performed in the peri-operative period.

General OPD (No. 178 GJB Bldg.)
Timing 9.15am - 1.30 pm (Monday to Friday)

Private OPD (No. 39 Main Bldg.)
Timing 9.15am - 1.30 pm (Monday to Friday)

Pain Service

The Pain Service looks after Acute Pain Management and Chronic Cancer Pain. Several consultants of the department are actively involved in pain management and rotate in the service on a monthly basis.

Acute Pain Service

The Acute pain service looks after post-operative pain after major surgeries and all other acute and acute on chronic pain conditions. Epidural analgesia and Patient Controlled Analgesia (PCA) are employed to relieve pain.

The Pain team consists of a pain consultant, a pain nurse and a pain resident. Pain medications are reviewed and readjusted accordingly, with the goal of keeping the pain scores below three. APS strives to reduce the incidence of severe pain to less than 10% in the ward. During 2006 about 1250 patients were treated by APS for post-operative pain using PCA, Epidurals etc.

The Pain Clinic

The Pain Clinic at TATA MEMORIAL HOSPITAL is one of the oldest pain clinics in the country. More than 1000 patients were managed in the pain clinic in the year 2006 with an over 800 patients follow up.

Chronic Cancer pain is managed using a multimodal approach, ranging from the use of oral analgesics including NSAIDs, co-analgesics, various forms of morphine, transdermal fentanyl patch to neurolytic nerve blocks given under fluoroscopic guidance.

The Pain Service actively supports and participates in the activities of the Palliative Care Clinic where treatment is offered for a variety of symptoms affecting those patients with advanced cancer.

Pain Clinic Timings
General OPD (No. 178 GJB Bldg.)
Timing 9.15am - 1.30 pm (Monday to Friday)

Private OPD (No. 39 Main Bldg.)
Timing 9.15am - 1.30 pm (Monday to Friday)

Post Graduation Education

Degree (M.D.) and Diploma (D.A.) Courses in Anaesthesia

The Department is affiliated to the Homi Bhabha National Institute (Deemed University) and is recognised for both postgraduate degree (M.D.) and diploma (D.A) courses in Anaesthesia (Formally affiliated to Maharashtra University of Health Sciences - MUHS). Seven staff members are recognized teachers for the above courses. The department receives seven M.D. (3 year course) and five D.A. (2 year course) students in anaesthesia every year. The designation of the post graduate student is 'Junior Registrar I, II or III' depending on the year of residency respectively.

Post Graduation Teachers

The following seven faculty members of the department are MCI recognised teachers for post-graduate diploma (D.A) and degree courses (M.D.) in Anaesthesia of the Homi Bhabha National Institute (Deemed University).

Senior Registrar Posts

Eligibility and Application

Senior registrar (SR) posts are available for a minimum period of one year (2 posts of 6 month duration) to those who have an M.D. (Anaesthesia) and/or D.N.B. (Anaesthesia) qualification from an MCI recognised institute. Newspaper advertisements for these posts are made about 2-3 months prior to the selection. The term commences on the 1st of September and 1st of March every year .Candidates are selected for the post following an interview, based on their experience and merit. SR I, II or III designations are given to the senior registrars based on the number of years completed after MD/DNB.
(Respectively in our department). JR III post is available for candidates who have done MCI Recognised post graduate diploma in Anaesthesia (D.A.) Application for these posts should be forwarded to the hospital HRD department directly. Selected candidates will be under a bond for a minimum period of 6 months.

Post continuation

Continuation in the department as senior registrar after completing one year is subject to the discretion of the Head of the Department, based on the candidate's work and conduct during the one-year period. Those interested is continuing may apply to Head of the Department one month prior to post completion.

Locum Posts

Locum senior registrar posts, for a minimum period of one month may be available from time to time against resignation or long leave of the senior registrars. Applications for locum posts may be made directly in the Anaesthesia department office. Eligible candidates will be contacted by the department office, as and when a locum post is available. Continuation beyond the locum period up to the end of the term is subject to the requirement of the department and the discretion of the H.O.D. For continuation into the next term, fresh applications should be made for senior registrar post to the H.R.D. office as per the newspaper advertisement requirements.

Registrar Rotation

All senior and junior registrars follow a monthly rotation in various areas like major and minor operating rooms, pain, recovery room, pre-op clinic etc. This rotation usually includes an ICU posting once in 3 months. Residents may also be rotated for a month at ACTREC (Advanced Centre for Treatment, Research and Education in Cancer) at Kharghar, which is the satellite institution of TMC .

Working Hours

O.T. posting

Work in the O.T. begins at 8.30 am and continues till the last case is shifted to the recovery room in the evening (not earlier than 4.45 pm) from Monday to Friday and half day (not earlier than 1.45 pm) on alternate Saturdays. One weekend ICU shift is done by the O.T. anaesthetist per month.

ICU posting

Registrars are posted in ICU once in every 3 months. Registrars work in 2 shifts – The morning batch works from 8.30 am to 7.00 pm and the evening batch from 7.00 pm to 8.30 am (Monday to Friday) which is alternated every week. On weekends the ICU registrar is required to do any one shift as designated.

Emergency duties

Registrars posted in O.T. will be required to do approximately 3-4 emergency duties per month from 4.45 pm to 8.30 am in addition to their routine O.T. work.

Orientation Programme

An orientation programme is conducted by the department for all newly joined residents.

A 'Handbook for Anaesthesia Registrars' will be available in the department office after appointment for information Further information related to the registrar post, can be obtained from the hospital HRD section.

Courses Conducted by the Department

1. Anaesthesia Review Course (ARC)

Anaesthesia Review Course, now, popularly known as ARC, was started in 2004. We felt that there was a lack of a CME course for postgraduate students which will help them prepare for their postgraduate examination. The purpose of ARC is thus to prepare the postgraduate student to face the examination with confidence. The course material that is given to the delegates gives the students a sound base from which to embark on their further studies. The anaesthesia machine and instruments is another neglected area in postgraduate teaching, hence we always attempt to rectify that through a hands on workshop on these topics with eminent faculty to facilitate interaction between the delegates and faculty at the workstations, we limit the number of registrations. The response to this annual CME has been overwhelming and enthusiastic all these years. For further information, the students can contact:

Dr. Atul Kulkarni
Anaesthestist & Additional Professor
Dept. of Anaesthesiology, Critical Care & Pain
TATA MEMORIAL HOSPITAL, Parel
Mumbai - 400 012.
Phone no. 098690 77526 and 022 -24177049
E-mail: kaivalyaak@yahoo.co.in

2. THEMATICC -Tutorials in Haemodynamic Monitoring & Therapy in Critical Care

Haemodyanmic monitoring is an essential area in the management of patients under anaesthesia and intensive care. As there was no comprehensive course dealing with all aspects of haemodynamic monitoring, interpretation and appropriate therapeutic approach, we commenced this CME as a joint venture with the Mumbai Branch of Indian Society of Critical Care Medicine. During the workshop, through hands-on interactive sessions at the workstations with experienced faculty, we deal with both basic and advanced haemodynamic monitoring modalities. At the end of the course we expect the delegates to have learnt physiologic principles involved in monitoring modalities, understood role and limitations of different modalities of haemodynamic monitoring in different pathological conditions and to be able to formulate appropriate therapeutic strategies based on available monitoring. In order to facilitate maximum interaction between delegates and faculty, we usually limit the number of registrations to 60 each year.

Dr. Vijaya Patil
Anaesthestist & Additional Professor
Dept. of Anaesthesiology, Critical Care & Pain
TATA MEMORIAL HOSPITAL, Parel
Mumbai - 400 012.
Phone no. 098690 77526 and 022 -24177049
E-mail: vijayappatil@yahoo.com

3. ICU Technician Course

Duration- One Year Certificate Course (starting in January each year)
No. of Seats – 10 seats
Eligibility- BSc. in Physics, Chemistry, Microbilogy, Zoology , Botany, other Life Sciences OR HSC with CMLT
Age Limit -35 years

Course Objectives - The course will provide an outline of, Anatomy, Physiology, Microbiology and training in electrical and electronics to improve the students understanding of the technical and diagnostic procedures used in ICU with special emphasis on applied aspects. There would be extensive coverage of theory as well as practical aspects in both basic life sciences as well as advanced technology used in modern ICUs.

Clinical Training – Students will be given training in the ICU under supervision where they would undertake graded responsibility of patient care. They would also be rotated through the operation theatre to understand airway management. The working of modern state of art equipments like ventilators, hemodynamic monitors etc. would be explained and taught by engineers working in the field.

* Age limit and Eligibility may be relaxed in case of departmental and sponsored candidates

For further information contact:

Dr. Vijaya Patil
Anaesthestist & Additional Professor
Dept. of Anaesthesiology, Critical Care & Pain
TATA MEMORIAL HOSPITAL, Parel
Mumbai - 400 012.
Phone no. 098690 77526 and 022 -24177049
E-mail:vijayappatil@yahoo.com

In-House Teaching Programmes

Anaesthesia

• 1Anaesthesia Post Graduate Teaching Programme – Case presentations,lectures,group discussions on topics related to post graduate training are taken under consultant supervision on Thursdays between 8.15 am to 9.00 am
• 2Anaesthesia Clinics –Lectures on topic of clinical interest in Anaesthesia are taken for the residents by consultants on Wednesdays between 3.00 pm and 4.00 pm
• 3Anaesthesia Journal Club – Interesting articles in Anasthesia are presented and discussed by department consultants on the 1st and 3rd Fridays of the month between 3.00 pm and 4.00 pm

Critical Care

• 1Case Discussion - Interesting ICU cases are discussed in the ICU among department consultants and registrars working in the ICU on Mondays between 3.00 pm and 4.00 pm.
• 2Journal Club – Interesting articles in critical care are presented and discussed among the consultants in the department on the 1st and 3rd Tuesday of the month between 3.00 pm and 4.00 pm.
• 3Critical Care Clinics - Lectures on key topics in Intensive care are taken for the registrars by different consultants from the department on the 2nd,4th and 5th Tuesday of the month between 3.00 pm and 4.00 pm.

Pain

Acute /Chronic Pain Clinics -lectures are taken for residents on pain topics ranging from assessment to treatment using all specialised techniques by consultants interested in pain management every Thursday between 3.00 pm - 4.00pm

ISCCM Post Graduate Diploma in Critical Care Medicine

The ICU is a recognised training unit for the ISCCM Diploma in Critical Care Medicine ( One Year Course) for a period of Six months. Two seats are available in the months of february and August each year. Applications for the post should be addressed to the Head of Department and sent in by the first week of January and July respectively.

Details about the ISCCM Diploma course are available on the following website.

http://www.isccm.org/ISCCM/Certificatecourse.aspx

The department secretary will be available during working hours(9.15 am to 5.30 pm Mon- Friday and 9.15 am to 2.15 pm on Saturdays)in the department office for any specific assistance/information required

Department Secretaries: Mrs Tanvi R Naik / Mr. Salim D Abbasi