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					                Annual Report 2009-2010
                Anaesthesia, ICU and Pain Management




T
Anaesthesia, ICU & Pain Management

       he Department of Anaesthesia, Intensive Care & Pain Management is a dynamic and very productive department of Sultan
       Qaboos University Hospital (SQUH). Our key roles are in the operating theatre, anaesthetising patients for all surgical specialties
       and subspecialties and in the Intensive Care Unit, managing critically ill patients. The Department provides twenty-four hour
elective and emergency anaesthesia services to the entire hospital, including referrals from other health institutions. We manage a
25 bed Intensive Care Unit. We are also involved in inserting venous access devices, both implantable and percutaneous, to patients
from various clinical departments. Pain management is also part of departmental functions with acute and chronic pain manage-
ment services. Cardiopulmonary resuscitation is a significant function of this Department and now cardiothoracic anaesthesia has
also been added. The Department forms a solid part of SQUH Trauma and Disaster management services.

The pre-Anaesthesia Assessment Clinic (PAC) has been fully functional since March 2009. Patients who have to undergo surgery are
assessed here for surgical fitness at the Out Patient Department (OPD) level. This was initiated with the main aim of reducing in-
patient cancellations—a key factor in improving hospital efficiency. The clinic is being run Saturday to Wednesday from 8 am to 2 pm.




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                                                 Pradeep K. Sharma, Senior Registrar
                                                 Jyoti Burad, Registrar
                                                 Aravind Narayanan, Registrar
                                                 Devaraj N. Dyamanna, Registrar
                                                 Hatem Abd El Ghany, Registrar
                                                 Amr A.H. Sewan, Registrar
                                                 Qutaiba Tawfiq, Registrar
                                                 P. Madhanagopal, Registrar
                                                 Ahmed Khamis, Registrar
                                                 Ali S. Faris, Senior House Officer
                                                 Hussain Hamdan, Senior House Officer
                                                 Ajai K. Arora, Senior House Officer
                                                 Prasad Fonseka, Senior House Officer
                                                 Vishnu Prasad, Senior House Officer
                                                 Khadija Al-Abri, Senior House Officer
                                                 Zainab Al-Breiki, Senior House Officer




                                                                                                                                            Anaesthesia, ICU & Pain Management
                                                 Zahra G. Ahmed, Senior House Officer

                                                 Support Staff
                                                 Leena Chacko, Coordinator
         Dr. Ama rna th Shetty
         Consultant, Acting Head of Department
                                                 Ibrahim Al-Farsi, Coordinator
                                                 Mohammed Al-Badi, Technician




                                                                                                    academic and patient care departments
                                                 Maheswariamma, Technician

Staff
Medical Staff
                                                 Highlights of the Year
Karin Nollain, Senior Consultant                 2009-2010
Suresh Chengode, Senior Consultant               The annual Scientific Session of the Oman Soci-
Ram Narayan Rao, Consultant                      ety of Anaesthesia and Critical Care was held in
Sinnakirouchenan, Consultant                     December 2009 at Sultan Qaboos University. Dr.
Rajini Kausalya, Consultant                      Rajini Kausalya, Dr. Amarnath Shetty, Dr. Sinna-
Ali Al-Abady, Consultant                         kirouchenan, Dr. Mohamed Al Ismaili and Dr. Pra-
Nasser Al-Kemyani, Consultant                    dipta Bhakta all acted as moderators. The theme
Mohammed Al-Ismaili, Consultant                  of the Session was “Anticoagulation and Regional
Jaswinder Sharma, Senior Registrar               Anaesthesia”.
Binoy Zachariah, Senior Registrar
Pradipta Bhakta, Senior Registrar                The Department organised 2 workshops on Ultra-




                                                                                                    27
       Annual Report 2009-2010
       Anaesthesia, ICU and Pain Management



     sound in Anaesthesia and Critical Care along with the Anaesthesia Department of Royal Hospital. The work-
     shops were held at Sultan Qaboos University in May and December 2009 respectively. Both the workshops
     were facilitated by international faculty. The response was very positive and both workshops were very
     successful.

     The Department also participated in the Quality Day, which was held in SQUH in March 2010, presenting
     posters related to the Pain Management and the Pre-anaesthesia clinic.


     N EW SER VI C ES
     The Department is proud to have introduced the new service of performing peripheral nerve blocks and
     vascular access under ultrasound guidance. The new ultrasound machine, which corporates the latest in
     portable ultrasound technology for clinical applications, has been a boon for the Department and has made
     it possible for this latest service to be initiated in the department. This machine is also going to be effectively
     put to use in the Intensive Care Unit for haemodynamic measurements and transthoracic echocardiogram.


     N EW SU B - SPEC I ALT Y
     In this period, anaesthesia for paediatric and neurological surgeries with postoperative intensive care moni-
     toring started its services which are now fully operational.



     Teaching Programmes
     U N D ER G R AD U AT E C L INICA L P R O GR A M M E
     The 6th year medical students carry out a compulsory two week rotation in the Department participating
     in the clinical activities. Students are given ‘hands-on’ experience, on both manikins as well as patients, un-
     der the close supervision of anaesthesiologists. This is in order to witness and learn airway management,
     endotracheal intubation, intravenous cannulation, fluid management and monitoring of the anaesthetised
     patient. The tutorials are aimed at making the student understand the use of airway adjuncts, respiratory
     equipment, central venous and arterial cannulation, regional blocks, and drugs used in anaesthesia and car-
     diopulmonary resuscitation. The main topics of these lectures are pre-anaesthetic evaluation; management
     of patients under anaesthesia; postoperative pain relief; the pharmacology of anaesthetic drugs; acid base
     and electrolyte disorders, and hypovolemic shock. The lecture is given by senior doctors in the department on
     a rotation basis followed by a 30 minute case discussion.




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P O ST G R AD U AT E PR O GR A M M E
Oman Medical Specialty Board (OMSB)
A 4-year residency programme in anaesthesia was started in September 2007 under the OMSB. Two resi-
dents were enrolled in this programme. An exit examination is planned at the end of 4 years; after the suc-
cessful completion, the residents would do a further year of specialised training. The Department is actively
involved in developing the curriculum, accreditation and examination processes for this programme


TR AI N I N G C O U R SES & CM E A CT IV IT IE S
The Department is actively involved in the teaching of training courses organised by the SQUH Training
Directorate. These include the Advanced Cardiac Life Support (ACLS) provider course, ACLS recertification
course, Basic Life support (BLS) provider course, BLS recertification course, AED (Accident & Emergency Dept)
course and the Pain Management course. Every Saturday there is a CME session in the Department covering
topics of recent interest in anaesthesia and intensive care. Doctors of the Department present interesting
topics beneficial to the staff. Residents are encouraged to attend. Members of the Department are also part
of OSAAC which is involved in regular CME activities and scientific sessions.




                                                                                                                                                                                                                                       Anaesthesia, ICU & Pain Management
Clinical & Diagnostic Services
A total of 5,591 anaesthetic procedures were carried out in 2010 compared to 4,761 in 2009 and 4,056 in 2008.




                                                                                                                                                                                               academic and patient care departments
                                                                                                                                                     Emergency        Elective         Total

                                                                                                                                                     448                           441
                                                           430                      420
                                                                       412                                                 410
                                                                                                 393                                                              398
                                                                                                              384                              386
                                               379
                                                      364                     356                                    366
                                  340   340                                                                                                                 344                  342
                                                                  328                      324
                              304                                                                       309                             306
                       600
     No. of Patients




                                                                                                                                  251
                       500

                       400

                       300

Figure 1: Anaesthesia Statistics 2010
          200                                                                                                                                                              98
                                                                 84                                    75
                             36                      66                      64           69                                                  62
                       100                                                                                          44           55                        54
                                        39

                         0
                              Jan            Feb          Mar         Apr     May              Jun          Jul          Aug          Sep          Oct          Nov              Dec




                                                                                                                                                                                               29
          Annual Report 2009-2010
          Anaesthesia, ICU and Pain Management




     Research
     RES EAR C H PR O JEC TS
     Sickle Cell Disease in Adult Patients and Intensive Care Management- A 5 Year Retrospective Study in the
     ICU of SQUH
     Project Code:                        MREC# 348; Dates: 2010
     Value:                               Unfunded; Project approval: Sultan Qaboos University
     Investigators:                       Dr. Qutaibah Tawfic, Dept. Anaesthesia, SQU

     RES EAR C H PU B LI C ATIO NS & B O O K S
     Journal Publications
     1.    Mishra P, Bhakta P, Janakiraman R, Darlong V. Intra-operative epidural catheter migration into subarachonoid space
           leading to massive subarachonoid injection of morphine-a case report. Middle East J Anaesthesiol 2009; 20:469−71.
     2.    Tawfic QA, Mishra P, Bhakta P, Kausalya R, Narayanan A. Missed congenital glottis web may mimic subglottic ste-
           nosis in a child. Eur J Anaesthesiol 2009; 27:217−9.
     3.    Bhakta P, Mishra P, Tawfic QA. Psychomimetic reaction after use of propofol in day care surgery: report of two cases.
           Middle East J Anaesthesiol 2010; 20:599−601.
     4.    Dyamanna DN, Bhakta P, Chouhan RS, Al Azri F. Anaesthetic management of a patient with pituitary adenoma for
           caesarean section. Int J Obstet Anaesth 2010; 19:460−1.
     5.    Tawfic QA, Bhakta P, Kumar S. Letter re Controlled hypotension for middle ear surgery: a comparison between remi-
           fentanil and magnesium sulphate. Br J Anaesth 2009; 103:247−9.
     6.    Tawfic QA, Bhakta P, Kausalya R. Unexpected cause of oesophageal obstruction due to accidental use of traditional
           medicine in a critically ill patient fed through naso-gastric tube. Ind J Crit Care Med 2010; 14:160–1.
     7.    Sharma D, Bithal PK, Dash HH, Chouhan RS, Sookplung P, Vavilala MS. Cerebral autoregulation and CO2 reactivity
           before and after elective supratentorial tumor resection. J Neurosurg Anesthesiol 2010; 22:132−7.
     8.    Kumar R, Goyal V, Chouhan RS. Venous air embolism during micro-electrode recording in deep brain stimulation
           surgery in an awake supine patient. Br J Neurosurg 2009; 23:446−8.

     C O N F ER EN C E & SEM INA R P R E S E NT A T IO NS
     Conference presentations
     International
     1.    Chengode S. Intra operative transeosophageal echocardiography workshop. 3rd National Workshop on Intraopera-
           tive Transoesophageal Echocardiography. Bangalore, India, October 2009.




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2.   Chengode S. Ischemic mitral regurgitation. Where do we stand in 2010? 13th National Conference of Indian Associa-
     tion of Cardiac Vascular & Thoracic Anaesthesiologists. Kolkata, India, February 2010.
3.   Chengode S. Basic TEE workshop - TEE in congenital heart diseases. 13th National Conference of Indian Association
     of Cardiac Vascular & Thoracic Anaesthesiologists. Kolkata, India, February 2010.

National
1.   Chengode S. Cardiac patient for non-cardiac surgery. 3rd International Conference and Annual Meeting of Oman
     Society of Anaesthesia and Critical Care. Muscat, Oman, November 2009.
2.   Kausalya R. Medical errors. 2nd International Conference on Quality Management in Health Care. SQUH, Muscat,
     February 2010.

S EMI N AR PR ESEN T A T IO NS
International
1.   Chengode S. Haemodynamic calculations in TEE. 3rd National on Intraoperative Transoesophageal Echocardiogra-
     phy Workshop. Bangalore, India, October 2009.




                                                                                                                                                                 Anaesthesia, ICU & Pain Management
                                                                                                                         academic and patient care departments
                                                                                                                          31

				
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