ANESTHESIOLOGY SERVICES

The Anaesthesia Department of Rajiv Gandhi Cancer Institute & Research Centre is well equipped with high end anaesthesia workstations to meet the needs of all types of cancer patients and for surgeries lasting for long hours. The hospital has fourteen major modular Operation Theatres (OT) in two towers and three minor OT’s. The Operation Theatre has the distinction of being GREEN OT CERTIFIED by Bureau Veritas. Electronic record keeping of the pre anaesthetic assessment, intra operative monitoring and procedures is being practiced. This data (Innovian and CPRS interfaces) has been incorporated into the Hospital Information System.

Every patient scheduled for surgery undergoes thorough pre-anaesthetic evaluation wherein a detailed history, physical examination focusing on the airway and spine and a battery of investigations, referrals to specialists based on the co-morbidity, stage of cancer and nature/extent of proposed surgery and counselling of patients is performed. A detailed pre-anaesthetic form is completed  for record keeping. After pre-medication, on the day of surgery the patient is wheeled into an OT, equipped with state-of-the-art monitoring equipments,  and expert anaesthesia personnel who administer anaesthesia- either general anaesthesia, regional anaesthesia or a combination of the two. In the post-operative period, the patient is shifted to the surgical ICU for variable periods of time for monitoring of vitals, pain relief, and mechanical ventilatory support as and when required..

The Pre Anaesthesia Checkup (PAC) clinic is functioning along with the surgical specialty OPD’s to provide a wholesome experience of perioperative care for the patients. The Enhanced Recovery After Surgery (ERAS) protocol is being adhered to wherever possible to seamlessly integrate the preoperative, intraoperative and postoperative periods The hospital is in the process of starting pre-habilitation of patients scheduled for major surgery.

All cancer patients pertaining to oral and maxillofacial surgery (including LASER surgery) with free-flap reconstruction, breast surgery with oncoplastic reconstruction and implant insertion, surgery for urogynaecological malignancy, neurosurgery (neuro-navigation assisted), thoracic surgery (including minimally invasive repair of pectus excavatum; Nuss procedure), abdominal and pelvic malignancies, paediatric surgery (including chemoport insertion),  major orthopedic malignancies including limb salvage are being operated. Facilities for  liver transplant in hepatic cancer patients exist. Specialized anaesthesia for laparoscopic surgery, High Intensity Focussed Ultrasound (HIFU), Hyperthermic Intraperitoneal Chemotherapy (HIPEC), Radio Frequency Ablation (RFA), Intraoperative Radiation, Stem cell harvesting, Interventional radiology such as Transarterial Chemoembolization (TACE), CT-guided facial artery embolization, cryotherapy, real-time ultrasound (USG) guided gastrointestinal endoscopy and biopsy, tracheal and bronchial stenting etc are being performed. Interventional pain management techniques are being conducted under CT-guidance under monitored anaesthesia care. The institution has more than a decade of experience in anaesthesia for robotic oncosurgery on all parts of the body including radical hysterectomy, radical prostatectomy, neobladder construction, Videoendoscopic Inguinal Lymph Node Dissection (VEIL), lobectomy, esophagectomy, Transoral Robotic Surgery (TORS), thyroidectomy and breast surgery.

The anaesthesia department boasts of state-of-the-art Perseus Workstations with Artificial Intelligence incorporated. Procedures such as, videolaryngoscopy, bronchoscopic intubations, double lumen tube insertion for one lung anaesthesia (bronchial blockers for difficult airway), Trans-Esophageal-Echocardiography (TEE), manual jet-ventilation, diagnostic and therapeutic perioperative ultrasound, regional blocks, invasive cardiac output and stroke volume variation (SVV) monitoring and are being used in anesthesia techniques.

General Anaesthesia as well as conscious sedation is performed for outdoor procedures such as endoscopies and in remote locations for Radiotherapy, Interventional Radiology, CT-Scan, Positron Emission Tomography (PET)-CT and Magnetic Resonance Imaging (MRI).

The Anaesthesiology team comprises of five Senior Consultants, four Consultants, apart from the Clinical Assistants, Senior Residents and DNB candidates.

The Department is accredited by the National Board of Examination and four primary and four secondary DNB candidates are admitted every year for the course. Oncological Anaesthesia fellowship of one year is being offered to preferred candidates interested in the post-doctoral training. An OT-technician course approved by Indian Medical Association is also being conducted by the Department.

Research activities pertaining to goal directed fluid therapy using IVC distensibility index, lung ultrasound and TEE guided cardiac output; ultrasound guided upper airway studies; Thromboelastography (TEG) studies in deranged coagulation profiles have been published and several others pertaining to  awake videolaryngoscopic intubation for difficult airway, USG guided PECS blocks and erector spinae blocks, evaluation of nasal patency for nasotracheal intubation and comparison of novel ventilatory modes in state of the art Perseus workstations are in progress.