Neuroanaesthesia and Neuro Critical Care

About the department:

The department of Neuroanaesthesia and Neuro Critical Care  at NIMHANS is in the forefront of dedicated patient care, quality research and high level training in neuroanaesthesia and neurocritical care to meet the increasing requirements of the nation since its inception in 1950s. The department is equipped with the latest and best of the equipments (anaesthesia work stations, advanced critical care ventilators, multiparameter monitors, echocardiography, latest airway gadgets, drug delivery systems, temperature management systems, brain function monitors etc)required for meeting the complex challenges in the neurosurgical operating rooms and intensive care units. The faculty are selected and promoted based on a rigorous assessment and selection criteria. Residents undergoing advanced training in this department are chosen based on ahighly competitive all India online entrance test and undergo extensive training and evaluation during the course period. Over several decades, the department has grown both in stature and eminence and is recognised as one of the best centers for training and research in neuroanaesthesia and neurocritical care both in India and abroad.

Summary information on key activities/work of the department:

The department caters to the requirements of various departments like neurosurgery, neurology, neuroradiology, psychiatry and neurorehabilitation with emergency services provided on a 24 X 7 basis throughout the year. Anaesthesia services are provided for nine neurosurgical operating theatres, three neurointensive care units with 30 beds to cater to critical care needs of neurosurgical, neuromedical and neurotrauma patients. Apart from this, anaesthesia services are provided for both diagnostic (MRI/CT) and interventional radiology procedures and electroconvulsive therapy for psychiatric patients. Perioperative pain management is another key area where department contributes to patient care. Recently a Pain Clinic has been added.

Vision: 

Treating patients with compassion, empathy and with at most dedication on par with world standards

Mission:

Aim to excel in all spheres of anaesthesia that is clinical anaesthesia, teaching and manpower development and research.

Objectives:

Support and treat the patients throughout the hospital stay as and when required for comfortable journey through various processes in the hospital. That includes preoperative services, intraoperative services, postoperative services and intensive care management.

Develop the manpower in neuroanaesthesia and neuro critical care to fulfill the requirements of the nation. Develop the policies and programs to fulfill the same in collaboration with other institutes, government and professional organizations.

As research being the future of anaesthesia, active encouragement and support is being provided to the research projects. Collaboration with other institutes within the country and abroad would be actively pursued. The department would strive to be recognized as a centre for research in the field of neurosciences in the world.

What we do

Services offered:

Perioperative care in nine neurosurgery OTsneurosurgical operating (including 24 X 7 emergency OTs), neuromedical and neurosurgical (including neurotrauma) ICUs consisting of 30 beds, diagnostic and interventional radiology units, electroconvulsive therapy unit, acute and chronic pain management.

Anaesthesia care is provided for various neurosurgical procedures include brain tumors, intracranial aneurysms, arterio-venous malformations, revascularization procedures for stroke in young, craniosynostosis, meningomyelocoele, paediatric tumors, epilepsy surgeries, cerebello-pontine angle lesions, neuroendoscopic procedures, spine pathologies, traumatic brain and spine injuries, functional neurosurgeries, neuro-rehabilitative surgeries and awake craniotomy procedures for surgeries in the eloquent areas of the brain.

Anaesthetic services are provided for magnetic resonance and computed tomography imaging studies in paediatric patients and uncooperative adults  and in the cath lab for interventional procedures like embolization of arterio-venous malformations, arterio-venous fistulae of brain and spine, vein of Galen malformation, endovascular coiling of aneurysms, WADA testing, diagnostic angiography and intra-arterial therapy for stroke and vasospasm, and carotid stenting.

Patients managed in the neurosurgical ICU include post-neurosurgical patients and traumatic brain and spine injury patients. The patients managed in the neuromedical ICU include but are not limited to those with status epilepticus, myasthenia gravis, acute and chronic inflammatory demyelinating polyneuropathies, neuroinfection and stroke.

Anaesthesia is provided for modified electroconvulsive therapy for patients with medically refractory schizophrenia, major depression, mania and other severe psychiatric disorders.

Acute postoperative pain management and interventional procedures for trigeminal neuralgia, chronic back pain and other acute neuropathic pain conditions.

Pain management clinic

Venue: F7, 1st Floor OPD complex

Time: 2:30 PM to 4:30 PM every Thursday except holidays

Service objective: Assessment and management of acute and chronic pain

Patient information:

Patients are generally referred to the Pain Clinic by one of the primary specialities. Patients should come with a referral letter and file when they visit us. No prior appointment is available at present and all visits are walk-in. If necessary, after evaluation, patients are referred to other specialists for opinion and management. The aim is to provide comprehensive multi-disciplinary care for patients with chronic pain.

The service provided include assessment and diagnosis and, medical and non-surgical (percutaneous interventional) management. The focus is to provide care based on patient’s needs, pathology and preference and enable early return to activities of daily living. Interventions are performed in the Cathlab or Operating room, usually on forenoon of Saturdays except second Saturday and holiday.

Pain management:

Varieties of medicines are used alone or in combination to manage pain after detailed evaluation. If medical management along with physical therapy and psychological support fail to effectively reduce pain, these patients are offered interventional treatment options. Most interventions are performed under ultrasonography or fluoroscopy guidance to enhance success and reduce side effects. The following interventional treatment procedures are currently undertaken:

• Epidural steroid injections
• Radiofrequency ablation
• Nerve blocks
• Targeted epidural blood patch
• Trigger point injections
• Ganglion block

The common painful conditions managed by our clinic include neck and back pain including that radiates to arm and leg from causes such as degenerated or herniated disc and facet arthralgia, neuropathic pain and neuralgias (post-herpetic, ilio-inguinal, trigeminal, occipital, meralgia etc), carpal tunnel syndrome, frozen shoulder, hemifacial pain, CRPS, peripheral neuropathies (diabetic neuropathy, etc), fibromyalgia and post-stroke pain. At present we do not cater to cancer pain.

Patient care

Intensive Care Units

Department of Neuro-anesthesia and Neurocritical care manages the neurocritical care unit (NCCU) at NIMHANS with the vision of excellence in patient care, education, research and leadership. The mission of the NCCU is to provide quality health care services. At present, there are three NCCUs at NIMHANS. The critical care units are open in nature. The NCCU specializes in the comprehensive critical care of all critically ill adult and pediatric neurological and neurosurgical patients. NIMHANS is a tertiary referral centre, and hence the NCCU manages most complex patients. The scope of Neurocritical care clinical services includes the provision of emergency medical interventions and resuscitation, provision of close observation and continuous multi-system monitoring and provision of mechanical ventilation for patients.  NCCUs provide an environment conducive to the continuous quality improvement of the medical, nursing and other healthcare professional staff.

As a primary teaching institution, the education of future physicians is at the pivot of our mission. The NIMHANS Neurocritical care fellowship program is of the highest quality with excellent teaching program in the country. Towards that objective, NCCU offers tertiary, referral-based intensive care for patients with serious, challenging and life-threatening diseases of the central and peripheral nervous system. The NCCU provides complete intensive care management to more than 1200 admissions per year with patients admitted from neurosurgery, neurology and interventional neuroradiology. The unit’s state-of-the-art equipment and technology and individualized care plans ensure the patients of optimal recovery.

Courses conducted by the department:

• DM Neuroanaesthesia – 3 years
• PDF Neuroanaesthesia – 1 year
• PDF Neurocritical Care – 1 year
• BSc Anesthesia Technology – 3 +1 year

Training to other students provided:

Training Nursing students, DM/Mch Residents from other departments of the institution during rotation postings Postgraduate trainees from other colleges (MD/DA/DNB) in neuroanaesthesia for one month Short term training  (3 to 6 months) in neuroanaesthesia from deputed from WHO/government institutes.

Contact (department):

Department of Neuroanaesthesia and Neurocritical Care, 3rd Floor, Neurosciences faculty centre, NIMHANS, Bangalore 560029

Current Faculty and staff

Technical Staff:

Mr. Mohanty SR

Mr. Manjunath RN

Mr. John P Andrew

Mr. Divakar C

Ms. Anusha Subakumar

Mr. Nune Videya

Mr. Hemanth Kumar

Mr. Samuel Jackson

Administrative staff:

Mr. Prince

Ms. Hema (Contract)

Supporting staff:

Mr. Shivakumar LH

Mr. ManjunathGM (Contract)

Infrastructure / Equipment / Facilities: 

• State of the art multi-function patient monitors for 8 OTs, 4 Radiology units, ECT unit and 3 ICUs
• Advanced anaesthesia work stations and ICU ventilators
• Portable multifunction ultrasound machine for central venous cannulation and nerve blocks, rapid diagnostic ultrasonography in emergency, transthoracic and transesophageal echocardiography, transcranial dopplersonography, peripheral vascular doppler for diagnosis of DVT
• Heart rate variability (HRV) monitors for autonomic nervous system function assessment
• Invasive and non-invasive cardiac output monitors
• Near infrared spectroscopy (NIRS) and jugular venous catheter for assessment of cerebral oxygenation
• Bedside integrated electroencephalography monitors for assessment of seizures in ICU and OT
• Depth of anaesthesia monitors like Bispectral index and spectral entropy
• Target controlled infusion pumps, MRI compatible anaesthesia work station, patient monitors and drug delivery systems
• Patient temperature management system, point of care coagulation monitoring systems
• Patient transport ventilators and monitors, defibrillators
• Many video laryngoscopes including Air traq, Mcgrath, CMAC..etc.
• Intubating laryngeal mask airway, light wand and fibreoptic scopes for difficult airway management
• Percutaneous tracheostomy services, bedside cardiac enzyme evaluation
• Intraoperative evoked potentials monitor

Patient information: 

FAQs, Facts about anaesthesia, Intensive care

Milestones:

1977- Establishment of modified ECT, Pain clinic

1978 – Establishment of Respiratory unit

1998 – One year Post-Doctoral Fellowship course in Neuroanesthesia started

2004 – Organised national conference of Neuroanesthesia and neurocritical care (ISNACC-2004)

2006 – Establishment of Liquid oxygen plant installed

2010 – Commencement of three year BSc Anaesthesia Technology course

2011 – Commencement of three year DM Neuroanaesthesia course

2014- Commencement of one year PDF in Neurocritical care course

2016 – Organised national annual conference of Neuroanesthesia and neurocritical care (ISNACC-2016)

2017 – Starting of intraoperative MRI OT complex, and pain clinic

Malathi Memorial Oration at ISNACC:

The department of Neuroanaesthesia and Neuro Critical Care constituted an oration in the name of Dr Malathi, the first HOD of the department, to be delivered every year during the annual ISNACC conference. The list of awardees is as below:

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