BPKMCH | ANNUAL REPORT - 2018
DEPARTMENT OF ANAESTHESIA
Introduction
The history of anesthesiology is to relate in detail the events surrounding the 1846 public demonstrat on
of ether anesthesia by William T. G. Morton (1819-1868). The first anesthet cs were given to ameliorate
the pain associated with dental extract ons and minor surgery. The department of anesthesiology started
funct oning from 2nd August 1999 at BPKMCH. As the complementary fields, surgery and anesthesiology
matured together, new skills are being performed by the anesthesiologist in this hospital, including expert se
in resuscitat on, Fluid replacement, Airway management, Operat ve stress reduct on, Postoperat ve, Chronic
and cancer pain management and palliat ve care to terminal stage cancer pat ents. Today, personnel from the
anesthesiology department are located throughout the hospital, ranging from the different department to
the crit cal care unit.
1. Routine Activities:
The department provides anesthesia service to all
Figure 1 : Types of anesthesia performed in 2018
the pat ents scheduled for surgery which include
rout ne and emergency cases. Total 5 operat on
theatres are running in full phase-out of these 4
major theatres and one minor. Surgery for cancer
pat ents, at most of the t mes, needs long surgical
t me for dissect on and composite resect ons.
As cancer pat ents in our part are coming in late
stage of their diseases, their general status and
nutrit onal status are poor. They are associated with
uncontrolled co-morbidit es.
Chart showing different Types of anesthesia in 2018
Extensive surgeries in these pat ents are associated
Figure 2 : Department wise distributon of cases done under anesthesia in 2018
with morbidit es and mortality. The department is
very successful in reducing operat ve stress by using
various intravenous drugs, gases and doing various
intervent ons including central and peripheral
nerve blocks with the aid of nerve st mulators and
ultrasound. Out of
2465 total cases; 65% of cases
were done under General Anesthesia, 3% of cases
were done under Epidural Anesthesia combined
with General Anesthesia. 12% of cases were done
under Central Neuraxial Block, 20% of cases were
done under total Intravenous Anesthesia, 1% of
Figure 3 : Monthly Distributon of total cases including departmental division cases were done under Peripheral Nerve Block.
The schemat c diagram is as presented above.
When number cases were divided into different
departments, we observed a total of 24% of
cases from ENT and HNS department followed
by Thoracic, Orthopaedic, Urology, Gynaecology,
Gastrointest nal, Breast, and Neurosurgery in
descending order. The illustrat ve diagram is as
presented below.
We observed a decreased number of cases around
the month of september may be due to the major
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BPKMCH | ANNUAL REPORT - 2018
fest vals of our country, and in rest of the months number of cases did not show much fluctuat ons as listed
in the chart below with departmental division.
Table 1: Showing the case done under Anesthesia in the year 2018 with Surgical Departmental dividion
Department/
Ortho
GI
Thoracic
ENT
URO
Gynae
Breast
Neuro
Other
Total
Total
Grand
Months
male
female
Total
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
JANUARY
8
6
9
7
12
11
32
17
18
9
-
25
-
23
2
3
-
-
82
101
182
FEBRUARY
15
7
6
10
19
9
28
15
12
5
-
22
1
17
5
-
-
1
86
86
172
MARCH
11
11
7
11
17
11
30
14
18
6
-
24
-
21
3
2
3
-
89
100
189
APRIL
18
9
15
10
17
19
39
13
18
10
-
28
1
16
-
1
-
-
110
104
214
MAY
19
21
15
11
18
14
40
18
22
14
-
31
4
14
-
3
-
1
118
127
245
JUN
13
11
9
14
23
14
40
18
18
11
-
25
1
16
-
1
-
-
104
110
214
JULY
14
7
10
18
29
21
34
14
22
11
-
14
2
16
1
1
-
-
112
102
214
AUGUST
24
8
9
21
12
21
38
20
19
11
-
25
2
16
2
-
-
-
106
122
228
SEPTEMBER
16
9
9
10
14
19
26
12
14
3
-
16
-
9
-
-
-
-
79
78
157
OCTOBER
11
5
6
14
13
16
29
13
16
9
-
22
1
14
1
-
-
-
77
93
170
NOVEMBER
16
10
12
16
17
19
31
13
19
5
-
27
-
11
2
-
-
-
97
101
198
DECEMBER
25
24
16
26
14
23
36
22
26
12
-
39
1
17
-
-
-
1
118
164
282
TOTAL M/F
190
128
123
168
205
197
403
189
222
106
-
298
13
190
16
11
3
3
1175
1290
2465
GRAND TOTAL
318
291
402
592
328
298
203
27
6
1175
1290
2465
2. Preoperative Check up (PAC):
Believing
that
inadequate
preoperat ve planning and errors
Figure 4 : Monthly Distribut on of Cases
in pat ent preparat on are the most
common causes of anesthet c
complicat on. An anesthet c plan is
formulated in preoperat ve room
that opt mally accommodates the
pat ent’s baseline physiological state,
including any medical condit ons,
previous operat ons, the planned
procedure,
drug
sensit vit es,
previous anesthet c experience,
and psychological thinking. In 2018
total number pat ents visited and
evaluated in the PAC room was 5,302
out of which almost 50% of them are
male and rest are female. When the monthly division was made greater PAC room visits was seen during the
months of May, August and December. Average PAC room visit number was 441 pat ents per month.
3. Other Services
Department of Anaesthesiology takes a leading role in care of crit cally ill pat ents, post-operat ve pat ents,
manage all vent lator and inotropes support. At present we have 8 ICU Vent llators. Department of
Anaesthesiology has been providing support in the selected group of pat ents in radiological and radiotherapy
units since long. More recently our department is working in the field of chronic and cancer pain management
including intervent ons. Department of Anesthesiology has long been taking a leading role in palliat ve care
of terminal stage cancer pat ents. We have been providing support at any ward of hospital during difficult
vascular access and have been taking leading role during resuscitat on including ACLS/BLS support and
training programmes.
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BPKMCH | ANNUAL REPORT - 2018
4. New Services
1.
Department is involved in manging airway with the help of videoscope, Retrograde intubat on for
difficult airway are done frequently.
2.
USG and Nerve locator guided blocks are done mainly for upper limbs and lower limbs, para vert cal
blocks, pec 1 and pec 2, tap and rectus blocks and other rout ne blocks also.
3.
Pat ents with severe comorbid pat ents posted for prolong surgeries were monitored regularly with
invasive arterial line monitors.
4.
Chemoport and PICC line inserton are done.
Academic Activities
Department of Anaesthesia Organised a Society of Anaesthesiologist of Nepal (SAN) Bharatpur
Chapter CME with presentat ons from Dr. Sanjaya Paudel regarding Mediast nal Mass Syndrome
and Dr. Eliza Koirala regarding an update in Perioperat ve steroid therapy
Dr. Bhawna Wagle did an oral presentat on regarding Barriers of Pain Management in SAN nat onal
conference in the year 2017
Dr. Sanjaya Paudel did an oral presentat on on Opioid free Anesthesia in SAN nat onal conference in
the year 2018
Dr. Bijay Neupane, Dr.Bhawna, Dr. Sudhir, Dr. Pradip, Dr. Sanjya and Dr. Eliza part cipated in SAN
National Conference in the year 2018
Dr. Yogesh and Dr.Eliza part cipated in USG and PNS guided regional anesthesia workshop organized
by URAN
Human Resources
Department of anesthesia started since 1999 with the effort of just one Nepali consultant Anaesthesiologist
and one anesthesia assistant. With the increase in the services provided by department of anaesthesiology,
this department now includes a group 17 experts which include one senior Consultant Anaesthesiologist,
one Consultant Anaesthesiologist, two junior Consultants Anaesthesiologist, four Registrar Anaesthesiologist
two Medical Officers and six Anaesthesia Technicians. Our department has regularly been helped by one
consultant Anaesthesiologist from China as expert assistance from government of Republic of China, who has
been working with us as a group for the beter care of pat ent.
Dr. Bhawna Wagle, Consultant and Head of the
Dr. Suraj Bishwakarma, Registrar
Department, Anaesthesia
Dr. Rasmi Subedi, Medical Officer
Dr. Bijaya Raj Neupane, Senior Consultant
Dr. Shrinkala Shrestha, Medical officer
Dr Yang Wang, Consultant (Chinese nat onal)
Mr. Krishna Aryal, Senior Anaesthesia Technician
Dr. Sudhir Shrestha, Jr. Consultant
Mr. Megh Raj Mandal, Anaesthesia Technician
Dr. Pradip Thapa, Jr. Consultant
Mr. Sujan Kandel, Anaesthesia Technician
Dr. Yogesh Regmi, Registrar
Mr. Sumit Singh, Anaesthesia technician
Dr. Sanjaya Paudel, Registrar
Mr. Kiran Chaudhary, Anaesthesia Technician
Dr. Eliza Koirala, Registrar
Mr. Rajeev Chaudhary, Anaesthesia Technician
Future Plans
Establishment of the Crit cal Care Unit.
Development of Intervent onal Pain Management Suit.
Cont nue improving quality of anesthesia service integrat ng fiberopt c bronchoscope, trans tracheal
jet vent lator for airway management in our exist ng difficult airway devices.
Cont nue improving the monitoring part in pat ents care with possible high-quality invasive
monitors in all operat ng theaters, post-anesthesia care unit, and post-operat ve room.
To strengthen the quality of service provider in the department by giving opportunity to all man
powers for further studies, training, conferences, workshops and etc.
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