ANAESTHESIOLOGY

This specialty offers comprehensive care for oncology patients, encompassing a diverse range of services, including pre-surgical patient optimization, anaesthesia administration, critical care support, acute pain management, and interventional pain management.

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Introduction

The inception of the Department of Anaesthesia at the Cancer Institute (W.I.A) dates back to its initial decade of establishment of the institute, marking the beginning of a remarkable journey. Throughout the course of the last six decades, this department has undergone a phenomenal metamorphosis. What once began as a solitary operation theatre, manned by a single anaesthetist, has blossomed into an epitome of modernity, housing eight major multispecialty theatres with a passionate cohort of anaesthesia professionals. This field goes beyond anaesthetising patients for surgery, by carefully tailoring the anaesthesia approach to the patient’s specific health needs, potential risks and complications during procedures done from disease diagnosis to post operative rehabilitation, thereby supporting across the entirety of the patient’s medical odyssey. The department also conducts multiple research endeavours and educational programs focused at fostering expertise in this specialty.

Department Vision

To provide excellent perioperative care to all patients in line with the Institute’s motto of “Service to all”.

Department Mission

Our department’s resolute mission is to administer evidence-based, secure, and all-encompassing anaesthesia care to each and every patient, driven by our unwavering dedication to inter-professional communication and pioneering research endeavours.

Our Priorites

  1. Patient safety ensured through strict adherence to care standards and infection control practices
  2. Well-planned pain management with regular review and modifications for post-surgical patients
  3. Specialized care settings based on surgical severity and patient illness
  4. Early implementation of chest physiotherapy, mobilization, and resumption of enteral nutrition.
  5. Standardized monitoring and timely intervention for complications
  6. Collaborative management involving intensivists, cardiologists, nephrologists, and pulmonologists
  7. Holistic care provided until discharge to home

Clinical Services

The department caters to various demands of the specialty of Oncology. The scope of services include –

  1. Preoperative patient assessment, pre-habilitation and optimization of comorbidities
  2. Anaesthesia services for major oncologic surgeries including robotic surgeries encompassing head and neck cancers, lung and mediastinal tumours, hepatobiliary and gastrointestinal malignancies, adrenal and urologic cancers, gynaecological cancers, breast cancer, musculoskeletal malignancies and space occupying lesions of the brain and spine
  3. Anaesthesia services for special neurosurgical procedures like awake craniotomy and intraoperative neuromonitoring
  4. Anaesthesia services for minor surgical procedures
  5. Procedural sedation for brachytherapy and paediatric radiotherapy
  6. Sedation for paediatric diagnostic and therapeutic procedures (bone marrow aspiration, central line placement, intrathecal drug delivery)
  7. Anaesthesia for interventional radiology procedures like microwave ablation of lung and liver metastases, PTBD, PCN, angio-embolisation
  8. Anaesthesia for interventional pulmonology procedures like endo-bronchial ultrasound (EBUS), trachea-bronchial stenting, debulking of airway tumours
  9. Anaesthesia for diagnostic and therapeutic medical gastroenterology procedures like diagnostic endoscopies, ERCP, endoscopic ultrasound, colonic stenting, oesophageal stenting
  10. Sedation for diagnostic imaging (CT, MRI, USG, renogram) and image guided biopsies
  11. Interventional pain management procedures such as celiac plexus block, ganglion impar block, epidural steroid injections, to name a few, and central desensitization for patients with severe pain

Departments

Emergency Cases

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(044) 22209150

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2020 Patient Reports

Opening Hours

Monday – Friday :  8.00 am – 7:00 pm

Saturday : 9.00 am – 8.00 pm

Sunday : 10.00 am – 9.00 pm

Registration Time

Monday – Sunday : 7.00 am – 11.00 am

Visiting Hours

Monday – Sunday : 4.00 PM – 6.00 PM

Pre-Anaesthetic Check-up Clinic

Monday – Friday: 11.00 AM – 1.00 PM &  2:00 PM – 5 PM

Saturday: 8:30 AM – 1:00 PM

Facilities and Equipments

  1. Eight major operating rooms and four procedure rooms with advanced multi-para monitors and anaesthesia workstations with anaesthesia gas monitoring modules
  2. Oxygen generator plant and liquid oxygen tank which provides oxygen supply to the entire hospital
  3. Advanced hemodynamic monitoring equipment which helps monitor cardiac function and fluid status
  4. Target controlled infusion pumps, bispectral index and entropy monitoring which provide total intravenous anaesthesia to facilitate central airway procedures and intraoperative neuro-monitoring during brain and spine surgeries including awake craniotomies
  5. Neuromuscular monitors to monitor the depth of neuromuscular blockade
  6. Forced air warmers and fluid warming devices to maintain patient’s temperature intra-operatively
  7. Point of care arterial blood gas analysis to measure the oxygenation and perfusion status of patients during surgery
  8. Four ultrasound machines which are used for bedside evaluation of cardiac function, for central venous access and nerve block procedures
  9. Advanced airway equipment to manage difficult intubations which includes fiberoptic bronchoscopes – adult and paediatric, video laryngoscope, jet ventilator, double lumen tubes, Arndt’s and EZ bronchial blockers
  10. Patient controlled analgesia pump which gives patients the ability to titrate the analgesic medications to achieve adequate pain relief
  11. Adequate numbers of syringe pumps to ensure analgesic infusions for pain relief for major surgeries intra-operatively and post-operatively
  12. Vein-finder to facilitate difficult intravenous cannulations
  13. 14 bedded ICU with round-the-clock specialist coverage, advanced monitors with central monitoring console, 8 ventilators capable of invasive and non-invasive ventilation, 5 BiPAP machines, transport ventilators, 2 high flow oxygen therapy units, intermittent pneumatic compression pumps, pneumatic mattresses, facilities for haemo-dialysis and plasma exchange. ICU has a dedicated ultrasound machine for point-of-care critical care sonography.
  14. MAXIO® – Image-guided physician-controlled stereotactic arm with CT scan which enables accuracy in performance of CT-guided interventional pain procedures
  15. MRI compatible monitor and workstation to provide sedation/anaesthesia during MRI scans
  16. State of the art sterilization equipment for autoclaving, plasma and ethylene oxide sterilization of various hospital equipment and premium indicators to monitor the efficacy of sterilization process

Statistics

Research Activities

Academic programme:
1. FNB Onco-Anaesthesia
o Affiliated to National Board of Examinations in Medical Sciences, New Delhi since 2023
o Two-year full-time course in Onco-Anaesthesia for Anaesthesiology graduates
o Sanctioned intake – 4 seats per year
Fellowship candidates –
o 2023 session
• Dr. R. Yogesh Kumar DA., DNB.,
• Dr. PR. Pravin Sankar DNB.,
• Dr. K. Ashwin MD.,
o 2024 session
• Dr. K. Vinoth Kumar MD., DNB.,
• Dr. N. Sumitha MD.,
• Dr. Prayag Premnath MD.,
2. B.Sc. Operation Theatre and Anaesthesia Technology
o Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Chennai since 2017
o Three-year full-time course with one year internship for 10+2 students of the science stream
o Sanctioned intake – 7 seats per year

3. Observership
o One-month observership programme for final year MD Anaesthesiology students from other institutions

Ongoing Studies
1. About to start a multicentre observational study I-INFUSE- PractIce pattern of INtraoperative FlUid therapy in elective major gaStrointestinal cancEr surgeries in India initiated by Tata Memorial Hospital.
2. Effects of anaesthetic agents on natural killer cells and biomarker releases during stage 3 epithelial ovarian cancer surgery: A prospective pharmacodynamics cohort study.
3. Prehabilitation in ovarian cancer cytoreductive surgery and its effect on post-operative morbidity (PROSPERITY): A Randomized Controlled Trial.
4. Efficacy of percutaneous electrical neuro-stimulation (PENS) of auricle as an opioid sparing postoperative analgesic technique in cancer endometrium and cancer uterine cervix patients.
5. Prospective randomized study to compare the efficacy of neurolytic ganglion impar block and combined superior hypogastric plexus with ganglion impar block for pain relief in patients with progressive cervical cancer.
6. Predictive value of the Respiratory Exchange Ratio (RER) for the occurrence of postoperative complications in laparotomy – a prospective observational pilot study.
7. Prospective observational study to identify the predictors of successful videolaryngoscopy guided nasal intubation in patients with restricted mouth opening in oral cavity tumor.
8. Prospective observational study to assess the time for optic nerve sheath diameter (ONSD) to return to baseline after carbondioxide desufflation in robotic and laparoscopic surgeries in Trendelenburg position.
9. Assessing subclavian vein collapsibility index for anticipating post-induction hypotension : a prospective observational cohort study.

Meet the Team –

The department comprises of experienced anesthesiologists, who have special training in providing perioperative care for high risk patients and complex surgeries.

Dr. Kalpana Balakrishnan
DA., DNB (Anaes)., NFPM., Professor and Head
Director, CI (WIA)

Dr. Punitha C
DNB (Anaes).,
Associate Professor

Dr. Aravind Narayanan
MD (Anaes)., DNB (Anaes).,
Associate Professor

Dr. Subramanian H A
MD (Anaes).,
Associate Professor

Dr. Nivedhyaa S
MD (Anaes).,
Associate Professor

Dr. Prasanna Vani V
MD (Anaes)., DNB (Anaes).,
Assistant Professor

Dr. Karthik AR
MD (Anaes)., DNB (Anaes).,
DM (Onco-Anaes).,
Assistant Professor

Dr. Nairita Das
MD (Anaes).,
Assistant Professor

Dr. Kausalya V
MD (Anaes).,
Assistant Professor

Dr. Poorna M S
MD (Anaes).,
Assistant Professor

Dr. Pritha Raj
MD (Anaes).,
Assistant Professor

Dr. Hariesh A
MD (Anaes).,
Assistant Professor

Dr. Sahithya Sriman
MD (Anaes).,
Assistant Professor

Dr. Vallary Gowtham Krishna
MD (Anaes).,
Assistant Professor

Dr. Karthikeyan R
MD (Anaes).,
Tutor

Dr. Vimalanathan P
MD.,
ICU Medical Officer

S.No

Name

Designation

1

Dr. Kalpana Balakrishnan

Professor & HOD

2

Dr. Punitha

Associate Professor

3

Dr.Nivedhyaa. S

Associate Professor

4

Dr. Prasanna Vani.V

Assistant Professor

5

Dr. Radhika Dash

Assistant Professor

6

Dr. Aishwarya Ramakrishnan

Assistant Professor

7

Dr. Mani Raj

Assistant Professor

8

Dr.Nairita

Assistant Professor

9

Dr. Sahithya Sriman

Assistant Professor

10

Dr. H S Subramanian

Associate Professor

11

Dr. Pritha Raj

Assistant Professor

12

Dr.Vallary Reshmikanth Modh

Assistant Professor

13

Dr. Poorna M S

Assistant Professor

14

Dr. Aravind Narayanan

Associate Professor

15

Dr. Hariesh A

Assistant Professor

16

Dr. Pavithra A S

Assistant Professor

Recent Publications

  1. Balakrishnan K, Srinivasaraghavan N, Venketeswaran MV, Ramasamy T, Seshadri RA, Raj EH. Perioperative factors predicting delayed enteral resumption and hospital length of stay in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Retrospective cohort analysis from a single centre in India. Indian J Anaesth 2020;64:1025-1031.

2. Jain P, Balkrishanan K, Nayak S, Gupta N, Shah S. Onco-Anaesthesiology and palliative medicine: Opportunities and challenges. Indian J Anaesth 2021; 65:29-34.

3. Venketeswaran MV, Srinivasaraghavan N, Balakrishnan K, Seshadri RA, Sriman S. Intubation outcomes using the aerosol box during the COVID-19 pandemic: A prospective, observational study. Indian J Anaesth 2021;65:221-228.

4. Srinivasaraghavan N, Balakrishnan K, Venketeswaran MV, Chockalingam P. Unusual Echocardiographic Diagnosis of a Metastatic Thrombus – A Case Report. J Indian Acad Echocardiogr Cardiovasc Imaging 2021;5:75-77.

5. Bhandoria G, Solanki SL, Bhavsar M, Balakrishnan K, Bapuji C, Bhorkar N, Bhandarkar P, Bhosale S, Divatia JV, Ghosh A, Mahajan V, Peedicayil A, Nath P, Sinukumar S, Thambudorai R, Seshadri RA, Bhatt A. Enhanced recovery after surgery (ERAS) in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC): a cross-sectional survey. Pleura Peritoneum. 2021;6:99-111.

6. Balakrishnan K, Chockalingam P. Specifying perioperative nonsteroidal anti-inflammatory drug use in trials of the effect of anaesthetic technique on oncologic outcomes. Comment on Br J Anaesth 2021;127:65-74. Br J Anaesth. 2021;127:e189-e190.

7. Ramasamy T, Veeraiah S, Balakrishnan K. Psychosocial Issues Among Primary Caregivers of Patients with Advanced Head and Neck Cancer – A Mixed-method Study. Indian J Palliat Care. 2021;27:503-512.

8. Vanamail PV, Dash R, Balakrishnan K, Edwin T. Recurrent pulmonary thromboembolism during radical cystectomy: A case report. Indian J Case Reports. 2021;7:260-262.

9. Vanamail PV, Balakrishnan K, Prahlad S, Chockalingam P, Dash R, Soundararajan DK. Ultrasonographic Assessment of Diaphragmatic Inspiratory Amplitude and Its Association with Postoperative Pulmonary Complications in Upper Abdominal Surgery: A Prospective, Longitudinal, Observational Study. Indian J Crit Care Med. 2021;25:1031-1039.

10. Bhattacharya, S., Srinivasaraghavan, N. Nasogastric Tube Knotting Around the Nasotracheal Tube in a Patient with Oral Cancer and Trismus. Indian J Surg. 2022;84:570–571.

11. Srinivasaraghavan N, Das N, Balakrishnan K, Rajaram S. Effect of Whey Protein Supplementation on Perioperative Outcomes in Patients with Cancer-A Systematic Review and Meta-Analysis (PROSPERO 2020: CRD42020188666). Nutr Cancer. 2022;74(7):2351-2364.

12. Balakrishnan K, Chockalingam P, Ramasamy T, Venkateswaran M, Sundaram M, Sridevi V. Association of Perioperative Use of Epidural Analgesia with Disease Free Survival in Epithelial Ovarian Cancer: A Retrospective Cohort Observational Study with Propensity Score Matched Analysis. Arch Anesth & Crit Care. 2022;9:107-115.

13. Book Chapter – Balakrishnan K, Chockalingam P. (2022). Anesthesia for Gynecological Oncology. In: Goswami J, Desai N, Mukherjee S, Nandi R. (eds) A Complete Guide to Onco-Anaesthesia, Critical Care and Cancer Pain. White Falcon Publishing, India.

14. Krishnan CK, Arivazhagan P, Karnawat A, Raja A. Isolated Limb Perfusion of Upper Limb: How I Do It. Indian J Surg Oncol. 2022;13:776-779.

15. Srinivasaraghavan N, Venketeswaran MV, Balakrishnan K, Ramasamy T, Ramakrishnan A, Agarwal A, Krishnamurthy A. Comparison of nutrition screening tools and calf circumference in estimating the preoperative prevalence of malnutrition among patients with aerodigestive tract cancers-a prospective observational cohort study. Support Care Cancer. 2022;30:6603-6612.

16. Srinivasaraghavan N, Modh V, Menon A. Acute Intraoperative Hyperkalemia During Robot-Assisted Radical Cystectomy: A Case Report. A A Pract. 2022;16:e01650.

17. Bhatnagar S, Biswas S, Kumar A, Gupta R, Sarma R, Yadav HP, Karthik AR, Agarwal A, Ratre BK, Sirohiya P. Institutional end-of-life care policy for inpatients at a tertiary care centre in India: A way forward to provide a system for a dignified death. Indian J Med Res. 2022 Feb;155(2):232-242.

18. Book Chapter – Karthik, AR., Kumar, V. (2022). Admission and Discharge in the Critical Care in Oncology Setting. In: Kumar, V., Gupta, N., Mishra, S. (eds) Onco-Critical Care: An Evidence-based Approach. Springer, Singapore.

19. Balakrishnan K, Goswami J, Koshy RC, Hariharan U, Srivastava D, Salgaonkar S. Newer frontiers in onco-anaesthesia and palliative medicine. Indian J Anaesth. 2023;67:71-77.

20. Tayal A, Shekh I, Karthik AR, Jat KR, Dhochak N, Mittal S, Gupta N, Kabra SK, Madan K. A “Cool” extraction technique for difficult pediatric airway foreign bodies: Report of two cases. Pediatr Pulmonol. 2023;58:2670-2674.

Academic CME / Conferences

  • The Department successfully conducted a one-day CME titled “OASyS – Onco-Anaesthesia Symposium and Synopsis – 2022” on 24.09.2022 which was attended by delegates from all over Tamil Nadu and faculty from South India
  • The Department successfully hosted a one-day CME titled “OASyS – 2023” on 24.09.2023. The CME was exclusively based on case discussions and received appreciation from the attendees
  • The Department will be organising the annual conference of SOAPC (Society of Onco-Anaesthesia and Perioperative Care) – SOAPCCON in Chennai in August 2025

Scientific Meetings

  • Monthly mortality audit meeting along with the Department of Surgical Oncology
  • Weekly high risk multi-disciplinary team (MDT) discussions in pre-operative preparation of high risk surgical patients
  • Fortnightly case discussions
  • Fortnightly journal club
  • Weekly academic seminars
  • Weekly department review meetings
  • Periodic BLS/ACLS training for hospital staff and resident doctors

Best Practices

  • We conduct periodic audits of hospital infections, adverse events and take corrective and preventive actions to mitigate them.
  • Patient feedback is obtained at discharge and reviewed periodically.
  • We maintain quality indicators for the department and assess them monthly

    Make Appointment

    Call: 044-22209150/22350131 Ext 105/152/164/169/211 between 7AM and 5PM

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