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Anaesthesia

Overview

The Department of Anesthesia and Critical Care is one of the largest departments at the Pakistan Institute Of Medical Sciences. Department was established in the year 1987 along with the surgical ICU. Over the years, various subspecialties were added to the main block of the hospital and our department has always supported new developing specialties with their full manpower support.

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The department of critical care medicine was formally commissioned in 2005, as a component of the department of anesthesia with the cooperation of the French Government, with whom the government of Pakistan signed an MoU. As a result of this co-operation, the Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU), which were previously working independently and as open ICUs, were brought under the umbrella of the Department of Anesthesia. The department holds the distinction of having the first closed ICU in Pakistan, through which the entire responsibility of care rests on the shoulders of the critical care physicians.

Services & Facilities

We take pride in the range of services provided in our department.

Our team is dedicated in its effort to ensure that quality care is provided free-of-cost to those in need. We are continuously expanding and serving more patients with the best healthcare.

  • Virtual rounds

  • Plasmapheresis

  • EEG facility

  • Bronchoscopy

  • Endoscopy

  • Colonoscopy

  • Tracheostomy (Percutaneous and open)

  • Ultrasound and Echocardiography

24/7 Services

24/7 critical care services & monitoring services with invasive blood pressure monitoring, end-tidal CO2 monitoring, CO monitoring under the supervision of trained intensivists

Ventilatory Support

Mechanical ventilatory support – invasive and non-invasive

Data Collection

Regular data collection and formation of yearly performance reports using SAPS3, APACHE II, SOFA scoring systems (Internationally recommended prognostic tools for ICU patients)

Backups

Electronic patient records with cloud backups

FACULTY

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Research & Services

List of Services

1. 24/7 critical care services under the supervision of trained intensivists
2. Regular morning and evening rounds 
3. Virtual rounds
4. Electronic patient records with cloud backups
5. Regular data collection and formation of yearly performance reports using SAPS3, APACHE II, SOFA scoring systems (Internationally recommended prognostic tools for ICU patients)
6. Mechanical ventilatory support – invasive and non-invasive
7. 24/7 monitoring services with invasive blood pressure monitoring, end-tidal CO2 monitoring, CO monitoring
8. In-house, bedside hemodialysis facility
9. Bedside ultrasound and echocardiography 
10. USG guided passage of central and arterial lines
11. Bedside plasmapheresis
12. Bedside EEG facility
13. Bedside Bronchoscopy 
14. Bedside Endoscopy & Colonoscopy
15. Bedside Tracheostomy (Percutaneous and open)
 
 
 
Performance
The department also holds the distinction of having the lowest standardized mortality ratio (SMR) among all public sector institutes in Pakistan. The SMR is the gold-standard to assess ICU performance and a value of less than 1.0 indicates excellent performance in any ICU. Our department is proud to have an average SMR of 0.64-0.82 since 2012, that is for the last ten years. This SMR is in line with international critical care departmentsand among public sector institutes in Pakistan, the best till date.
 

Research & International Collaboration

Since its inception, the department has been at the forefront of research in critical care and has collaborated with other departments nationally and internationally. In the initial years, there was close collaboration with ESICM (European Society of Intensive Care Medicine) and PIMS sister institute, Saint Antoine Hospital in Paris, France. There was a regular exchange of physicians through which PIMS physicians went abroad to train in intensive care and French physicians came to PIMS to assist in the management of critically ill patients. Additionally, there were regular skype sessions and case discussions with international faculty once the training programs were started. 
 
​More recently, our department was a founding member of PRiCE (Pakistan Registry of Intensive Care) which was the first of its kind collaboration in intensive care in the region. Now, it had grown to include 60 ICUs across the country with PIMS being the only tertiary care government institute participating in the registry. This has also allowed us to be included in the CritCareAsia Network (under the umbrella of the Oxford-Wellcome Group), which is a collaboration between 50 ICUs in 10 countries across South & Southeast Asia. Our department is only one of 4 ICUs included nationwide in this ambitious project, through which research and innovation in critical care is being carried out.
 
Additionally, the department regularly participates in multicenter, multinational cutting-edge trials such as,
• WEAN-SAFE (with ESICM)
• ProVENT-IMC (with the Singapore society of intensive care medicine)
• VentiBRAIN (with ESICM)
• MEGA-ROXX (an international trial involving 83 centers around the world)
• REMAP-CAP (A groundbreaking trial looking into various aspects of management of community-acquired pneumonia including covid-19 infections – again being run in more than 100 centers around the world)

Academics

Post-Graduate Residency
The Department is providing post-graduate residency programs in both, Anesthesia and Critical Care Medicine. This includes Fellowships in Anesthesia, a level-III diploma, and Critical Care Medicine, a level-IV diploma(FCPS) offered by the college of physicians and surgeons (CPSP). Master’s in surgery (MS) in Anesthesia and Master’s in Medicine (MD) in Critical Care, both level-III Degree programs being run under the auspices of Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU). 
The department has provided fully trained anesthetists and critical care physicians to Pakistan, in the above-stated residency programs, who are providing their services in every corner of Pakistan and in many countries around the world. The residents of the department are trained to provide anesthetic and critical care services in either specialty as both of them are closely related to each other and all of our residents display a passion and drive to provide the best possible care to their patients. They are supervised by the faculty at every step of their training, from their induction into the residency to their exit exam. 
The department also holds the distinction of offering the first post-graduate critical care medicine qualification in Pakistan, a two-year degree of Master’s in Critical Care Medicine (MCCM). This degree was initially offered under the umbrella of Quaid-e-Azam University and then was transferred to Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU). It was designed with the cooperation of the French Government and the European Society of Intensive Care Medicine (ESICM) based on the internationally recognized CoBaTriCE modular system of intensive care training. It also holds the distinction of being one of the first three units recognized nationwide for training in FCPS Critical Care Medicine, which is a level IV postgraduate qualification offered by CPSP. At the same time, the first MD Critical Care Medicine training program was also started by our department in the country with the collaboration of SZABMU as a 6-year post-graduate qualification. 
Post-graduate residency is offered in the following programs currently,
• FCPS Anesthesia (4-year level III Diploma program) – CPSP 
▪ Requirement – Residents must have completed basic medical qualifications (MBBS, MD) & Must hold one year of house job experience with permanent PMC Registration AND also must have passed FCPS Part-I in Anesthesia
• MS Anesthesia (4-year level III Degree program) – SZABMU
▪ Requirement – Residents must have completed basic medical qualifications (MBBS, MD) & must hold one year of house job experience with permanent PMC registration AND must have passed MD Part-I exam held by SZABMU
• FCPS Critical Care Medicine (2-year level IV Diploma program) – CPSP
▪ Requirement – Residents must have completed FCPS in any of the following fields,
▪ Anesthesia, Internal Medicine, Nephrology
• MD Critical Care Medicine (6-year level III Degree program) – SZABMU 
▪ Requirement – Residents must have completed basic medical qualifications (MBBS, MD) & must hold one year of house job experience with permanent PMC registration AND must have passed MD Part-I exam held by SZABMU
 
The residents have a fully structured residency program in both specialties where their teaching takes place via various methods including,
• Full time calls where they work with patients under the supervision of seniors
• Lectures on a weekly basis
• Case presentations on a weekly basis
• Case discussions/problem-solving scenarios on a biweekly basis
• Journal clubs where the latest articles from international journals are selected and presented by all residents on a biweekly basis
• Mortality and Morbidity reviews, where our residents learn to identify the problems and discuss how to improve care
 
 
 
Performance
The department has successfully produced more than 200 trained anesthesiologists who have acquired different post graduate qualifications who are now providing their expert services within Pakistan and also in various countries across the world (US, UK, UAE, Saudi Arabia, Kuwait, Australia and more). The department of anesthesia has produced anesthetists holding qualifications such as FCPS, MS, MCPS and DA. 
Similarly, the department of critical care medicine has produced 6 MCCM degree holders so far and 2 FCPS trained critical care physicians. The MD degree program was started in 2014 and the first batch is appearing in their exams currently. The FCPS program was started in 2012 and due to lack of supervisors in the early years, it is now that more residents are being inducted under the leadership of Prof. Rana Imran.

Components

Department is divided into two main components
A. Anesthesia Department / Theater Complex 
B. Critical Care Medicine / Intensive care Units
 
A. Anesthesia Department / Theater Complex:
Services & Facilities
Islamabad Hospital Theater Complex:
Islamabad hospital is a center for all kinds of adult surgical and allied specialties. There is a dedicated preoperative clinic run by a fourth-year resident under the supervision of a consultant.
Anesthesia services are provided to various surgical patients, ranging from simple to very complicated cases for general surgery, Otolaryngology-Head & Neck Surgery/ENT, Ophthalmology, Oro-Maxillofacial & DentalSurgery, Orthopedic, and Plastic & Reconstructive Surgery.  The Adult theater complex is comprised of 11 fully equipped theaters with state of art anesthesia workstations.
 
Children Hospital Theater Complex:
This complex has four fully equipped modern theaters, for elective procedures and one for emergency procedures. Providing Anesthetic services to neonatal and pediatric populations is a very challenging part of anesthetic practice. A consultant-led team of senior medical officers/registrars is present at the complex 24 hours a day, 7 days a week, to provide services for all types of neonatal and pediatric surgeries. The theater has backup in the form of, NICU and PICU for critically ill neonatal and pediatric patients, which is fully equipped with the latest ventilators, monitors, and all essential equipment to run a level III ICU.
 
Mother And Child Hospital (MCH) Theater Complex:
MCH is one of the busiest components of the institute, where 24 hours emergency services are provided to the gynecological & obstetric population. The ever-expanding population of the capital and increased number of referred cases of maternal and fetal complications from Azad-Jammu Kashmir (AJK), Gilgit-Baltistan, Khyber-Pakhtunkhwa (KP), and Punjab, are placing a lot of load on this component of the institute.
Along with providing anesthetic services to Obstetrics and Gynecology patients, our team is also looking after critically ill patients arriving at MCH. There is a two-bedded HDU that is equipped with ventilators and cardiac monitors as well as bedside ultrasonography, to manage critically ill patients.
The theater complex has a built-in preoperative area and a recovery area. The department is fully capable of providing the option of painless labor to any patient who desires to have it, via the use of epidural anesthesia.
 
 
 
Burn Hospital Theater Complex:
The Burn Center was established in 2012 as a state-of-the-art facility, to provide the requisite care to burn cases. It is one of the handful of centers in Pakistan that is fully equipped to provide specialized care to burn patients.Due to the extremely specialized nature of burn surgeries and the fact that anesthetic services for burn patientsare challenging, two state-of-the-art theaters were established within the center. The theaters are equipped with anesthesia workstations and have fully trained anesthetists supervising senior residents in every burn-relatedsurgery. The burn center also has a fully equipped level III ICU with 12 beds with ventilators, invasive cardiac monitors, the facility of bedside endoscopy & bronchoscopy as well as Continuous Renal Replacement Therapy (CRRT). Critically ill burn patients are given anesthesia services for dressing, debridement, and skin grafting. 
Due to the involvement of the airway (inflamed or damaged airway) in most of these patients, maintaining an airway to provide anesthesia as well as to save the life of a burn victim is a difficult challenge for even the most experienced anesthetists, not only that but even administering anesthesia and then stabilizing the patient during the surgery is a difficult process. However, we are proud to state that our team has never failed in helping these patients and providing them with the best care possible in Northern Pakistan
 
Cardiac Surgery Theater Complex
Cardiac center is one of the few state of the art facilities in Pakistan dedicated to Cardiac Care. The first cardiac surgery was conducted at PIMS in 2005 and PIMS is one the first few public sector institutes where cardiac surgery was initiated in Pakistan. Cardiac surgery is a part of the cardiac center with two state of the art modular theaters as well as a 8 bedded level III cardiac surgery ICU equipped with monitors, ventilators as well as an ABG machine, in house dialysis facility. All kinds of adult cardiac surgeries are done under supervision of trained cardiac anesthetists as per international standards. The quality indicators for cardiac theaters and ICU are comparable to the best cardiac care centers in the world.
 
Performance
The Anesthesia part of the department has a record of the lowest mortality among all public sector institutes in the region. All complicated and uncomplicated surgical cases have been performed and ARE being performed with lowest morbidity and mortality in the region as per international standards. The department is providing services to the people of the region with highest degree of care, following WHO safety guidelines and in international guidelines for any type of surgery.
 
 B. Critical Care Medicine Department / Intensive Care Units:
The department of critical care medicine is composed of two primary level-III Intensive care units, 
1. 10 bedded SICU 
2. 9 bedded MICU 
During the recent pandemic, an 18 bedded Covid-ICU was also run by the department independently. 
Additionally, there are several other ICUs that fall under the umbrella of critical care medicine and are run in conjunction with other departments, namely Burn ICU, Cardiac Surgery ICU, Neurosurgery ICU, Coronary Care Unit (CCU), MCH (Gynae & Obs) HDU. All of the other ICU’s are fully equipped level III-ICU’s as well.

Workshops/Training Programs

BASIC training – BASIC training is a 3-day workshop designed by the University of Hong Kong and recognized by the Government of Pakistan to impart the basics of critical care medicine to residents and doctors to manage critically ill patients in their setups. It includes lectures as well hand-on training via skill stations to teach the doctors. PIMS is the only public sector hospital to have certified instructors for the BASIC program and runs the workshop regularly for the improvement of critical care around the country.
 
Critical Care Training – USAID – Our department also has the distinction of being selected by USAID to offer a 5-day training program to doctors from the remote areas of Pakistan (AJK, Gilgit-Baltistan, Northern KP) during the covid pandemic to manage the critically ill covid patients. The program is still being run even after the pandemic and is offered for 8 weeks twice a year. So far 3 such sessions have been run where 24 batches of healthcare professionals have been taught critical care.