Department of Cardiothoracic and Vascular 2ne0s8th0e-s2io0lo8g1y

1

Message from the Head

Department of Cardiothoracic and Vascular Anesthesiology (CTVA), being upgraded from "Cardiothoracic and Vascular Anesthesiology Unit on 20th Asar 2074 (4th July 2017), has been consistently providing specialized anesthesia

services for patients with cardiac, thoracic and vascular issues inside as well as outside the Operation Theater.

Vision, Mission & Goals

The department aims to achieve excellence in both clinical, academic and research activities. The main aim of the department is to provide evidence based high standard per-operative and postoperative care to the most complicated cardiothoracic and vascular surgeries.

Some of the short and long term goals of the department:

• To start Fellowship in Cardiothoracic & Vascular Anesthesia in near future.
• To provide anesthesia services to advanced services like hybrid surgeries, robotic surgeries, lung/heart transplants in future
• To increase the number of faculties to operate at full clinical and academic potential.
• To train and facilitate faculties for super specialization in cardiothoracic vascular anesthesia and critical care.
• To establish this department as a Centre of excellence and academic focal point for postgraduate training center in cardiothoracic vascular anaesthesia and critical care of MMC, IOM, TU
• To develop and maintain bilateral relations with international institutes for expertise and knowledge sharing

Our Team

Prof. Dr. Bishwas Pradhan MD, FCTA

Head,

Department of Cardiothoracic & Vascular Anesthesiology Manmohan Cardiothoracic Vascular & Transplant Centre Maharajgunj Medical Campus

Institute of Medicine, Tribhuvan University, Nepal

Dr. Bibhush Pradhan

MD

Assistant Professor

Dr. Basanta Ghimire

MD

Lecturer

Dr. Priska Bastola

MD

Assistant Professor

Dr. Shiva P. Paudyal

MD

Lecturer

Dr. Arjun Gurung

MD

Assistant Professor

Dr. Kanchan P. Paudyal

MD

Lecturer

Clinical Care

CTVA department provides specialized anesthesia services for patients with cardiac, thoracic and vascular diseases inside as well as outside the operation theater in following set ups.

• Pre anesthetic check up clinic
• 5 - operation theatres
• 16 bed ICU
• 14 bed CCU
• 2 cath labs

24 hours emergency services are also provided in all the area of MCVTC including wards. Department is equipped with all the necessary medical equipments including advanced technologies like ECMO, ROTEM, Cerebral oximetry, Transesophageal Echocardiography, BIS monitoring, Autologous Blood Transfusion system, IABP etc.

Total Pre-Anesthetic Cases

607                                507

2775*

*based on FY80/81

341

116

48                                  15

Vascular                Cardiac                    Thoracic

508

Arterial Lines

32

Epidural

98

Dialysis Catheter

6%

General Anesthesia Neuraxial/regional MAC/Sedation

Anesthesiology Critical Care

Our faculties also provide exclusive coverage in the CT surgical ICU. Our team of anesthesiolologists, residents and medical officers participate in daily, multidisciplinary ICU rounds where complex care discussed at bedside.

622

Cardiac Surgery

295

Vascular Surgery

425

Thoracic Surgery

122

Cardiology

Academics

Department's academic activities are conducted together with Dept of Anesthesiology which is 4 theory classes per week. Besides it CTVA dept conducts two theory classes separately per week.

Department also conducts Cardiopulmonary Resuscitation training program to all the MD residents of MMC & nursing staffs of MCVTC.

43

Anesthesiology

Residents

3

Perfusion

Students

Based on FY80/81

2

DM-CCM

Residents

20

Medical

Officers

Doctorate of Medicine program in Cardiothoracic and Vascular Anesthesiology and Critical Care (DM CTVA & CC) has been approved from TU & Medical Education Commission (MEC). The program will start from next academic calendar year.

Teaching plan:

Yearly calendar is published with respect to theory classes, thesis work condution and exam conduction. Theory classes are divided in Seminars, Case presentations, Journal clubs and Morbidity/Mortality sessions.

MD anesthesiology residents are posted for elective posting in CTVA from various medical colleges:

• Maharajgunj Medical Campus (MMC)
• Affiliated medical colleges of TU ( Eg: UCMS, NMC Birgunj, CMC, Kist MC, NAIHS )
• Other institutes: Patan AHS, Lumbini MC, Pokhara AHS, Birat MC
• International Institute: Bhutan

DM Critical Care residents from MMC are posted for 2 months in CT-ICU.

• BSc. Perfusion are posted for a total of 5 hrs theory classes.

Research

Published researches in last year:

1. Small Volume Plasma Exchange as an Alternative to Conventional Plasma Exchange and Intravenous Immunoglobulin for Myasthenic Crisis: A Case Report. Ankit Rimal, Gentle Sunder Shrestha, Bishwas Pradhan, Subhash Prasad Acharya. Journal of Advances in Internal Medicine (JAIM), July - Dec 2022, 1 -2, 52-54.

1. Patient blood management for cardiovascular surgery.Clinical practice consensus statement. Nepalese Heart Journal. Apurba Sharma, AshishAmatya, ArjunGurung.

Hundred plus Minimally Access Cardiac Surgery: Our Experience. World Journal of Cardiovascular Surgery, 2022, 12, 256-263. Anil Bhattrai, ArjunGurung, RaviBaral, Prabhat Khakurel.

1. Primary Spontaneous Pneumothorax: Surgery for the first occurrence? Anearly experience from Nepal. The Indian Journal of Chest diseases and allied sciences. Ranjan Sapkota, Arjun Gurung, Aakriti Sharma.

1. Microbiological and Antibiotic Susceptibility Patterns in Cardiothoracic and Vascular Intensive Care Unit of a Tertiary Level Hospital in Nepal. Bibhush Shrestha, Priska Bastola, Bishwas Pradhan, Arjun Gurung, Basanta Ghimire, Anil Bhattarai. World Journal of Cardiovascular Surgery, 2023, 13, 61-70

1. Prevalence of Preoperative Anemia in Elective Rheumatic Valve Surgery at a Tertiary Care Center in Nepal. Priska Bastola, Bibhush Shrestha, Bishwas Pradhan, Arjun Gurung, Basanta Ghimire, Anil Bhattarai. World Journal of Cardiovascular Surgery, 2023, 13, 1-9

1. Femoral artery Pseudoaneurysm: Presentation Causation and Outcome in Cardiothoracic Vascular and Transplant Centre of a Tertiary level hospital in Nepal. Bibhush Shrestha, Shiva Prasad Poudyal, Anil Bhattarai, JNHLS, Vol 3, 2024.

Ongoing researches:

1. Validation of Society of Thoracic Surgeons (STS) score in Nepalese Cardiac surgical patients in a tertiary level teaching hospital
2. Comparison of attenuating effect of Lignocaine on Hemodynamic response to Laryngoscopy and Intubation with Etomidate induction for CABG surgery.
3. qCON and qNOX for assessment of unconsciousness level and noxious stimulation response during surgery in a tertiary level center in Nepal.

Miscellaneous

Record keeping, sharing and periodic reporting methods:

All the clinical activities and academic activities are recorded on daily basis; and as required; in Microsoft Excel file.

Those data are shared by monthly audit presentation with all the faculties and residents.

Student Counseling, Feedback & placement:

Students are given orientation regarding their academic activities and rights to learn during orientation, which are continued throughout their term as residents.

Mentors are allocated for the MD anesthesiology residents for personal one to one interaction regarding their achievements and problems. Residents are also enquired about any changes in teaching learning methods, and are modified accordingly.

Students are placed in various subspecialty areas according to the yearly academic calendar.

Support to Internal Quality Assurance:

Department follows the protocols for teaching learning activities provided by MMC and records all the data and provides it to the authority as needed.