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Sankara Nethralaya
Sankara Nethralaya
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Anaesthesiology

Introduction of the Speciality

Ophthalmic anaesthesia is one of the upcoming sub-specialities in the recent years.The varied age group of patients right from preterm, neonate, to geriatrics with multiple congenital and systemic disorders makes it a very challenging sub speciality.

Ophthalmic surgeries are done under Local and/or General anaesthesia and this provides several unique challenges for the Anaesthesiologists. Surgical duration varies from 10-15 minutes to prolonged surgery (5-6hours). The intricacies of Ophthalmic anaesthesia includes regulation of intraocular pressure, prevention of oculocardiac reflex, management of its consequences, control of intra ocular gas expansion and the need to deal with possible systemic effects of ophthalmic drugs.

Facilities available:
Sankara Nethralaya has 22 operation theatres located at five different complexes.
Two annexes areas used exclusively for Examination under general anaesthesia, TTT and intravenous cannulation prior to chemotherapy are also available.
Each state of the art theatre suite has a preoperative holding area to receive patients undergoing surgery and an ICU to observe patients in the immediate post-operative period.
The operation theatres are well equipped with pipeline oxygen and Nitrous oxide supply, newer anaesthesia machines like Aestiva, Drager Fabius, Boyle MK III machines, with inbuilt adult and paediatric anaesthesia ventilators, multi parameter monitors to record ECG, NIBP, Oxygen saturation, end tidal carbon- dioxide. Neuromuscular moniotor, radiant warmers and apnea monitors are also available.
Each operation theatre has anaesthetic equipments including circle system, Bain circuits, Paediatric Jackson Rees and Mapleson F circuits, Laryngoscopes, Guedel airways, Face masks, LMA's (Laryngeal mask Airways), Endotracheal tubes, gum elastic bougies, stilettes, and Tec vaporizers for Isoflurane, and Sevoflurane.
All preoperative patients are thoroughly evaluated in our Pre-anaesthetic clinic.
The ICU and theatre suite has emergency drugs, resuscitation kit, oxygen delivery devices, CPAP circuits, nebuliser and a cardio plus defibrillator.
The ophthalmic subspecialities attended include Vitro-retinal (preterm to adult cataract (peaditric and adult),Glaucoma (peadiatric and adult ),Oculoplasty and Aesthetic procedures, corneal and emergency surgeries ( 24 hours ).
There is a difficult intubation trolley for adults and children in each theatre suite. This trolley has different types of Laryngoscopes including McCoy (Trupti) blades, gum elastic bougies and cricothyrodotomy set. This trolley is readily available for use in difficult intubations situations.
Major activities:

1. Anaesthesia for extreme premature Infants and neonates with associated congenital anomalies
2. Hypotensive anaesthesia for orbital decompression and endoscopic DCR
3. Anaesthesia for MOOKP surgeries
4. Anaesthesia at remote locations – ERG, VEP and YAG
5. Ongoing research project:

A comparative study between three different mydriatic regimens for fundus examination of children under general anaesthesia
Effect of sedation on retained visual sensation in patients undergoing phacoemulsification cataract surgery under topical anesthesia.
Prevalence of Multi-system disorders associated with Childhood Cataract and Squint: Anaesthetic Implications.
Recent publications:

1. Jaichandran V V, Angayarkanni N, Coral Karunakaran, Bhanulakshmi IM, Jagadeesh V. Diffusion of lidocaine buffered to an Optimal pH across the Endotracheal tube cuff – An in-vitro study. Indian Journal of Anaesthesia 2008: 52(5): 536-540.

2. Jaichandran V V , Bhanulakshmi IM “Anaesthetist’s Role in IOP control” The Journal of British Ophthalmic Anaesthesia Society, 2008: 18-27.

3. Jaichandran V V, Bhanulakshmi IM, Jagadeesh V, Sujatha R, Kavitha Devi J, Manimaran. A multimodal approach to Post-operative pain relief in children undergoing ambulatory eye surgery. Indian Journal of Anaesthesia 2008:52(6): 794-799.

4. Jaichandran V V, Bhanulakshmi IM, Jagadeesh V. Intracuff buffered lidocaine versus saline or air – A comparative study for smooth extubation in patients with hyperactive airways undergoing eye surgery. SAJAA 2009; 15(2): 11-14.

5. Jaichandran V V, Bhanulakshmi IM. The Uncooperative patient: the sugeon’s nightmare. How does the anaesthetist manage?. The Journal of British Ophthalmic Anaesthesia Society, 2009:55-58.

6. Jaichandran V V, Bhanulakshmi IM, Sujatha R, Kavitha Devi J, Thennarasu Ragavendra. A method of Endotracheal Tube Cuff inflation in paediatric patients undergoing general anaesthesia - A pilot study. SAARC J. Anaesth.2010; (2):184-187.

7. Jaichandran V V, Vijaya L, Ronnie Jacob George, Bhanulaksmi Indermohan. Peribulbar anesthesia for cataract surgery: Effect of lidocaine warming and alkalinization on injection pain, motor and sensory nerve blockade. Indian J Ophthalmol 2010;58:105-8. .

Faculty list:
Director : Dr. Jagadeesh V
Advisor: Dr. Ian Sundararaj
Professor Emeritus: Dr. Sailender G V
Anaesthetist: Dr. Shobha Ravishankar
Dr. Jaichandran V V
Dr. Pradnya Senthil Kumar
Dr. Kannan R
Dr. Manonmani B
Dr. Sujatha R
Dr. Usha Somanathan
Dr. Alo Ganguly
Dr. Lakshmi Prasanna S
Dr. Sujatha V
Dr. Saptarshi Dasgupta (Kolkata)
Dr. Manjula Khosla Nee Bhatnagar (Kolkata)
Part-time Anaesthetists: Dr. Sridhar Raj D
Dr. Babita Basu (Kolkata)
Dr. Thirumaaran U G