Department of Anaesthesiology

History of Anaesthesia in Malaysia.

In the 1950s, Malaysian doctors had to travel to the United Kingdom and Ireland for clinical training and to undertake their Fellowship examinations (FFARCS / FFARCSI). In Malaysia, specialist training in Anaesthesiology started with the establishment of an academic Department of Anaesthesiology at the University of Malaya in 1965. A collaboration was also established with the Faculty of Anaesthetists of the Royal Australasian College of Surgeons to allow for the fellowship examinations (primary and finals) to be conducted from the 1970s to 1985 in Kuala Lumpur.

In June 1987, the Faculty of Medicine of the University of Malaya introduced the Master of Anaesthesiology training programme. In December 1988, the Part I, Master of Anaesthesiology Examination was conducted jointly with the Faculty of Medicine of the National University of Malaysia (UKM). This was the first major step by the two universities to establish a conjoint Master of Anaesthesiology programe. The first batch of graduates completed their postgraduate degrees in June 1991. The programme received the full support from the Ministry of Health Malaysia through scholarships or paid leave granted to applicants for the duration of training. This support has enabled the training of a large number practicing anaesthesiologists in the country.

The conjoint examinations are now fully established with a total of six universities participating in the programme. The four-year training programme comprises of:

a. Training in anaesthesia, pain medicine, resuscitation and intensive care.
b. Exposure to research methodology.

The aim of the training is to enable professionally trained anaesthesiologists to practice independently in anaesthesia, whilst inculcating a lifelong commitment to excellence and learning.

 

History of Department of Anaesthesiology.

The Department of Anaesthesia and Intensive Care was established on the 1st of June 1965 with Professor Dr A Ganendran as the first Head of the Department. He was also appointed as the first Professor of Anaesthesia in Malaysia. Other anaesthetic academic trainees from University Hospital of Liverpool included Associate Professor Dr Peter Kam Chin Aik and Dr Liew Pak Shim. Professor Dr Ganendran was a cardiac anaesthetist with special interest in intensive care and parenteral nutrition. He also studied the clinical and biochemical aspects of malathion poisoning in patients admitted to the Intensive Care Unit.

The University Hospital of Malaya was the first hospital in Malaysia and Singapore to have total parenteral nutrition. Professor Dr Ganendran also headed the first Intensive Care Unit in Malaysia, which was started up on the 18th of January 1969. He pioneered the treatment of organophosphorus poisoning and subsequently, the unit became a centre of referral for organophosphorus poisoning. He led the team to develop techniques to measure serum and red blood cell cholinesterase.

Professor Dr A E Delilkan was appointed to the chair of Anaesthesia after Professor Ganendran emigrated to Australia. Professor Dr A E Delilkan extended his research interest in the treatment of cerebral protection in patients with head injury.  He advocated the understanding of Brain Death among public, leading to its eventual acceptance in the community. Professor Dr A E Delilkan retired in 2000 after many years of dedicated teaching. The University Hospital established Malaysia’s first acute and chronic pain management service under Professor Dr A E Delilkan and Professor Dr Ramani Vijayan. The University Hospital also established Malaysia’s first obstetric analgesia and anesthesia with epidural, spinal and general anesthesia in 1989 under Professor Dr Chan Yoo Kuen.  In the recognition of his contribution, the University of Malaya awarded the title of Professor of Excellence in Obstetric analgesia and anaesthesia and Pain management to Professor Dr A E Delilkan.

Since then, the department has been led by many notable anaesthesiologists who each are leaders in their fields. Professor Dr Gracie Ong Siok Yan is an Intensivist by training and led the department from 1999 to 2006. Professor Dr Chan Yoo Kuen took over from 2006 to 2008 and handed over to Professor Dr Marzida Mansor who led the department from 2008 to 2019 and is the current President of the Malaysian Society of Anaesthesiologists (MSA). Our current Head of Department since 2019 is Professor Dr Ina Ismiarti bt Shariffuddin, who is also the President -elect for the MSA.

 

Contact Information

Department of Anaethesiology,
Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, MALAYSIA
Tel : +603-7949 2052
Fax : +603-7955 6705

 

Currently, the Department of Anaesthesiology provides services throughout the whole hospital, ranging from perioperative care within or outside of operation theatres, critical care and pain management as well as other clinical specialized anaesthesia services. We have numerous subspecialized units with trained anaesthetists running each unit.

1. Clinical anaesthesia services:

The Department provides clinical anaesthesia services in:

  • General surgery
  • Orthopaedic surgery
  • Neurosurgery
  • Paediatric surgery
  • Plastic surgery
  • Trauma surgery
  • Maxillofacial surgery
  • Dental surgery
  • Cardiothoracic surgery
  • Obstetrics and gynaecology


Paediatric Anaesthesia services

The paediatric anaesthesia services include the majority of paediatric surgical subspecialities, namely general surgery, urology, neurosurgery, otorhinolaryngology, orthopaedics, ophthalmology and oral surgery. The age of our patients ranges from the premature neonates to young adults with multiple comorbidities. The most recent expansion of services includes anaesthesia for paediatric bronchoscopy and paediatric liver transplantation. Our ultimate aim is to provide a comfortable experience and safe, evidence based anaesthesia to all our patients undergoing surgery.

Cardiothoracic Anaesthesia services

The cardiothoracic anaesthesia team meets the anaesthetic needs of the cardiothoracic surgical team, which includes anaesthesia for minimally invasive and open-heart surgeries for valve repair and replacements, coronary artery bypasses, and various thoracic surgeries for diseases of the lungs, aorta (vascular) and chest wall. We utilise both invasive and non-invasive monitoring, namely intraoperative transesophageal echocardiography and pulse contour analysis cardiac output monitoring to guide our anaesthesia. We co-manage patients in the Cardiothoracic Intensive Care Unit (CICU) with the surgeons and intensivists to optimize postoperative care in our cardiac patients. We also organise multidisciplinary team meetings to discuss complex cases to provide the best possible care for our patients.

Neuroanesthesia Services

The neuroanesthesia unit provides specialized anaesthetic care for a comprehensive spectrum of neurosurgical procedures, including neuro-oncological surgery, vascular neurosurgery, endoscopic skull base surgery, functional and movement disorder surgery, epilepsy surgery, spine surgery, pediatric neurosurgery, neuroradiology and neurointerventional procedures. A wide variety of complicated cases are facilitated and supported with the use of advance equipment such as intraoperative MRI and CT-guided imaging, neurophysiological monitoring, endoscopy or endonasal surgery and awake brain surgery, under the watchful eye of our highly skilled and trained neuroanaesthetists. We strive to deliver high quality of neuroanesthesia services to our patients whilst providing a good learning platform to our Master trainees to hone their clinical experience. 

Vascular anaesthesia Services

Vascular anaesthetists provide clinical care to patients in a variety of locations, from the general operating theatre to the hybrid operating theatre or the interventional radiology suite. The team covers anaesthesia for complex endovascular surgeries, open aortic surgery, lower limb peripheral vascular surgeries and venous surgery. The provision of care begins from a comprehensive pre-operative assessment where we form a multidisciplinary team comprising of the surgeon, cardiologist, interventional radiologist, physician and patient to explore the incurred risk and benefits of treatment, options of prehabilitation, risk stratification, optimisation and enhanced recovery after anaesthesia. We also provide regional anaesthesia for brachiocephalic / basilic access creation and transposition.

Transplant Anaesthesia Services

The University of Malaya Medical Centre is a leading organ transplant centre for living-related renal and liver transplant. For liver transplants, the transplant anaesthetists support both adult and paediatric liver transplantation. Our scope features a comprehensive pre-operative assessment and optimisation of all donor-recipient pairs and safe anaesthesia to facilitate the conduct of surgery. We work towards excellent peri-operative care involving a dedicated multidisciplinary team of surgeons, anaesthesiologists, intensivists, nephrologists, hepatologists and specialised nursing staff to discuss and manage all the complex cases in every step of the way towards a successful transplant programme. In transplant anaesthesia, our main goal is to provide patients with end stage kidney and liver disease a second chance in life, allowing them to return to their normal lifestyles whenever possible. 

Obstetric Anaesthesia Services

The unit embraces the importance of providing service, opening avenues for learning and conducting research. Comprehensive care for the obstetric patient is provided throughout her journey.  This is accomplished antenatally via multidisciplinary team discussions, Obstetric Anaesthetic High Risk Clinics, Obesity Complicating Pregnancy Clinics and in-house referrals during admissions. During labour, an array of modalities such as labour epidural, inhalational analgesia, and intravenous Patient Controlled Analgesia are available to the parturient in order to enrich her experience.  For Caesarean sections, both elective surgical lists and a 24-hour emergency service are available. Learning opportunities for the team is achieved through bed-side teaching, case discussions, courses and exam orientated tutorials.  On-going audits assist with quality assurance and improvement of services.  Finally, research activities allow us to explore new frontiers in providing holistic care for our patients. 

Remote Anaesthesia Services

Remote anaesthesia services provide anaesthesia and sedation outside the operation theatre that include:

  • Electroconvulsive therapy (ECT),
  • Endoscopic procedures - retrograde cholangiopancreatography (ERCP), esophagogastroduodenoscopy (OGDS), colonoscopy,
  • Oncology procedures - radiotherapy and brachytherapy
  • Magnetic resonance imaging (MRI) and interventional radiology such as cerebral coiling, thrombectomy, radiofrequency ablation (RFA).


Our objective is to deliver safe anaesthesia and ensure patient comfort during a diverse range of procedures in various locations, as well as address the challenges of different patient groups while at the same time, provide full support to assist in the success of the procedures.

 

2. Critical care services:

The department provides intensive care expertise for the hospital and manages the ICU with a team of trained staff lead by Intensivists. The intensive care team also provide services to other critical care areas in the hospital.

3. Pain management services

The pain management team in UMMC strive to achieve the highest standard of care for adult and paediatric patients who suffered from acute and chronic pain. We have an established acute pain service team, which comprised of dedicated nurses and doctors to provide 24-hour service to surgical, trauma, and medical patients in order to alleviate their pain and reduce their suffering.

We practise a wide range of analgesia regimes, ranging from multimodal analgesia, patient control analgesia, epidural analgesia, regional nerve blocks with or without a catheter. We aim to manage our patient’s pain, improve their clinical outcomes, minimize complications and achieve better overall patient satisfaction.

Chronic pain is recognised as one of the most debilitating symptoms, which causes depression and a low quality of life. Our chronic pain team endorses a multidisciplinary approach to manage a variety of chronic pain patients. We offer a wide range of treatment modalities, including pharmacological treatment, physiotherapy, interventional procedures, such as trigger point injection, diagnostic and therapeutic blocks, epidural injection, and radiofrequency ablation. Our aim is to help patients to minimise their chronic pain whilst restoring their normal daily function.

4. Pre-anaesthetic clinic services

The anaesthetic clinic is the first contact of surgical patients with our anaesthetic services. For the majority of patients, it will be their first meeting with the anaesthetists after the decision of surgery has been made. The primary role of the anaesthetic clinic is to assess, optimise and prepare patients for their upcoming surgeries. This is particularly useful for patients with multiple comorbidities and/or planned for moderate to high complexities of surgeries. The anaesthetic clinic also engages the role of interdisciplinary liaison if interdepartmental referral or multidisciplinary meeting are deemed necessary to ensure the best interest for the patients. By incorporating the principles of perioperative medicine into the future development of the anaesthetic clinic, we aim to return patients to their baseline functional status as soon as possible after any surgery, to maintain their quality of daily living and to lower the associated socio-economic impacts on their lives.

5. Daycare surgery services

Daycare surgery is defined as scheduled surgical procedures to patients who do not require an overnight hospital stay. It is a process of care by which selected patients are managed with admission, treatment and discharge on the same day. Daycare surgery is often catered for diagnostic and therapeutic procedures, which require local, regional or general anaesthesia with minimal post-operative complications. However, a short period of observation in the hospital is often warranted instead of hospital admission.

UMMC has a dedicated daycare unit, which is located at the Level 4, Menara Timur. The daycare service centre operates from Monday to Friday (0800hrs to 1700hrs). Our staff include anaesthesiologists, medical officers, nursing manager/sister, theatre scrub nurses, general anaesthetic nurses, ancillary staffs and recovery ward nurses. Selecting patients for daycare surgery is facilitated through the protocols of our unit including a comprehensive pre-anaesthetic clinic review. Eligibility criteria and prerequisites for day care surgery are assessed prior to the decision of daycare surgery. Currently, it has become a popular modality of surgical intervention. Our aim is to provide the same standard of care seen in in-patient surgery for all our daycare surgery patients.

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ADDRESS

  • Pusat Perubatan Universiti Malaya,
    Lembah Pantai, 59100,
    Kuala Lumpur, MALAYSIA

EMAIL

  • Email : ummc@ummc.edu.my

TEL

  • Phone No : 03-79494422
    Fax : 03-79492030

WEBSITE

  • WEBSITE : www.ummc.edu.my