Neuroanesthesia and Neurocritical Care Activity in Nepal

Ritesh Lamsal, MD, DM
Joint Secretary, Society of Anaesthesiologists of Nepal (SAN)
Assistant Professor, National Academy of Medical Sciences,
Kathmandu, Nepal

Rutesg Kansakm NDm DN
Ritesh Lamsal, MD, DM

Nepal is a small, landlocked country in South Asia with a population of around 30 million.  As most of the land is covered by hills and tall mountains, equitable distribution and accessibility of healthcare facilities are a major challenge. Nearly all the major hospitals are clustered in and around a few big cities.

The Society of Anaesthesiologists of Nepal (SAN) was formed in 1987 with the vision to uplift the status and broaden the role of anesthesiologists in providing safe and quality anesthesia services. Since then, SAN has played a pivotal role in uplifting the quality of anesthesia, critical care and pain medicine in the country. Nepalese Society of Critical Care Medicine (NSCCM) has also played an important role in uplifting the standards of critical care. Nepal has a very small pool of anesthesiologists with approximately 400 registered physicians. However, the landscape of anesthesia is changing fast with a spurt of teaching hospitals in recent years. There are 19 medical colleges in the country and most of these colleges provide anesthesia residency programs (three-year MD Anesthesia). Further subspecialty training has also begun in doctorate level programs (three-year DM Critical Care). Subspecialties like neuroanesthesia are still in their infancy. Neuroanesthesia and neurocritical care lag far behind other neuroscience disciplines like neurosurgery or neurology. To compare, there are over 50 registered neurosurgeons in the country.

There is a steady increase in the number of hospitals providing neurosurgical services in the country. However, there is very little published data on the annual number of neurosurgical cases or neurocritical care admissions. Neurosurgical services were earlier confined to large government hospitals like Bir Hospital and Tribhuvan University Teaching Hospital, but in the last few decades, there has been a surge of neurosurgical services in private hospitals as well. Currently, there are over a dozen hospitals in the country that cater to neurosurgical patients. Most of these hospitals are situated in the capital city of Kathmandu, which also has the country’s first and only dedicated trauma center (National Trauma Center). In most hospitals, neurosurgical anesthesia and neurocritical care are provided by anesthesiologists with limited or no formal subspecialty training. At present, formal neuroanesthesia or neurocritical care training programs are not available in Nepal. Only a limited number of short training programs like Emergency Neurological Life Support (ENLS) have been running for a few years with the initiatives of the Neurocritical Care Society (NCS). There is a pressing need to start neuroanesthesia fellowship programs. Professional societies like SAN and NSCCM are planning to start such programs, but there are several glaring deficiencies, such as the lack of neuromonitoring during anesthesia and critical care, neurocritical care unit beds, blood banks, and trained manpower. International collaboration and support from other professional societies like Society for Neuroscience in Anesthesiology and Critical Care (SNACC), Neurocritical Care Society (NCS)and the neighboring Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) will prove beneficial.

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