Dr Dipankar Dasgupta, Director and HoD, Anesthesia Department, Jaslok Hospital and Research Centre
Procurement plan is a composite decision to buy from the available market with limited resources and a long-lasting functioning. Procurement planning for hospitals is processed by world federation guidelines adopted by a national body of affiliated countries. Medicolegal constraint and safety compel us for uniform adaptation of given guidelines. Procurement planners need knowledge in subject, quality functioning, market dynamics, on spot servicing facility, sense in finance, integrity, and honesty. Planning mainly depends on whether procurement is for new/running/primary health center/district/medical college/service establishment/super specialty/tertiary care hospital.
In India, till 1990, medical college hospitals designed their individual norms of procurement. Global products were not available freely, and were compounded by inadequacy of national manufacturing of medical equipments. Agents used to push products unscrupulously. In 1988 the Prague WFSA conference task force was created for assessing the mandatory needs for anesthesia set-up. In the 1992 world conference at Washington monitors were declared mandatory, dividing the hospitals at three levels covering the remotest hospital to the ultra modern urban center for safe practice in anesthesiology. ISA a member country for WFSA took the challenge and listed requirements at all levels with minimal realistic changes which covered basic to advanced requirements.
In the last six decades, revolutionary changes have taken place in the monitoring system and workstation in anesthesia. Earlier we were monitoring clinically, assisted by sphygmomanometers, ECG, and thermometer. Modernization started with availability of equipment revealing central venous pressure, arterial pressure, pulmonary wedge pressure, haemogram, blood biochemistry, blood gas analysis, blood glucose, and lactate level. Cardiac output monitoring with a pulmonary artery catheter is replaced by pulse pressure analysis and is the latest trend. PICCO, LIDCO, volume view, and cardiac output variations work on principle of transpulmonary, thermodilution, and arterial pressure waveform analysis with continuous cardiac output display. Oesophageal Doppler with transducer at the tip demonstrates constant cardiac function along with thoracic aorta blood flow and is a late additional assistance.
Anesthesiology, critical care, and the dolorology-related appliances procurement plan involve modern equipments
Dr Rajani M R
Jaslok Hospital and Research Centre