CURRICULUM VITAE

DR AJIT KUMAR KAYAL

MBBS, MD, FRCA

Consultant Bariatric Anaesthetist

St Georges NHS Trust, London

United Kingdom

Advisory member NECOPD Bariatric

United Kingdom 2010-2012

Visiting Specialist(consultant)

Newfoundland,

Canada

PERSONAL DETAILS

NAME: AJIT KUMAR KAYAL

ADDRESS: 239 Raeburn Avenue

Surbiton, Surrey

KT5 9DF

TELEPHONE: 020-****-**** (home)

077*-***-**** (mobile)

E-mail: acbaei@r.postjobfree.com

acbaei@r.postjobfree.com

Nationality

British

GMC REGISTRATION: 4549006 (Full July 1996)

SPECIALIST REGISTRATION: April 2007

MDU NO 390169G

PROFESSIONAL QUALIFICATIONS

1986 MBBS

S.C.B. Medical College Cuttack

Orissa India

1990 M.D. (Anesthesia)

Postgraduate Institute of

Medical Education and Research

Chandigarh, India

2001 FRCA

Royal College of Anaesthetists, London

2007 CCT- Entry to Specialist Register

MEMBERSHIP OF PROFESSIONAL BODIES:

Royal College of Anaesthetists

Association of Anaesthetists of Great Britain and Ireland

Medical Defence Union

Society of Bariatric Anaesthesia

Society of Regional anaesthesia of London

CAREER PLANS

My sub-speciality areas of interest are anaesthesia for bariatric surgery

and regional anaesthesia. I have had a broad exposure to all the main sub-

specialities of anaesthesia over the last 20 years not only in the UK but

also in India, Canada, and USA.

I enjoy teaching and have a keen interest in clinical research, audit and

the implementation of clinical governance, to continuously improve the

quality of the healthcare we deliver.

HOSPITAL APPOINTMENTS

Present appointment

Nov 2007 to date Consultant.

St George(s Hospital NHS Trust, London

United

Kingdom

April 2009 to date Visiting Specialist

(consultant)

Newfoundland, Canada

Post CCT appointments in Canada

Aug 2007 - Oct 2007 Specialist (Consultant)

And Jan2011- June 2011 Carbonear University

Hospital,

Newfoundland Canada

Training appointments in United Kingdom

Feb 2002 to Aug 2006 CCT and Post CCT Specialist

Registrar

London

Deanery

St

George(s NHS Trust, UK

Mar 2000 to May 2002 University Hospital of

Hartlepool UK

Staff

Grade in Intensive care

Aug 1996 to Feb2000 Sandwell Healthcare NHS

Trust UK

Appointments in India

Sep 1993 to Jul 1996 Assistant Professor

Anaesthesia

All

India Institute of Medical Sciences New Delhi India

Jan1988 to Sept 1993 Junior and Senior

Resident anaesthesia and ICM

Postgraduate Institute of

Medical Education and

Research, Chandigarh, India

.Jan 1987 to Dec1987 SHO in General Medicine,

AIIMS. New Delhi,

Bariatric Consultant St Georges NHS Trust (2006-2013)

Lead Anaesthethetist for Bariatric service

Development of Anaesthesia for Bariatric Service

St Georges NHS Trust, London, and St Anthony Hospital ( Pvt Healthcare )

Cheam London

I was appointed as a consultant with an interest in anaesthesia for

bariatric surgery and regional anaesthesia at St. George's Hospital in Oct

2006. We are doing now about 350 - 400 cases per year

The experience of working as a consultant in a busy university teaching

hospital has been very valuable both in terms of the clinical environment,

as well as in teaching and management. I enjoy the challenges of managing

bariatric patients with their multiple associated co-morbidities.

I am familiar with pre-operative optimisation, intra-operative invasive and

non-invasive hemodynamic monitoring and the use of thoracic epidurals in

bariatric patients

I am experienced with adjustable gastric banding, Sleeve gastrostomy,

vertical banded gastro-plasty. I am also familiar with more complex

procedure such as duodenal switch, Roux-en-Y gastric bypass, and (1831

cases).

I am involved in preoperative preparation for difficult and complex cases

with preoperative assessment team. I am also developed post-operative

recovery guidelines for bariatric patients

I am start with one consultant in St Georges and now we have three

consultant provided the service

Development of High Risk Bariatric Anaesthetic Clinic at St Georges

Hospital

I am also Running the high risk bariatric clinic in St Georges Hospital,

specially patient with Respiratory and Cardiac problems, we have done 269

cases of bariatric surgery associated with various cardiac( CABG, Stent

insertion), Respiratory problem. Renal failure on dialysis including

cases of Severe sleep apnoea, severe pulmonary hypertension on

wheel chair and Cardiomyopathy with obesity waiting for Cardiac Transplant

Development of Sedation for Endoscopy list for Bariatric patients for

gastric balloon insertion: ( St Georges and St Anthony)

The flexible lists have helped me keep my knowledge and experience up-to-

date with different specialities. I regularly provide sedation for gastric

balloon insertion. This has been an exciting, and at times challenging,

experience and has highlighted the importance of remote site sedation

Development Regional anaesthesia for Bariatric Patients and Development of

Regional anaesthesia Module for Trainee

. I am a faculty member of London Society of Regional Anaesthesia course

(LSORA)

. I have used lumber and thoracic epidural for open gastric bypass

surgery

. TAB block for Laparoscopic Gastric Bypass in patient with severe

respiratory problem

My current post has given me the opportunity to further my skills and

confidence in regional anaesthesia using ultrasound.

. I have taken courses for ultrasound guided regional which I have

practiced regularly for last 8 years.

I have done more than 1000 regional anaesthesia blocks in last 18 years. I

am proficient in blocks under ultrasound guidance for the following

. Upper limb: Cervical, brachial(supraclavicular,

axillary)

and peripheral

nerves blocks

. Shoulder Surgery: interscalene blocks and suprascapular

Blocks

. Lower limb: fascia iliac block,femoral,

sciatic nerve

Blocks, 3in 1

block, lumber plexus block,

Obdurate block,

saphenous nerve block,

and popliteal

fossa block

. Carotid Endartrectomy deep and superficial cervical blocks

. Thoracic paravertebral, intrapleural

and intercostals

blocks.

. Ophthalmic Surgery sub-tenons, peribulbar block and

retro-bulbar

block

I have regularly anaesthetised for paediatric squint surgery. I am familiar

with the anaesthetic procedures for vitrectomy and retinal surgery. I do

regular ophthalmic theatre list in Moorefield Eye Hospital attached to St

Georges NHS Trust.

Day Surgery and Bariatric Patients

I have broad exposure to a wide range of day surgery specialities including

ENT, orthopaedics, urology, general surgery, ophthalmology and dental

procedures and the specific requirements of day case surgery and

anaesthesia. Some of patients having BMI more than 45.

Orthopaedic surgery

St George's hospital, which is a national referral centre for major

pelvic fractures. has enhanced my skills in the immediate assessment and

resuscitation of patients with major trauma.

At numerous hospitals in India and the UK, I have independently dealt with

wide range of orthopaedic and trauma procedures including major joint

arthroplasty and spinal surgery under general anaesthesia, spinal and

epidural anaesthesia/analgesia. I am proficient in brachial plexus, femoral

and sciatic nerve blocks. Extensive experience, including anaesthesia for

spinal and trauma surgery

Day surgery

Broad exposure to a wide range of day surgery specialities including ENT,

orthopaedics, urology, general surgery, ophthalmology and dental procedures

We do 60-70% of cases in day surgery, which includes diabetic,

hypertension, Renal failure for small peripheral surgery, lap

Cholecystectomy

Head & Neck Surgery and dental and oral surgery

Identification and management of difficult airways including performing 24

awake fibre optic nasotracheal intubations at St. George's hospital.

Anaesthetised patients for craniofacial procedures; neck dissection;

mastectomies with free flap reconstruction; repair of Le fort fractures;

mastoid explorations; middle ear surgery; pharyngolaryngectomies; upper

airway LASER surgery and the more common procedures such as

adenotonsillectomy, grommet insertion and septorhinoplasty.

Urology

Urological procedures ranging from TURP to radical cystectomy and ileal

reconstruction and Robotic surgery,

Renal procedures include renal transplant surgery, laparoscopic and open

nephrectomy and for vascular and peritoneal access procedures.

I am experience with various urological procedure including PCNL, Stent,

Pelvic reconstruction and various urethral procedures

General Surgery

Management of major upper and lower gastrointestinal operations and the

Challenges related to preoperative and postoperative care.

Pre-operative optimisation, intra-operative invasive and non-invasive

haemodynamic monitoring and the use of thoracic epidurals.

Obstetric and Gynaecology

I am competent managing for both elective and emergency caesarean sections

under general and regional anaesthesia and also Managing labour epidural.

I have anaesthetised for all type of gynaecological Surgery including

major gynaecological malignancy

Ophthalmic Surgery ( Moorefield Hospital)

I am familiar with, subtenon and peri bulbar local block. I have

regularly anaesthetised for paediatric squint surgery

Vascular Surgery

The hospital is a national referral centre for endovascular aneurysm repair

in high risk patients

Fibre optics experience

INTENSIVE CARE EXPERIENCE

I have spend 6 yrs time in intensive care

I am familiar with both non invasive and invasive cardiac out put

monitoring, Lid CO, PiCCO device, Swan-Ganz catheters, Tran oesophageal

Doppler, Renal replacement therapy, percutaneous tracheostomy I have

experienced in management of complex general surgical, Medical, trauma, and

Nerve and muscle problems that jeopardize breathing, such as Guillain-Barr

syndrome and myasthenia gravis, acute disseminated encephalomyelitis Brain

infections such as encephalitis and meningitis. Contemporary ventilation

techniques, including pressure support, pressure control, inverse ratio,

and high frequency ventilation. Familiar with one lung ventilation

I have extensive experience in both tertiary and district hospital

intensive care units, Covering subspecialty units including Cardio

thoracic. neurosurgery, spinal injuries, general medical and surgical

intensive care . The sum of my experience is equivalent to qualification of

intermediate Level intensive care in paper.

Staff Grade anesthesia Intensive care (2 yrs 6 months)

Hartlepool university hospital U.K

The Staff Grade posts at Hartlepool General Hospital, though as non-trainee

appointments, are quite academic and interesting. This post was mainly

covering ITU and the Juniors Registrar and SHO who were posted in ITU.

The job has given me an opportunity to supervise junior Registrar and SHOs

in theatre and ITU. I have presented many topics in tutorial and I have

improved my presentation skills.

INTENSIVE CARE EXPERINCE IN INDIA

Assistant Professor in Anaesthesia and intensive care (3 years)

ALL India Institute of Medical Science (AIIMS)

New Delhi, India

I was selected as an assistant professor (Consultant) in AIIMS after an

interview following a national advertisement. The post was full-time with a

teaching commitment. I worked 3 days in the intensive care, two days in

Orthopaedics list, one day in management of trauma cases

Postgraduate Experience in anaesthetics and Intensive care ( 6 Yrs

training)

Postgraduate Institute of Medical Education & Research

Chandigrah. INDIA

Junior and Sr Residency in anaesthetic and Intensive care (6 Years)

Working Experience: Canada

I have had worked in Carbonear University Hospital attached to St John's

University Newfoundland Canada. In this community, 31% of the population

are obese (average BMI 30- 55) compared with 21% in the rest of Canada in

2004 -06. I worked as a specialist (Consultant) in this hospital and was

involved in managing various type of laparoscopic procedures including

partial gastrostomy, gastroplasty, gastric bypass, and splenectomy. Hemi

colectomy in patients with a BMI from 55 to 96. As a specialist, I was

responsible for the theatre staff and patient management. I regularly visit

this hospital and exchange experience and knowledge about the management of

complex bariatric cases.

Hospital Visits: Massachusetts USA

Miriam Hospital, Rhode Island, USA

Tobey Bariatric Centre South Coast Hospital Group Hospital USA

I visited these two hospital twice in 2008 -2009 and I regularly exchange

views about the management of difficult cases. They do 300 to 400 cases per

year, I have learnt about the setup of the bariatric centre, and the

delivery of health care in large private health organisations.

Hospital Visits: Catherine Hospital, Holland

I visited this Hospital in 2013 .They do 600 cases per year, I have learnt

about the setup and theatre efficiency and new way of providing Health care

called Fast Track Bariatric surgery.

Development of Guidelines in Department of Anaesthesia,

St George's Hospital London,

St Anthony PVT Healthcare London

. Developed post operative recovery guidelines for bariatric patients

in

St George's Hospital

. Changed the guidelines for grouping and cross-match for patients

undergoing for elective hysterectomy

. I with the help of my colleagues have written guidelines for pre-

operative testing for endoscopy patients.

ADMINISTRATIVE AND MANAGEMENT EXPERIENCE

My engagement in management roles as locum consultant has expanded my

communication and interpersonal skills essential for good working

relationships with clinical colleagues and management. It has also given me

better insight into working of anaesthetic department, its role within the

hospital and broader understanding of the NHS as an organisation. This has

enabled me to play a more active role in effective and efficient delivery

of training and service

My experience includes

. Organisation and management of High Risk Bariatric anaesthesia Clinic

for last 5 years

Selection of the appropriate patients for Surgery and management of Staff

in clinic and Theatre.

. Co-ordinating Consultant at St. George's Hospital. This involved

ensuring the smooth running of the Department's clinical activity and

liaising with theatres, ITU and surgeons to ensure the smooth running of

the theatre lists

. Organisation of Regional Anaesthesia Course as Faculty Member at St

Georges Oct 2008, Sept 2009 to 2013

. Organisation of OSCE Course as Faculty member in Hartlepool Hospital

2000-2002

. Attendance for the three-day St Thomas Management Course for Specialist

Registrars in Anaesthesia, which helped me to understand some of the

organisational structure of the wider NHS.

. Member of the panel on the interview committee for selection of medical

students to St. George's Hospital Medical School in 2007. This gave me

valuable insight into the admissions process for Medical Schools.

. Successful completion of the Management Module training at St Richards

Hospital. I arranged meetings with 5 of the management executives of the

hospital, including the Medical Director. This gave me a much deeper

understanding of their roles and responsibilities and the organisational

structure of a NHS Hospital.

. Attendance for the three-day Keele Management Course for Specialist

Registrars in Anaesthesia, which helped me to understand some of the

organisational structure of the wider NHS.

I consider my key management skills to be

. Maintaining clear and open communication lines

. Negotiation

. Knowing when to control and when to persuade

. Awareness of my own and my team strength and weakness

. Being open to advice and opinion

. Practicing personal and team review and analysis

TEACHING EXPERIENCE

I am currently taking regular tutorials for Final FRCA candidates,

presented lectures and viva practice for the candidates within the

anaesthetic department at St Georges Hospital.

I have taught on the one day courses for regional anaesthesia at St Georges

Hospital.

I have been teaching on the London Society of Regional Anaesthesia Courses

for the last two years as a Faculty member.

I taught on the National OSCE Course, as a Faculty Member, in Hartlepool in

2001 and 2002.

I am committed to teaching and regularly take the opportunity to teach

anaesthetic trainees and members of staff in various settings.

Examples of this include;

I have presented many topics in the department meetings,

Skill based teaching to medical students, operating department

practitioners and paramedics in theatre

Seminar based teaching to outreach nursing staff

I have attended 3 days of teaching training course in Cardiff University

I have attended the course for supervision and assessment in workplace

(Case based discussions, DOPS, Multisource feedback, Mini CEX)

PAPER PRESENTATIONS

International

2013 PGI Chandigarh CME and Conference PGIMER,

Chandigrah India

Anaesthesia for bariatric Surgery

2007 South Asia Confederation of Anaesthesiologist Kathmandu, Nepal

Chairing the session for obesity and anaesthesia

Oral Presentations:-Presentation of paper

1996 Monitoring during Neuro-anaesthesia

International Symposium on Neurointensive Care and Neuro-

anaesthesia; New Delhi

National

2013 Anaesthesia for bariatric surgery, Lewisham Hospital

London

2012 NECOPD Report 2012 St Georges Hospital London

2006 Changes in electrolytes and base deficit following

intraoperative

Fluid therapy in elective neurosurgical

patients Poster

Presentation

Annual meeting Neuro-anaesthesia and Neuro Intensive Care,

Brighton UK

2003 Outcome in elderly after critical care in Wrexham Maelor

Hospital

2nd best paper in AGE AND ANAESTHESIA conference, Cambridge May

The SOCIETY OF ANAESTHETIST OF WALES Brecon Feb2003 UK

1992 Comparative study of Vecuronium and Pancuronium on ICP

North Zone Anaesthetist Association, Chandigarh India

Regional

2005 Changes in electrolytes and base deficits following Intraoperative

fluid therapy in elective neurosurgical patients

Hospital clinical governance meeting, PRH, Hayward Heath, West

Sussex

2003 Failure of epidural for Caesarean section

Hospital clinical governance meeting, Kingston Hospital

Morbidity and Mortality after 2 years after discharged from ICU

in Wrexham, Maelor Hospital, and North Wales Trust Symposium

AUDIT EXPERIENCE

2013

. Analgesia for Shoulder surgery

. TAP block for bariatric Patients

2012

. NECOPD Bariatric service NECOPD United kingdom

2011

. Sleep apnoea and post operative care for Bariatric Patients

2010

. National Laparotomy Network

2009

. Outcome of Bariatric Surgery in St Georges

. Compared with published papers and other Hospital

. Sedation for ERCP and Bariatric patients

. Development of guidelines ( NCEOPD report)

. Inadvertent perioperative hypothermia

. NICE Clinical Guideline 65

2008

. Cost effectiveness of cross matching all patient undergoing for

Hysterectomy, St George's NHS Trust.

Development of Guidelines .Only selective patient need cross match

before surgery.

2006

. Re-audit pre-operative fasting St Georges NHS Trust

2005 Changes in electrolytes and base deficit following intraoperative

Fluid therapy in elective neurosurgical patients

Use of Ringer lactate and saline in long surgical procedure.

2004

Temperature monitoring in vascular anaesthesia.

2003

. Failure of epidural for Caesarean Section,

Incidence of failure of epidural during CS in Kingston Hospital

Compared with published papers and other Hospital

. Use of prophylactic anti- emetic

Compared the use of preoperative oral cyclizing and ondansetron,

Cost effective

. Outcome after discharged from intensive care unit in Wrexham Maelor

Hospital.

Patients admitted age 60 yrs and above, who were discharged from ITU.

The average 2yr survival after discharged- Surgical 39 %(elective

Surgery 34%, emergency Surgery 44%) and Medical 28%

. Epidural experience and patients satisfaction, patients view

Aim- To find out the patients experience during and after epidural

while awake and under anaesthesia. Conducted in 3 Hospitals to avoid

bias.

. Incidence of Epidural to GA or Spinal during caesarean Section

. Low flow anaesthesia audit.

After audit most of the member in department use low flow anaesthesia

2002

. Central line position audit

Repositioning of central line after X-ray, 21% were not repositioning

the central line.

. Doctor communication to patient's relatives in ITU and HDU meets RCA

Recommended Standards.

Pre 2001

. Re-audit on Post operative Hypothermia since 1997

Post operatively in recovery, hypothermia reduced by 30% in this

audit compared to1997.

. Evaluation of Anaesthetic Records during Elective Cases

RESEARCH EXPERIENCE

NSAID and asthma in children. A Survey

St Helier NHS Trust, Dr Ajit Kayal, Dr, Patrick Radford

2006-07

Hemodynamic Response following Application of Transdermal

Nifedipine during Trans-sphenoidal Pituitary Surgery

1995

The study showed that the rise of blood pressure and heart rate were

less in those receiving transdermal nifedipine patch over the forehead

in addition to inhalation anaesthetics. This is another way of

controlling the haemodynamic responses of nasal speculum insertion

during trans-sphenoidal pituitary surgery.

Comparative Study of Vecuronium and Atracurium on Intracranial

Pressure"

1990

The study showed that the rise of intracranial pressure was less with

vecuronium than pancuronium during intubation and post-intubation. In

this study, I learned how to measure ICP using the subarachnoid bolt.

COURSES AND CONFERENCES

2012 Bariatric, Tauonton United Kingdom 2012

2011 AAGBI Update from WSM London Jan 2011

2010 Chichester Bariatric Sept 2010

European Society of perioperative care of the obese patients

Ostend Belgium

Remifentanil in Practice workshop Royal College Physician London

Regional anaesthesia workshop (LSORA) St Georges

St Georges anaesthesia day St George Hospital

Current Topics Royal College Anaesthetists

Supervision and assessment in workplace St Georges (London

Deanery)

2008 Respiratory Update Royal society of medicine

Regional anaesthesia workshop (LSORA) St Georges

St Georges anaesthesia day St George Hospital

2007 South Asia conference of Anaesthesiologist Kathmandu, Nepal

Critical care symposia

2006 Intraosseous infusion Mini workshop

Management courses for SPR St Thomas

2004 Difficult airway conference Leicester

Difficult airway Stimulator Chelsea and Westminster

ATLS Provider course of UK

APLS one day successfully completed

Obstetric Stimulator Chelsea and Westminster

2003 Teaching Techniques Cardiff

Acute Crisis management stimulator Chelsea and

Westminster

ALS Provider Course of the UK

Obstetric Course WESTMINISTER

2002 Management Course KEELE UNIVERSITY

Ultrasound in anaesthesia and critical care, Newcastle

upon Tyne.

2001 Symposium in transfer of critically ill patients, Hartlepool

PUBLICATIONS

Abstract Changes in electrolytes and base deficit following

intraoperative fluid therapy in elective neurosurgical patients

Kayal.A,Cerry C,International Journal of Neurosurgical Anaesthesia P146

Vol19, Issue2Apr2007

Abstract Outcome in elderly after critical care in Wrexham Maelor

Hospital

Kayal.A, Gemmell L, Anaesthesia Volume 58 Issue 10 Page 1048 October 2003

Hemodynamic Response following Application of Transdermal

Nifedipine during Trans- Sphenoidal Pituitary Surgery.

Kayal.A, Sexena.P and Bitha.P.Kl

Journal of Anaesthesiology Clinical pharmacology 1997 Vol 13(2), 145-148

Pulmonary Oedema following Posterior Fossa surgery in Sitting Position -

Kayal.A, Sexena.P and Bhithal.P.K,

Journal of Anaesthesiology Clinical pharmacology 1996 Apr.; 12(2): 147-9

"Fatal Air Embolism" - A case report

Kayal.A, Sexena.P,

Indian Journal of Anaesthesia 1996; 44(3): 215-7

Comparative Study of Vecuronium and Pancuronium on Intracranial Pressure

Kayal.A, Wig.J.

Neurology India 1993 Jan; 41(1): 25-8

Referees:

Dr Davinder Garewal Sr Consultant

Consultant anaesthetist

Department of Anaesthesia

St George's Hospital

Blackshaw Road

London

SW17 0 QT

020-****-**** Fax 020-****-****

Email address: acbaei@r.postjobfree.com

Dr Agnieszka Crerar-Gilbert

Consultant Anaesthetist and Intensivist

Department of Anaesthetics St George's Hospital

Blackshaw Road,London SW17 0 QT

Phone:- 020-****-**** Fax 020-****-****

Email: acbaei@r.postjobfree.com

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