Anaesthesiology and Intensive Care
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Anaesthesiology and Intensive Care in Lithuania. Prof. Juozas Iva škevičius. Historical facts Present situation Education and trainig The future. VILNI US. 12 th of February, 1847 , Vilnius Medical Society - A.ADOMAVIČIUS Presentation about ether anaesthesia.

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Prof juozas iva kevicius

Anaesthesiology and Intensive Care in Lithuania

Prof. Juozas Ivaškevičius


Prof juozas iva kevicius

  • Historical facts

  • Present situation

  • Education and trainig

  • The future


Prof juozas iva kevicius

VILNIUS


Prof juozas iva kevicius

12th of February, 1847, Vilnius Medical Society - A.ADOMAVIČIUS Presentation about ether anaesthesia.


William stewart halsted 1852 1922

William Stewart Halsted, 1852-1922

“The advent of anaesthesia

has made it so that any idiot

can become a surgeon”


Prof juozas iva kevicius

  • 1946

  • Anaesthesia

    • open mask ether anaesthesia only for complicated operations

    • Performed by nurses from surgical department

    • local infiltration anaesthesia

  • Fluid therapy

    • no infusions perioperatively,

    • after operation – subcutaneous infusion

  • Statistics

    • up to 50% of patients died because of ileus,

    • 5% of patients died because of acute appendicitis


Prof juozas iva kevicius

1955 – the first endotracheal anaesthesias were performed

1958 – Health Care Ministry introduced incumbency of anaesthesiologist

1961 – Spinal anaesthesia

1962 - Lithuanian Society of Anaesthesiology and Intensive Care was founded

1963 – the first department of anaesthesiology was opened in Vilnius

1964 – postgraduate training of anaesthesiologists was started


Prof juozas iva kevicius

1991 – Lithuanian Society of Anaesthesiology and Intensive care joined WFSA

1994 – Pain Clinic


Hospitals in lithuania 2004

Hospitals in Lithuania - 2004

80 hospitals

Kaunas Medical University Clinics

Vilnius University Hospital Santariškių Clinics


Number of departments in lithuania 2004

Anaesthesia departments

Intensive care departments

Number of Departments in Lithuania - 2004

80 hospitals

76

79


Number of anaesthesias 2004

Number of Anaesthesias - 2004

Total number – 210 000

  • General anaesthesia –

    147 000 (70 %)

  • Regional and local anaesthesia –

    63 000 (30 %)


Prof juozas iva kevicius

Development of anaesthesiology and intensive care in Lithuania was close related with

Vilnius University

Faculty of Medicine

Kaunas Medical

University


Prof juozas iva kevicius

ANAESTHESIOLOGY in VILNIUS UNIVERSITY

AFTER 1990

Clinic of anaesthesiology and intensive care with 2 centers

5 training Hospitals: 30 192 anaesthesias, 11 080 ICU pts.


Prof juozas iva kevicius

Development of Anaesthesiology and Intensive Care in Kaunas Medical University

Number of anaesthesias – 34 650, 9 030 ICU pts.


Prof juozas iva kevicius

Scientific research work

  • Anaesthesia and coexisting diseases.

  • Regional anaesthesia.

  • 3. Cardiac anaesthesia and cardiopulmonary bypass.

  • 4. Sepsis and multiple organ system failure.

  • 5. Enteral and parenteral nutrition.

  • 6. Treatment of acute and chronic pain.

  • 7. Therapeutic apheresis.


Residency program

Residency Program

In compliance with:

  • Lithuanian laws and regulations

  • European Union laws and regulations:

    • Training Guidelines in Anesthesia of the European Board of Anaesthesiology Reanimation and Intensive Care, 2001

    • European Council Directive 93/16/EEC

    • European Council Directive 2001/19/EC


Anaesthesiologists in training

Anaesthesiologists in Training

  • Vilnius University Faculty of Medicine

    27 residents

    2005 graduated 10 residents

    Admitted - 8 residents

  • Kaunas Medical University

    36 residents

    2005 graduated 12 residents

    Admitted - 12 residents


Training of anaesthesiologists

Training of Anaesthesiologists

  • Until 2003 –

    1 year of internship, 3 years of residency

  • Now –

    1 year of internship, 4 years of residency


Residency program1

Residency Program

  • 1 year – basics of anaesthesia and intensive care

  • 3 years – specialty anaesthesia and intensive care

  • New program – more time to spend in intensive care, pain clinic.

  • One credit point – 40 hours


Residency program 176 credits

Residency Program – 176 credits


Residency program 176 credits1

Residency Program – 176 credits


Residency program procedures anaesthesiology

Residency Program Procedures Anaesthesiology


Residency program procedures anaesthesiology1

Residency ProgramProcedures - Anaesthesiology


Residency program procedures intensive care

Residency ProgramProcedures - Intensive Care


Residency program procedures pain treatment

Residency ProgramProcedures - Pain Treatment


Continuing medical education cme

Continuing Medical Education (CME)

Recertification every 5 years.

CME forms

Formal CME – 120 hours, training at

  • Vilnius University Faculty of Medicine

  • Kaunas Medical University

  • Also publications in scientific journals, lectures, etc.


Continuing medical education cme1

Continuing Medical Education (CME)

CME forms

Nonformal CME – 80 hours,

  • Local conferences held by medical university or faculty together with scientific society

  • Conferences abroad, etc.


Continuing medical education cme2

Continuing Medical Education (CME)

  • Government should ensure 70 % of the finances for CME. The other part – doctor himself, employer, company, etc.

  • Financial difficulties to go to conferences abroad


Lithuania

Lithuania

10-11 May, 2003

Referendum about the membership in European Union

64 % came to vote.

90 % said yes.


Lithuanian statistics inhabitants thousands 1998 2004

Lithuanian Statistics - Inhabitants (thousands) (1998-2004)


Lithuanian statistics number of births 1998 2004

Lithuanian Statistics - Number of Births (1998-2004)


Lithuanian statistics number of p hysicians

Lithuanian Statistics - Number of Physicians

2005

2nd Baltic Conference of Health Care Policy, September 30th , 2005


Lithuanian statistics number of p hysicians in lithuania

Lithuanian Statistics - Number of Physicians in Lithuania

2015

Shortage of physicians - 1000

2nd Baltic Conference of Health Care Policy

September 30th , 2005


Reasons of shortage of physicians in lithuania 2015

Reasons of Shortage of Physicians in Lithuania, 2015

  • Emigration

  • Age

  • Other reasons

  • Critical areas:

  • Anaesthesiology and intensive care

  • Gynecology, obstetrics

  • Ophthalmology

2nd Baltic Conference of Health Care Policy September 30th , 2005


Number anaesthesiologists in lithuania

Number Anaesthesiologists in Lithuania

  • Year 1996 – 576

  • Year 2002 – 634 (all licensed)

  • Year 2005 – 683 (all licensed)

    Lithuanian Society of Anaesthesiology and Intensive Care

    • Year 2002 – 384 members

    • Year 2005 - 505 members


Licensed anaesthesiologists in lithuania

Licensed Anaesthesiologists in Lithuania

  • Number of anaesthesiologists age > 60 years – 10 %

  • 10 % have applied for references from Lithuanian Health Care Ministry that are required in EU countries

2nd Baltic Conference of Health Care Policy, September 30th , 2005


Number anaesthesiologists in lithuania1

Number Anaesthesiologists in Lithuania

  • Enough according to WSFA recommendations – 1,9 per 10000 pop.

  • Shortage of anaesthesiologists in some rural hospital

  • Some foreign countries do not include doctors working in intensive care

  • Possible problem in future – “brain drain”.


Inhalation anaesthesia agents

29%

12 %

28 %

31 %

Inhalation Anaesthesia Agents


Intravenous anaesthesia agents

74 %

15 %

7 %

4 %

Intravenous Anaesthesia Agents


Opioid s

Opioids


Muscle relaxants

39 %

26%

21 %

11 %

3 %

Muscle Relaxants

39 %

26%


Local anaesthethics

16 %

47 %

37 %

Local Anaesthethics


An a est hesia machines

Anaesthesia Machines

  • Less than10 years

57%


An a est hesia machines1

Anaesthesia Machines

  • More than 10 years

43%


Artificial ventilation equipment in icu

Artificial Ventilation Equipment in ICU

Less than 10 years

64 %

More than 10 years

35 %


Yearly maintenance of the equipment

Yearly Maintenance of the Equipment

Performed in departments

89 %


Lithuanian society of anaesthesiology and intensive care should play active role in

Lithuanian Society of Anaesthesiology and Intensive Care should play active role in:

  • Propagation of modern methods of anaesthesia and intensive care

  • Training and CME of anaesthesiologists

  • Play active role in Health Care Ministry, influencing legal background, financial decisions, etc.

  • Increase international partnership


What we have today

What we have today?

  • Lithuanian Norm of Medicine “Anaesthesiologist – reanimatologist”

  • Resuscitation standards

  • Anaesthesia safety standards are being prepared

  • Valuation of ICU service, pain treatment

  • Partnership with foreign organizations


Hea l th e xpenditures as of gdp 2004

Health Expenditures as % of GDP (2004)


Financial situation in lithuania

Financial Situation in Lithuania

  • Introduction of realistic and proper valuation for anaesthesia requires additional funds from State Patient Fund

  • Difficult to expand the range of modern anaesthesia techniques


Financial situation in lithuania1

Financial Situation in Lithuania

  • There is no valuation for anaesthesia service in Lithuania

  • Prices for anaesthesia is included in the price for surgery

  • Prices for pain treatment are currently announced


Number of icu patients 2004

Number of ICU Patients - 2004

Number of patients in the ICU

74 200

Mortality in the ICU

6,4 %


Number of icu patients 20041

47 %

36%

11%

6%

Number of ICU Patients - 2004


Valuation for icu service in lithuania

Valuation for ICU Service in Lithuania


Prof juozas iva kevicius

THANK YOU FOR YOUR ATTENTION


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