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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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Anaesthesiology and Intensive Care in Lithuania

Prof. Juozas Ivaškevičius




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”


  • 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


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



Hospitals in lithuania 2004
Hospitals in Lithuania - 2004 care joined WFSA

80 hospitals

Kaunas Medical University Clinics

Vilnius University Hospital Santariškių Clinics


Number of departments in lithuania 2004

Anaesthesia departments care joined WFSA

Intensive care departments

Number of Departments in Lithuania - 2004

80 hospitals

76

79


Number of anaesthesias 2004
Number of Anaesthesias - 2004 care joined WFSA

Total number – 210 000

  • General anaesthesia –

    147 000 (70 %)

  • Regional and local anaesthesia –

    63 000 (30 %)


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

Vilnius University

Faculty of Medicine

Kaunas Medical

University


AN Lithuania was close related withAESTHESIOLOGY in VILNIUS UNIVERSITY

AFTER 1990

Clinic of anaesthesiology and intensive care with 2 centers

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


Development of Anaesthesiology and Intensive Care in Kaunas Medical University

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


Scientific research work Medical University

  • 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 Medical University

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 Medical University

  • 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 Medical University

  • Until 2003 –

    1 year of internship, 3 years of residency

  • Now –

    1 year of internship, 4 years of residency


Residency program1
Residency Program Medical University

  • 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 procedures anaesthesiology
Residency Program Medical UniversityProcedures Anaesthesiology


Residency program procedures anaesthesiology1
Residency Program Medical UniversityProcedures - Anaesthesiology


Residency program procedures intensive care
Residency Program Medical UniversityProcedures - Intensive Care


Residency program procedures pain treatment
Residency Program Medical UniversityProcedures - Pain Treatment


Continuing medical education cme
Continuing Medical Education (CME) Medical University

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) Medical University

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) Medical University

  • 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 Medical University

10-11 May, 2003

Referendum about the membership in European Union

64 % came to vote.

90 % said yes.



Lithuanian statistics number of births 1998 2004
Lithuanian Statistics - Number of Births Medical University(1998-2004)


Lithuanian statistics number of p hysicians
Lithuanian Statistics Medical University- Number of Physicians

2005

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


Lithuanian statistics number of p hysicians in lithuania
Lithuanian Statistics Medical University- 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 Medical UniversityLithuania, 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 Medical University

  • 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 Medical Universityin 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 Medical University

  • 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% Medical University

12 %

28 %

31 %

Inhalation Anaesthesia Agents


Intravenous anaesthesia agents

74 % Medical University

15 %

7 %

4 %

Intravenous Anaesthesia Agents


Opioid s
Opioid Medical Universitys


Muscle relaxants

39 % Medical University

26%

21 %

11 %

3 %

Muscle Relaxants

39 %

26%


Local anaesthethics

16 % Medical University

47 %

37 %

Local Anaesthethics


An a est hesia machines
An Medical Universityaesthesia Machines

  • Less than10 years

57%


An a est hesia machines1
An Medical Universityaesthesia Machines

  • More than 10 years

43%


Artificial ventilation equipment in icu
Artificial Ventilation Equipment in ICU Medical University

Less than 10 years

64 %

More than 10 years

35 %


Yearly maintenance of the equipment
Yearly Maintenance of the Equipment Medical University

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? should play active role in:

  • 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
Hea should play active role in:lth Expenditures as % of GDP (2004)


Financial situation in lithuania
Financial Situation in Lithuania should play active role in:

  • 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 should play active role in:

  • 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 should play active role in:

Number of patients in the ICU

74 200

Mortality in the ICU

6,4 %


Number of icu patients 20041

47 % should play active role in:

36%

11%

6%

Number of ICU Patients - 2004


Valuation for icu service in lithuania
Valuation for ICU Service in Lithuania should play active role in:


THANK YOU FOR YOUR ATTENTION should play active role in:


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