Transcript Anaesthesiology and Intensive Care in Lithuania Prof. Juozas Ivaškevičius

Anaesthesiology and Intensive Care
in Lithuania
Prof. Juozas Ivaškevičius
Historical facts
Present situation
Education and trainig
The future
VILNIUS
W.T.G.Morton
16th October, 1846
L.Lechavičius (1811-1880)
23rd February,1847
J.V.Simpson
21st December, 1847
10th November,1847
Ether anaesthesia
Chloroform anaesthesia
12th of February,
Vilnius
Medical
1847,
Society
-
A.ADOMAVIČIUS
Presentation
anaesthesia.
about
ether
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
1991 – Lithuanian Society of Anaesthesiology and
Intensive care joined WFSA
1994 – Pain Clinic
Hospitals in Lithuania - 2004
80 hospitals
Kaunas Medical University Clinics
Vilnius University Hospital Santariškių Clinics
Number of Departments in
Lithuania - 2004
80 hospitals
Anaesthesia
departments
76
 Intensive
care
departments
79
Number of Anaesthesias - 2004
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
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.
Development of Anaesthesiology and
Intensive Care in Kaunas Medical University
Number of anaesthesias – 34 650, 9 030 ICU pts.
Scientific research work
1. Anaesthesia and coexisting diseases.
2. 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
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
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
Until 2003 –
1 year of internship, 3 years of residency
Now –
1 year of internship, 4 years of residency
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
Subject
Credits
General anaesthesia and pain treatment
40
Anaesthesia for abdominal surgery
12
Anaesthesia for neurosurgery
8
Anaesthesia for thoracic surgery
8
Anaesthesia for orthopedic surgery and trauma
8
Anaesthesia in obstetrics
8
Anaesthesia for pediatric surgery
8
Anaesthesia for vascular surgery
8
Anaesthesia for odontology and surgery
4
Anaesthesia for urological surgery
4
Anaesthesia for cardiac surgery
8
Total for anaesthesiology
116
Treatment of acute and chronic pain
8
Electives
8
Residency Program – 176 credits
Subject
Credits
Resuscitation and basics of intensive care
Intensive care in abdominal surgery
16
16
Neonatal and pediatric intensive care
Intensive care after cardiac surgery
Intensive care in cardiology
Intensive care in toxicology
4
4
2
2
Total for intensive care
44
Residency Program
Procedures Anaesthesiology
Procedures
General anaesthesia
Minimum
number of
procedures
Lithuania
Recommended
UEMS
500
500
Spinal anaesthesia
50
50
Epidural anesthesia
50
50
Nerve and plexus blocks
20
20
1200
1500
Total number of
anaesthesias
Residency Program
Procedures - Anaesthesiology
Minimum number
of procedures
Lithuania
Recommended
UEMS
Pediatric patients, age < 5 years
30
30
Pediatric patients, age < 1year
10
10
Obstetrics, S.Caesarea
10
10
Epidural for delivery
10
10
Thoracic
16
15
Neurosurgery
15
15
Urology
10
10
Odontology, head and neck surgery
15
15
Orthopaedic endoprostheses
15
15
Day case surgery
30
30
Vascular
10
10
Procedures
Residency Program
Procedures - Intensive Care
Procedures
Minimum number pf patients in ICU
Minimum
number of
procedures
Lithuania
Recommended
UEMS
50
50
Pediatric patients, age < 5 years
3
3
Pediatric patients, age < 1year
2
2
Respiratory disorder
3
3
10
2
CNS problems
2
2
Sepsis
4
2
Renal failure
4
1
Transport of critically ill patients
5
5
Resuscitation
5
5
Cardiovascular disorder
Residency Program
Procedures - Pain Treatment
Procedures
Minimum
number of Recommended
procedures
UEMS
Lithuania
Minimum number of patients in
pain treatment
50
50
Pediatric patients
5
5
Major surgery
10
10
Thoracic surgery
5
5
Major orthopedic surgery
5
5
Day-case surgery
10
10
Chronic pain
20
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 (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 (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
10-11 May, 2003
Referendum
about the
membership in
European Union
64 % came to
vote.
90 % said yes.
Lithuanian Statistics - Inhabitants (thousands)
(1998-2004)
3550
3549,3
3524,2
3499,5
3500
3481,3
3469,1
3454,2
3452,6
3450
3400
1998
1999
2000
2001
2002
2003
2004
Lithuanian Statistics - Number of Births
(1998-2004)
45000
37019 36415
34149
35000
31546
30153 30598 30419
2001
2002
25000
1998
1999
2000
2003
2004
Lithuanian Statistics - Number of Physicians
2005
Country
Number of physicians per
100 000 population
Lithuania
390
European Union
340
UK
250
2nd Baltic Conference of Health Care Policy, September 30th , 2005
Lithuanian Statistics - Number of
Physicians in Lithuania
2015
Country
Lithuania
Number of physicians per
100 000 population
313
Shortage of physicians - 1000
2nd Baltic Conference of Health Care Policy
September 30th , 2005
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
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
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 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%
N2O
12 %
Sevoflurane
N2O
Sevoflurane
28 %
Izoflurane
Izoflurane
Halothane
31 %
Halothane
0
10
20
30
40
Intravenous Anaesthesia Agents
80
74 %
70
60
Thiopental
50
Propofol
40
Ethomidate
30
15 %
20
7%
4%
10
0
Thiopental
Propofol
Ethomidate
Others
Others
Opioids
Fentanil
91 %
Remifentanil
0,1 %
Morphine
6%
Muscle Relaxants
39 %
39 %
40
35
30
26%
26%
21 %
25
Atracurium
20
11 %
15
10
Sux
3%
5
0
1
Cisatracurium
Mivacurium
Pipecuronium
Local Anaesthethics
16 %
47 %
Lidocaine
Bupivacaine
Other
37 %
Anaesthesia Machines
 Less than 10
years
57%
Anaesthesia Machines
 More than 10
years
43%
Artificial Ventilation Equipment in ICU
Less than 10 years
64 %
More than 10 years
35 %
Yearly Maintenance of the Equipment
Performed in departments
89 %
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?
Lithuanian Norm of Medicine
“Anaesthesiologist – reanimatologist”
Resuscitation standards
Anaesthesia safety standards are being
prepared
Valuation of ICU service, pain treatment
Partnership with foreign organizations
Health Expenditures as % of GDP (2004)
14
13
10,9
12
10
7,7
8
5,3
6
4
2
0
USA
Germany
England
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 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 patients in the ICU
74 200
Mortality in the ICU
6,4 %
Number of ICU Patients - 2004
50
47 %
45
40
36%
35
30
ICU I - 1
ICU I - 2
25
20
ICU II
11%
15
10
6%
5
0
ICU I - 1
ICU I - 2
ICU II
ICU III
ICU III
Valuation for ICU Service in Lithuania
Level
Hours
Cost EUR
I - I (recovery
room)
24 hours
60,40
I - II (primary
ICU)
48 hours
88,44
II level
3 days
601,73
III level
4 days
989,88
III-3 level
20 days
1 day –
354,05