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Prof. Juozas Iva škevičius

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 škevičius

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  1. Anaesthesiology and Intensive Care in Lithuania Prof. Juozas Ivaškevičius

  2. Historical facts • Present situation • Education and trainig • The future

  3. VILNIUS

  4. 12th of February, 1847, Vilnius Medical Society - A.ADOMAVIČIUS Presentation about ether anaesthesia.

  5. William Stewart Halsted, 1852-1922 “The advent of anaesthesia has made it so that any idiot can become a surgeon”

  6. 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

  7. 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

  8. 1991 – Lithuanian Society of Anaesthesiology and Intensive care joined WFSA 1994 – Pain Clinic

  9. Hospitals in Lithuania - 2004 80 hospitals Kaunas Medical University Clinics Vilnius University Hospital Santariškių Clinics

  10. Anaesthesia departments Intensive care departments Number of Departments in Lithuania - 2004 80 hospitals 76 79

  11. Number of Anaesthesias - 2004 Total number – 210 000 • General anaesthesia – 147 000 (70 %) • Regional and local anaesthesia – 63 000 (30 %)

  12. Development of anaesthesiology and intensive care in Lithuania was close related with Vilnius University Faculty of Medicine Kaunas Medical University

  13. 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.

  14. Development of Anaesthesiology and Intensive Care in Kaunas Medical University Number of anaesthesias – 34 650, 9 030 ICU pts.

  15. 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.

  16. 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

  17. 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

  18. Training of Anaesthesiologists • Until 2003 – 1 year of internship, 3 years of residency • Now – 1 year of internship, 4 years of residency

  19. 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

  20. Residency Program – 176 credits

  21. Residency Program – 176 credits

  22. Residency Program Procedures Anaesthesiology

  23. Residency ProgramProcedures - Anaesthesiology

  24. Residency ProgramProcedures - Intensive Care

  25. Residency ProgramProcedures - Pain Treatment

  26. 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.

  27. 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.

  28. 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

  29. Lithuania 10-11 May, 2003 Referendum about the membership in European Union 64 % came to vote. 90 % said yes.

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

  31. Lithuanian Statistics - Number of Births (1998-2004)

  32. Lithuanian Statistics - Number of Physicians 2005 2nd Baltic Conference of Health Care Policy, September 30th , 2005

  33. Lithuanian Statistics - Number of Physicians in Lithuania 2015 Shortage of physicians - 1000 2nd Baltic Conference of Health Care Policy September 30th , 2005

  34. 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

  35. 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

  36. 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

  37. 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”.

  38. 29% 12 % 28 % 31 % Inhalation Anaesthesia Agents

  39. 74 % 15 % 7 % 4 % Intravenous Anaesthesia Agents

  40. Opioids

  41. 39 % 26% 21 % 11 % 3 % Muscle Relaxants 39 % 26%

  42. 16 % 47 % 37 % Local Anaesthethics

  43. Anaesthesia Machines • Less than10 years 57%

  44. Anaesthesia Machines • More than 10 years 43%

  45. Artificial Ventilation Equipment in ICU Less than 10 years 64 % More than 10 years 35 %

  46. Yearly Maintenance of the Equipment Performed in departments 89 %

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