Anaesthesiology and Intensive Care in Lithuania. Prof. Juozas Ivaškevičius

Transcription

1 Anaesthesiology and Intensive Care in Lithuania Prof. Juozas Ivaškevičius

2 Historical facts Present situation Education and trainig The future

3 VILNIUS L.Lechavičius ( ) W.T.G.Morton 16 th October, rd February,1847 Ether anaesthesia J.V.Simpson 10 th November, st December, 1847 Chloroform anaesthesia

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

5 William Stewart Halsted, 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 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 hospitals Kaunas Medical University Clinics Vilnius University Hospital Santariškių Clinics

10 Number of Departments in Lithuania hospitals Anaesthesia departments Intensive care departments 76 79

11 Number of Anaesthesias Total number General anaesthesia (70 %) Regional and local anaesthesia (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: anaesthesias, ICU pts.

14 Development of Anaesthesiology and Intensive Care in Kaunas Medical University Number of anaesthesias , ICU pts.

15 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.

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 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 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

21 Residency Program 176 credits Subject Credits Resuscitation and basics of intensive care 16 Intensive care in abdominal surgery 16 Neonatal and pediatric intensive care 4 Intensive care after cardiac surgery 4 Intensive care in cardiology 2 Intensive care in toxicology 2 Total for intensive care 44

22 Residency Program Procedures Anaesthesiology Procedures Minimum number of procedures Lithuania Recommended UEMS General anaesthesia Spinal anaesthesia Epidural anesthesia Nerve and plexus blocks Total number of anaesthesias

23 Residency Program Procedures - Anaesthesiology Procedures Minimum number of procedures Lithuania Recommended UEMS Pediatric patients, age < 5 years Pediatric patients, age < 1year Obstetrics, S.Caesarea Epidural for delivery Thoracic Neurosurgery Urology Odontology, head and neck surgery Orthopaedic endoprostheses Day case surgery Vascular 10 10

24 Residency Program Procedures - Intensive Care Minimum Procedures number of Recommended procedures UEMS Lithuania Minimum number pf patients in ICU Pediatric patients, age < 5 years 3 3 Pediatric patients, age < 1year 2 2 Respiratory disorder 3 3 Cardiovascular disorder 10 2 CNS problems 2 2 Sepsis 4 2 Renal failure 4 1 Transport of critically ill patients 5 5 Resuscitation 5 5

25 Residency Program Procedures - Pain Treatment Procedures Minimum number of patients in pain treatment Minimum number of procedures Lithuania Recommended UEMS Pediatric patients 5 5 Major surgery Thoracic surgery 5 5 Major orthopedic surgery 5 5 Day-case surgery Chronic pain 20

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 May, 2003 Referendum about the membership in European Union 64 % came to vote. 90 % said yes.

30 Lithuanian Statistics - Inhabitants (thousands) ( ) ,3 3524,2 3499, ,3 3469,1 3454,2 3452,

31 Lithuanian Statistics - Number of Births ( )

32 Lithuanian Statistics - Number of Physicians Country 2005 Number of physicians per population Lithuania 390 European Union 340 UK nd Baltic Conference of Health Care Policy, September 30 th, 2005

33 Lithuanian Statistics - Number of Physicians in Lithuania 2015 Country Number of physicians per population Lithuania 313 Shortage of physicians nd Baltic Conference of Health Care Policy September 30 th, 2005

34 Reasons of Shortage of Physicians in Lithuania, 2015 Emigration Age Other reasons Critical areas: Anaesthesiology and intensive care Gynecology, obstetrics Ophthalmology 2 nd Baltic Conference of Health Care Policy September 30 th, 2005

35 Number Anaesthesiologists in Lithuania Year Year (all licensed) Year (all licensed) Lithuanian Society of Anaesthesiology and Intensive Care Year members Year 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 2 nd Baltic Conference of Health Care Policy, September 30 th, 2005

37 Number Anaesthesiologists in Lithuania Enough according to WSFA recommendations 1,9 per 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 Inhalation Anaesthesia Agents N2O 29% Sevoflurane Izoflurane Halothane 12 % 28 % 31 % N2O Sevoflurane Izoflurane Halothane

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43 Intravenous Anaesthesia Agents % % 4 % 7 % Thiopental Propofol Ethomidate Others 0 Thiopental Propofol Ethomidate Others

44 Opioids Fentanil 91 % Remifentanil 0,1 % Morphine 6 %

45 Muscle Relaxants % 39 26% 26% 21 % 11 % 3 % 1 Sux Atracurium Cisatracurium Mivacurium Pipecuronium

46 Local Anaesthethics 16 % 47 % Lidocaine Bupivacaine Other 37 %

47 Anaesthesia Machines Less than 10 years 57%

48 Anaesthesia Machines More than 10 years 43%

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

50 Yearly Maintenance of the Equipment Performed in departments 89 %

51 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

52 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

53 Health Expenditures as % of GDP (2004) , ,7 5,3 0 USA Germany England Lithuania

54 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

55 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

56 Number of ICU Patients Number of patients in the ICU Mortality in the ICU 6,4 %

57 Number of ICU Patients % 36% 11% 6% ICU I - 1 ICU I - 2 ICU II ICU III ICU I - 1 ICU I - 2 ICU II ICU III

58 Valuation for ICU Service in Lithuania Level Hours Cost EUR I - I (recovery room) I - II (primary ICU) 24 hours 60,40 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

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