Department of Anaesthesiology
Aims of the Clinic of Anasthesiology:
- To prepare highly qualified specialists in anesthesiology and develop traditional and new teaching methods
- To improve the quality of health care services through successful implementation of the latest diagnostic and treatment technologies in order to provide more scientific evidence-based medical services.
Objectives of the Clinic of Anaesthesiology:
- Organise and conduct studies and research;
- Develop study plans and study programmes as well as subjects and specialisations plans;
- Compile hardware and software necessary for research and studies;
- Prepare textbooks, scientific articles, books and other teaching and learning instruments;
- Ensure that qualifications of regular academic and research staff comply with new requirements of the university;
- Ensure quality of anaesthesiology training programmes and its compliance with the European Union and the national quality criteria.
- Participate in the provision of high quality health care services and in the introduction of new diagnostic and treatment methods.
Development of anesthesiology in LSMU:
In 1946, the Department of Surgery (with two sections) was established. Jaržemskas became the head of the Department. Liesytė, nurse of the surgical unit, performed an open mask ether anaesthesia from 1947. During this period, most of the surgeries were performed using the local infiltrative anaesthesia. On 06 May 1955, V. Mikalauskas performed the first finger control endotracheal intubation (without a laryngoscope). On 01 February 1958, the Ministry of Health ordered to establish the position of an anaesthetist in the clinics, and J. Gumauskas became the first anaesthesiologist. He was also the first to use manually assisted ventilation with automatic respirator SP-2. Manually assisted ventilation led to the development of endotracheal anaesthesia. During 1958-1961, urgent and major operations were performed using general anaesthesia with intubation and manually assisted ventilation. Such anaesthetics as ether, N2O, thiopental, and muscle relaxants (diplacine, tubocurarine) were used. In 1962, the Department of Anaesthesiology was established (head of the Department J. Gumauskas) and seven anaesthesiologists worked there. In 1966, the Clinic of Cardiosurgery had the first post-graduate students (Irena Marchertienė, Zenonas Dulevičius) in anaesthesiology (coordinator J. Brėdikis), who contributed to the development of anaesthesiology science. In 1975, the Department of Anaesthesiology - Intensive Care (head prof. A. Lukoševičiūtė in 1975-1997) was established. In 1997, the Clinics of Anaesthesiology, consisting of Central, Neurosurgery, Obstetrics-Gynaecology and Anaesthesiology Departments, was established. The new anaesthesia and postoperative pain management techniques were gradually introduced in the Clinics of Anaesthesiology and, as a result, the number of performed anaesthesia procedures was steadily increasing.
Currently, the Clinic of Anaesthesiology contains three sections:
- Central Anaesthesiology (head M.Dr. Darius Trepenaitis);
- Obstetrics and Gynaecology, Anaesthesiology and Intensive Care (head assoc. prof. Kęstutis Rimaitis);
- Neurosurgical Anaesthesiology (head assoc. prof Diana Bilskienė).
The structure of the Central Department of Anaesthesiology was gradually expanding in order to effectively apply the anaesthetic support before and after surgical intervention. In October 2002, the Pain Treatment division was opened. In December 2005, the postoperative intensive care unit (with 12 beds in it) was opened. Since December 2005, the structure of the Clinic of Anesthesiology was expanded by the section of anaesthesiology of the Oncology Hospital, Kaunas branch (head Irina Semakina). In 2009, the Clinic of Anaesthesiology employed 73 doctors, anaesthesiologists and resuscitators as well as 122 nurses of anesthesia and intensive care. The administrators – Inga Tamošiūnienė, Aušra Geivelienė and Ingrida Bielskienė – coordinate the work in the clinics.
Studies and research
The Clinic of Anaesthesiology is a training base at LSMU, providing all the study cycles: continuous, postgraduate residency studies, 3rd cycle (doctoral) studies and refresher courses of professional medical qualification.
Students from different courses and various faculties study in our clinics:
- Undergraduate students (the 5th year) from the Faculty of Medicine study anaesthetics (study coordinators assoc. prof. Danguolė-Česlava Rugytė and assoc. prof. Bilskienė Diana)
- 2nd and 4th year students from the Faculty of Nursing study anaesthetics (study coordinators assist. Laima Juozapavičienė and assist. Milda Švagždienė)
- 3rd year students from the Faculty of Dentistry study anaesthesiology and resuscitation (study coordinator assoc. prof. Jūratė Gudaitytė).
- Student Society of Anesthesiology (coordinator assoc. prof. Jūratė Gudaitytė).
- 3rd year students from the Faculty of Nursing study obstetrics care (coordinator assoc.ptof. Kęstutis Rimaitis)
During the studies, students are introduced to the concept of general anaesthesia, the main modern methods of anaesthesia, pain physiology and pathophysiology as well as pain-relieving drugs in clinical pharmacology. Students, seeking for deeper practical and scientific knowledge of anaesthesiology, can attend the Student Society of Anesthesiology. Approximately from 45 to 48 doctors-residents of Anaesthesiology and Intensive Care study in the Clinic. In the Clinic of Anaesthesiology, residents become familiar with basic common and regional anaesthesia techniques and learn how to safely anesthetise patients before they undergo surgery because of various surgical pathologies. During the residency time, residents must independently perform from 450 to 500 different types of anaesthesia. Doctors anaesthesiologists-resuscitators, working in the Clinic of Anaesthesiology, are involved in residents’ trainings. A. Macas is a coordinator of residents. The lecturers of the Clinic of Anaesthesiology are supervisors of residents.
The Clinic has 8 doctorals students, who do research on:
- Acute burn pain treatment optimisation (doctoral student Laima Juozapavičienė)
- Preoperative sedation in maxillofacial surgery in children (doctoral student Lina Kalibatienė);
- Post-operative pain relief methods and influence of acute and chronic pain in early knee function after a full knee replacement surgery (doctoral student Janis Zinkus);
- Use of different concentrations of bupivacaine and levobupivakaino on epidural labor pain relief effectiveness (doctoral student Vilda Baliulienė);
- Biochemical markers and haemodynamic parameters: comparison of predicted outcomes in acute heart failure (doctoral student Linas Pėteris);
- Neonatal and infant brain oxymetry and changes in nerve cell damage markers in perioperative period (doctoral student Ilona Šuškevičienė);
- Circulatory changes in patients on anorectal surgical pathology small doses of local anaesthetic spinal anaesthesia litotomic or jack-knife position (doctoral Jurgita Borodičienė);
- Children after thoracic operations in systemic and regional analgesia technique rating (doctoral student Laura Lukošienė).
Doctors and doctoral students of the Clinic are actively involved in research. They write articles for various scientific journals, give presentations in various international conferences and prepare medical qualification courses.
The Clinic of Anaesthesiology has the following refresher courses for doctors anesthesiologists-resuscitators:
• KMU403 Inhaliation anaesthesia
• KMU029 Regional anaesthesia
• KMU030 Urgent anaesthesiology
• KMU473 The neuromuscular blockade: current clinical practice and perspectives
• KMU482 Anesthesiology innovations
• KMU483 General anaesthesia innovations
• KMU484 Anaesthetic monitoring news and developments
• KMU485 Selected perioperative medical issues (outgoing)
• KMU568 The European Society of Anesthesiologists (National Education Committee) courses on neuroanaesthesia, regional anaesthesia and pain medicine
• KMU569 Inhaled anaesthetic and respiratory support measures and innovation by medical simulation
• KMU026 Obstetric anaesthesiology
• KMU027 Attendant pathology and anaesthesia
• KMU570 Child anaesthesia and postoperative pain relief
• KMU623 Difficult airway management using medical simulation
• KMU616 inhaled anaesthetic and respiratory support measures and innovation by medical simulation.
• KMU674 The European Society of Anesthesiologists (Educational Committee) Courses on cardiovascular system. Cardiovascular Anesthesiology, Intensive Care Ultrasonography: Fundamentals of Lithuanian University of Health Sciences
In the Clinic of Anaesthesiology, the Lithuanian Regional Center of Committee for European Education in Anaesthesiology is established. It organises all programmes approved by the European Society of Anaesthesiology and contributes to the organisation of the Baltic States Congress. On 26 June 2012, the Simulation Centre of the Clinic of Anaesthesiology (head Arūnas Gelmanas) was established by the decision of the Senate. The Clinic of Anaesthesiology cooperates with Queen’s Hospital in London, Ghent University Hospital and Danish Institute for Medical Simulation since 2011-2012. Regarding this cooperation, our doctors and residents have an opportunity to go for a traineeship abroad.
Central Department of Anaesthesiology provides services for nine surgery units (General Surgery, Coloproctology, Paediatric, Ophthalmology, Otorhinolaryngology, Urology and Brachytherapy, Orthopaedics and Traumatology, Plastic and Reconstructive Surgery). In addition, the Department also provides anaesthesia services to patients who require services in invasive radiology, radiation oncology, bronchoscopy, endoscopy, MRI and CT scan. In the chronic pain clinic, professionals work together to provide care for individuals with chronic and cancer-related pain. They focus on the early interventional approach to pain management to minimise the development of chronic/disabling pain. There are 48 anaesthesiologists-intensive care doctors, 76 nurses of anaesthesia and intensive care and 10 support staff working in the Department. Anaesthesia is performed with modern anaesthetics. We also use modern monitoring such as the depth of anaesthesia with entropy, myorelaxation controlled using a muscle stimulator. In our clinic, central regional anaesthesia and peripheral nerve blockade are widely used. Since 2005, the Central Department of Anaesthesiology opened a postoperative care unit with 21 acute care beds (intensive care RI-1, RII), where anaesthesiology services are provided 24 hours a day, 7 days a week. The postoperative clinic provides an acute pain service including PCA and epidural infusions and symptom relief to post-surgical patients using safe, effective and innovative therapies to ensure the patient’s maximum comfort level. With expanding surgical profiles, specialised anaesthesiological methods were in parallel improved in liver and kidney transplantations, tracheal and bronchial, radical reconstructive urological and proctological, joint arthroplasty and microsurgery operations. Over the years, through various anaesthesia techniques, more than 30,000 anaesthesia procedures were performed in infants, children and adults.
Obstetrics-Gynaecology Department of Anesthesiology provides specialised anaesthesiology service (general or regional anaesthesia) for patients with gynaecological diseases and at childbirth. The choice of anaesthesia is an individualised decision for each woman; many cesarean sections are performed under regional anaesthesia, so mothers can be conscious to see their babies immediately after birth. Epidural analgesia or other modern methods of analgesia are applied during the labor and delivery process. We have Obstetric-Gynaecology Intensive Care unit where patients after gynaecological and cesarean sections are observed, cared for and treated. Treatment of pregnant women with pre-eclampsia or eclampsia is also available.
Neurosurgical anaesthesiology unit provides care for neurosurgical and mixed trauma patients, including management of patients undergoing cerebrovascular surgery, benign and malignant intracranial tumours, stereotactic procedures, spinal surgery, epilepsy surgery, evacuation of cerebral hematomas, complex spinal surgery and others. Doctors of the Department work in 8 surgery rooms and auxiliary rooms.
Doctors of the Department of Neurosurgica' Anaesthesiology apply a variety of general and regional anaesthesia techniques in patients of different age groups, including infants and elderly patients. Many of our doctors in this Department are subspecialty trained in neurological anaesthesiology and provide innovative care to our patients who undergo neurosurgical procedures. In this area, the knowledge of neurological anatomy, cerebral physiology, effects of anaesthetic agents on cerebral pathophysiology, neurological monitoring and management of intracranial hypertension and cerebral edema is needed. Specialised anesthesiological service is ensured 24 hours a day.