Modern Anesthesia

High performance anesthesia teams are a mandatory component of modern perioperative medicine. Continuous development of new technologies and improving access to advanced equipment makes the specialty of anesthesiology a high-tech area requiring specialists with sophisticated knowledge not only in medicine but also in the management of novel devices and approaches. However, pronounced fluctuations of the availability and skills of anesthesiology staff are observed worldwide. Anesthesia teams adequately trained to deal with complex surgical and perioperative issues are specifically lacking. The department of Anesthesiology of the Lithuanian University of Health Sciences unites a large multidisciplinary team of specialists who are not only experienced clinicians and respected scientists in their fields of expertise, but also teachers willing to share their knowledge both at the national and international level. We are looking forward to the collaboration with foreign scientific and healthcare institutions. We strongly believe that our training would improve qualification of the participants, reduce inequalities in clinical and technological expertise, and will encourage efficient collaboration of interdisciplinary teams involving different specialties of physicians, nursing specialists, medical engineers, and technicians. Updated clinical and technological knowledge, advanced multidisciplinary approach, effective teamwork, and patient oriented care would ultimately lead to improved patient outcomes.

QUALIFICATION IMPROVEMENT PROGRAMME

High Performance Anesthesia Teams in Perioperative Medicine. Anesthesia in General, Cardiac, Thoracic, Neuro, Obstetric, Pediatric, and Transplant Surgery

Course details
Organizer: Department of Anesthesiology, Lithuanian University of Health Sciences
Available modules:

Perioperative blood management; Anesthesia for general surgery; Cardiac anesthesia; Thoracic anesthesia; Neuroanesthesia; Anesthesia, analgesia and critical care in obstetrics; Principles of pediatric and neonatal anesthesia; Anesthesia for transplant surgery; Acute postoperative pain management; Rapid ultrasound protocols for anesthesiologists and intensive care specialists.

Duration:

2 weeks total (upon request, several modules may be combined within the period)

Target audience:

multidisciplinary teams including doctors, nurses, and administrators

Award:

Certificate of achievement

Language:

English (additional explanations may be presented in Russian if necessary)


Perioperative Blood Management

Despite improving surgical techniques, development of minimally invasive approaches and technological advancements, severe perioperative bleeding remains one of the major complications associated with increased patient morbidity and mortality.
Deep understanding of hemostatic physiology and awareness of the fundamental concepts of patient blood management are essential for the multidisciplinary team to provide high quality care to the patient undergoing surgery. Effective communication and collaboration between the surgical and anesthesia teams is specifically important. Strategic application of basic and advanced approaches directed at the management of anemia, optimization of hemostatic function, minimizing blood loss and transfusions may lead to better patient outcomes.
Participants of the course will be provided with up-to-date knowledge on perioperative blood management in general, trauma, cardiac and neurosurgery. The problems of hemodilution, hypothermia, acidosis, hyperfibrinolysis, deficiencies of coagulation factors and substrates, will be addressed. Latest developments in the diagnosis and treatment of coagulopathies will be discussed. Specific attention will be directed at the sharing of experience and insights in the practical environment during operating room visits.

Primary course structure:

• Primary and secondary hemostasis: physiology and clinical considerations
• Current approach to perioperative assessment of patient hemostatic function
• Preoperative preparation in anticipation of severe surgical bleeding
• Major bleeding in trauma
• Bleeding in cardiac surgery
• Bleeding in neurosurgery
• Perioperative management of patients on antiplatelet and anticoagulant agents
• Thrombosis prophylaxis in the perioperative period

Anesthesia for General Surgery

Anesthesia for general surgery is a very broad specialty ranging from anesthesia for minor procedures (e.g., hemorrhoidectomy) to anesthesia for major abdominal surgeries (e.g., Whipple procedure, liver resection, esophagectomy, HIPEC). Despite the wide range of procedures performed in general surgery excellent anesthesiology care must be provided for every patient what requires anesthesiologists with broad competencies, deep knowledge, and outstanding practical skills. Moreover, patients undergoing various general surgeries often have multiple comorbidities interfering with anesthesia course which should be managed accordingly.
Numerous procedures are performed in General surgery department: approximately 3172 elective and 1492 urgent surgeries per year majority of them for complicated and difficult patients. Having such a large patient inflow, anesthesiologists in our center must always be ready to face various challenges in operating theatre: massive bleeding, polytrauma, difficult airway management, anaphylaxis and in rare cases even malignant hyperthermia. Being involved in such a team is a rewarding experience resulting in increased knowledge and skills for both elective and urgent surgeries.
Fellows of the course will be able to work together with general surgery anesthesia team providing services for the whole perioperative period involving preoperative assessment, anesthesia, and post-anesthesia care for wide range of surgeries including bariatric, endocrine, and other types of surgeries mentioned above. Most of the anesthesiologists working in general surgery department are also teachers and tutors willing to share and spread their knowledge with other colleagues, trainees and fellows allowing them to grow their knowledge and increase their proficiency in anesthesiology.

Primary course structure:

• Didactic lectures on preoperative assessment, preparation for anesthesia and preoperative evaluation for patients undergoing non-cardiac surgeries
• Anesthesia for general surgery (bariatric, endocrine, hepatopancreatoblliary, colorectal etc.)
• Early postoperative care and management
• Basic considerations for various urgent surgeries
• Crisis in operating theater. Facing an unanticipated challenge during anesthesia  

Cardiac Anesthesia

Cardiovascular disease (CVDs) is our society’s biggest health problem. According to World Health Organization data from 2019, an estimated 17.9 million people died from CVDs in the world. While this type of diseases is often successfully treated through medication, frequently surgery is required to ensure a healthy and functioning heart.
In our department surgeons perform more than 800 cardiac surgeries each year. Cardiac surgery requires precise attention to detail to ensure the best possible surgical result and to maximally reduce the patient’s risk for morbidity and mortality during surgery and the postoperative period. Decision-making in the perioperative period involves close communication among all anesthesia members of the team: anesthesiologist, anesthesia nurses and trainees.
Fellows will be part of our anesthesia team. Our program will provide a solid clinical and theoretical experience to fellows in the perioperative management of patients undergoing a variety of complex cardiac procedures and anesthesia: coronary artery bypass surgery (CABG) on cardiopulmonary bypass, heart valve surgery, aortic reconstruction requiring deep hypothermic arrest, thoracic aortic aneurysm/dissection repair, implantation of ventricular assist devices. Fellows will be trained to achieve expertise in the advanced monitoring techniques and invasive procedures, including invasive blood and central venous pressure measurements, cardiac output monitoring, arterial blood gas analysis, central venous oxygen saturation, neuromonitoring and many others.

Primary course structure:

• General preoperative considerations and preparation of the patient for cardiac surgery
• Cardiac anesthesia: cardiopulmonary bypass and myocardial protection
• Anesthesia management for thoracic aorta surgery
• Anesthesia management for percutaneous heart valve replacement/repair
• Devices for cardiac support and replacement

Thoracic Anesthesia

The goal of this fellowship is to encourage knowledge and practice skill in the perioperative care of thoracic surgical patients. Our focus is on presenting principles important to adult clinical management in the operating room. Our department performs around 200 thoracic operations per year which includes open thoracotomies, video – assisted thoracoscopic surgery (VATS) and tracheal surgery.
During this course fellows gain experience in perioperative anesthetic management of thoracic patient, including management of physiological changes in the lateral position, intraoperative monitoring of oxygenation and capnometry, invasive hemodynamic, one-lung ventilation and alternative ventilation methods. Fellows also will be trained to achieve expertise in different techniques of lung ventilation and isolation (single-lung ventilation), including the use of endobronchial blockers, double-lumen endotracheal tubes, fiberoptic bronchoscopy.
Following completion of the program, fellows will have the knowledge and technical skills and clinical experience to safely provide anesthesia care for patients undergoing a thoracic surgery.

Primary course structure:

• Management of the airways. One lung ventilation
• Principles of fiberoptic bronchoscopy
• Anesthetic management and perioperative monitoring for surgery of the lungs and mediastinum
• Postoperative care, including analgesia, sedation, ventilation
• Perioperative neurological complications

Neuroanesthesia

Our hospital is a tertiary neurosurgical center of national relevance equipped with advanced technologies including intraoperative electromagnetic surgical navigation systems and gamma knife. The department of Neuroanesthesia provides anesthesiological care to the patients undergoing urgent and elective neurosurgical or neuroradiological procedures irrespective of their age – from neonates to the elderly.
Successful management of the most complex neurosurgical cases requires careful planning and close collaboration between the anesthesia and surgical teams. Participants of this course will have the opportunity to gain insights into the organizational aspects and case consideration principles between the anesthesiologists and neurosurgeons regarding surgical and anesthesiological equipment placement in the operating room, patient positioning, surgical and anesthesia risk assessment. The problem of the limited access to the patient during neurosurgical and neuroradiological procedures will also be addressed.
Our fellows will be encouraged to visit neurosurgical operating rooms to gain experience in perioperative anesthetic management of the neurosurgical patients with different pathologies including traumatic brain injury, brain tumors, neurovascular disease, spinal pathology, and congenital abnormalities of the central nervous system. Hemodynamic monitoring and management in different clinical scenarios as well as anesthesiological approach to neurosurgical emergencies will be presented through the management of real cases.

Primary course structure:

• Anesthesia in urgent neurosurgery. Intracranial hypertension. Neurotrauma
• Anesthesia in brain tumor and neurovascular surgery
• Anesthesia in spinal neurosurgery
• Anesthesia for neonatal and pediatric neurosurgical procedures
• Anesthesia outside the operating room for advanced neuroradiological procedures including MRI, gamma knife, percutaneous neurovascular interventions

Anesthesia, analgesia and critical care in obstetrics

The purpose of this module is to overview modern anesthesia, analgesia and critical care in obstetrics. Our fellows will discuss the main physiologic and anatomic changes of pregnancy and their anesthetic considerations. Physiology of labor pain and its pathways will be presented and all recently available methods of labor analgesia (systemic and regional) with their advantages and disadvantages will be discussed.
Next topic will cover regional and general anesthesia methods for elective and emergency cesarean delivery: risk factors, anesthetic considerations, scientific evidence on the management of hypotension and uterotonic drug (oxytocin, prostaglandins and methergine) dosage. Exceptional attention will be paid at the possible adverse events and complications during cesarean delivery and prompt management of them.
Recent developments regarding obstetric bleeding and hemorrhagic shock will be discussed in detail with participants, including anesthetic and surgical management. Evidence-based strategy of infusion and transfusion therapy will be presented. Diagnosis and management of coagulopathy including TEG / ROTEM and treatment with concentrated coagulation factors will be discussed as well. Advances in the understanding of amniotic fluid embolism will be presented separately. Recommendations of the European Resuscitation Council on pregnant patient care will be discussed in detail with our fellows.
Latest news in hypertensive disorders of pregnancy, particularly preeclampsia, eclampsia and HELLP syndrome, will be presented: definition, pathophysiology, clinical manifestation, laboratory changes, treatment options and optimal timing of delivery.

Primary course structure:

• Anonymous pre-test on obstetric anesthesia and critical care at the beginning of the course
• Morning discussion on emergency cases of the night shift
• Everyday work in operating theatres and delivery wards
• Lectures and seminars with case scenario analysis
• Discussion on “real-life cases” in operating theatres and delivery suits
• Case presentations and original movie reviews of anesthetic procedures
• Anonymous post-test on obstetric anesthesia and critical care at the end of the course
• Evaluation of knowledge improvement. Certificates of attendance

Principles of Pediatric and Neonatal Anesthesia

Anesthesiology is one of the leading medical specialties in patient safety. Pediatric anesthesiology is inherently higher risk than adult anesthesia due to differences in the physiology in children. The neonate has unique requirements for equipment, fluid and drug therapy, anesthetic dosage, and environmental control. Children younger than 1 year of age have a more frequent incidence of complications than older children. These complications primarily relate to oxygenation, ventilation, airway management, and response to anesthetic medications. An understanding of the basic differences in physiology and pharmacology, and an understanding of the common comorbidities and the underlying pathologic surgical problem is essential for the development of a safe anesthesia plan. Anesthesiological team must always ensure there is thorough preoperative preparation, appropriate monitoring, the proper size, and variety of equipment available, and obtain the most intense level of support, both in the operating room and in the non-operating room locations.
Pediatric anesthesiologists of our hospital provide specialized anesthetic care in pediatric, neonatal operating rooms and non-operating room locations. The goal of this program is to share the best practice, to provide a comprehensive, up-to-date, and current research review of the most important changes and advances relevant to the practice of pediatric and neonatal anesthesia

Primary course structure:

• Approach to the pediatric patient, clinical and operational aspects of pediatric anesthesia
• Pediatric anesthesia safety topics
• Pediatric trauma management and perioperative bleeding management
• Ultrasound-guided regional anesthesia and vascular access
• Emerging challenges around the globe, the pearls of neonatal anesthesia

Transplant Anesthesia

Transplant anesthesia is a very sophisticated part of anesthesiology requiring highly experienced anesthesia team containing of high-class anesthesiologists, anesthesia nurses working together with experienced surgical, gastroenterological, and intensive care team. Our center is leading transplant center out of two centers in Lithuania performing up to 16 orthotopic liver transplantations and up to 50 kidney transplants per year from both living, brain dead (DBD) and non-heart beating (DCD) donors.
During this course the fellows will be part of transplant anesthesia team working together in preparation for transplantation, preoperative evaluation of recipient and during the process of the whole surgery and early postoperative period. Every part of transplantation process requires not only deep knowledge and good theoretical background but also clinical experience and excellent practical skills. Moreover, every transplantation is a teamwork between different parts of anesthesia team, anesthesia and surgical team, operating theater team and ICU team. Combining all those competencies and skills lets our team achieve our goals and have good patient outcomes in the end of the treatment. Organ harvesting is also an integral part of the transplantation process which will be included in the program accordingly.
Fellows of the course will be provided with up-to-date knowledge on anesthesia for both liver and kidney transplant surgeries, proper preparation for the surgeries and equipment requirements for successful process. After completion of the program fellows will have basic knowledge about the transplantation process.

Primary course structure:

• Preoperative evaluation and preparation of the kidney transplant recipient
• Preoperative evaluation and preparation of the liver transplant recipient
• Preparation and the basic equipment for kidney transplant surgery
• Preparation and the basic equipment for liver transplant surgery
• Anesthesia for kidney transplant surgery
• Anesthesia for liver transplant surgery
• Early postoperative period and management of kidney transplant recipient
• Early postoperative period and management of liver transplant recipient
• Organ harvesting form DBD, DCD and living donors

Acute Postoperative Pain Management

Postoperative pain is still a major medical challenge. Almost 20% of patients experience severe pain within the first 24 hours post-surgery. Adequate perioperative pain management is integral to patient care and outcomes. Effective and proper management of acute postoperative pain leads to earlier mobilization, increased patient satisfaction, shortened hospital stay and reduced hospital costs.
The goal of this program is to share best practices in acute pain management using multimodal analgesic, regional anesthetic (central and perineural), ultrasound-guided regional anesthetic and infiltrative techniques. During this course we will discuss a multimodal approach of acute postoperative pain management which we believe will lead to better understanding of the acute pain problem and its long-term consequences. Course participants will learn which parameters should be reviewed as part of a pre-operative pain assessment while planning a pain management strategy before the surgery. After this course participants will learn detailed insight in all treatment modalities which are used in treatment of postoperative pain. We encourage not only doctors but also nursing specialists to join this course as postoperative nursing care is no less important while coping with this medical challenge.
We believe that multidisciplinary approach is particularly important to achieve enhanced recovery post-surgery. We will introduce a multimodal perioperative care pathway which is designed to achieve early recovery for patients post major surgery. We hope that shared qualifications with all involved in perioperative care will lead to better understanding of acute postoperative pain problem and will help them to work as a well-coordinated team to provide the best care for the patients.

Primary course structure:

• Systemic analgesia (pharmacology)
• Regional anesthesia (procedure-related pain relief)
• Organizational aspects of acute pain management
• Acute postoperative pain
• Rapid Recovery Program

Rapid Ultrasound Protocols for Anesthesiologists and Intensive Care Specialists

Point-of-care ultrasonography is a rapidly expanding diagnostic tool in anesthesiology, emergency, and intensive care medicine. Bed-side ultrasound helps to evaluate the cause of patient’s condition deterioration. Each of these rapid ultrasound protocols combine many of the same core ultrasound elements, differing mainly in the priority of the exam sequence according to a clinical situation. We believe that rapid ultrasound protocols are easy to learn, frequently used in emergency situations, and can be lifesaving. This course will include focused assessed transthoracic echocardiography for non-cardiologist (FATE protocol), lung ultrasound (BLUE protocol), rapid ultrasound in shock (RUSH protocol), focused assessment with sonography for trauma (FAST protocol). The fellow will also be presented with the principles and basic hands-on training of transesophageal echocardiography (TEE). TEE findings pre- and post- cardiopulmonary bypass will be discussed.
Teaching rapid ultrasound protocols to novice learners improves their diagnostic skills, confidence, and clinical decision-making when dealing with critically ill patients. Bedside ultrasound is shown to decrease complications and improve success rates for many common critical care procedures.

Primary course structure:

• Didactic sessions on physics (terminology, knobology, image acquisition, artifacts, etc.)
• Focused assessed transthoracic echocardiography for non-cardiologist (FATE)
• Lung ultrasound (BLUE)
• Trauma exam (FAST)
• Normal anatomical structures (ultrasound images)
• Abnormal findings
• Practical session for rapid ultrasound protocols
• Perioperative transesophageal echocardiography (TEE)

MORE INFORMATION AND TRAINEESHIP INQUIRIES

International Relations and Study Centre

+370 37 327 259

traineeship@lsmuni.lt