Anesteesia ja intensiivravi Eestis 2007.aastal

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1 Anesteesia ja intensiivravi Eestis 27.aastal Joel Starkopf Pühajärve a. Aruande esitasid 26 raviasutust 37 osakonda (puudu Läänemaa ja Hiiumaa) 1

2 Aruannete esitamisest Elektrooniline vorm Anesteesia kaartide koopiad Anestesioloogid Eestis Meditsiiniteaduste doktorid 27.a. Juri Karjagin The pharmacokinetics of metronidazole and meropenem in septic shock: a microdialysis study Inga Karu Ischaemia-reperfusion injury of the heart during coronary surgery: a clinical study investigating the effect of hyperoxia 2

3 Anestesioloogid Eestis Tervishoiuameti register: 25.a. 275 anestesioloogi 26.a. 27.a. 28 anestesioloogi 282 anestesioloogi EAS liikmeid 27.a. 191 Anestesioloogid Eestis Tervishoiuameti register: 25.a. 275 anestesioloogi 26.a. 28 anestesioloogi 27.a. 282 anestesioloogi EAS liikmeid: 27.a. 191 Pädevuse hindamine a. : 121 avaldust 113 pädevus viieks aastaks 5 pädevus 2-3 aastaks 3 ei saanud pädevustunnistust 3

4 Anestesioloogid Eestis Tervishoiuameti register: 27.a. 282 anestesioloogi Dokumendid väljavõtnud tervishoiutöötajate arv: Tervishoiuameti poolt väljastatud eriala tõendav sertifikaat ja juurdekuuluv, mis võimaldavad Eestis registreeritud tervishoiutöötajal kasutada tervishoiutöötajate vaba liikumise õigust 25.a. 41 (15 %) 26.a. 45 (16 %) 27.a. 47 (17 %) Dokumentide väljavõtmise aeg Kokku Osakaal aastate lõikes 24 I kvartal 9 1% 24 I kvartal % 24 III kvartal 15 14% 24 IV kvartal % 25 I kvartal 78 7% 25 II kvartal 65 6% 25 III kvartal 78 7% 25 IV kvartal 58 5% 26 I kvartal 37 3% 26 II kvartal 44 4% 26 III kvartal 74 7% 26 IV kvartal 4 4% 27 I kvartal 33 3% 27 II kvartal 58 5% 27 III kvartal 57 5% 27 IV kvartal 34 3% Kokku

5 C. B. Egger Halbeis, K. Cvachovec, P. Scherpereel, J. Mellin-Olsen, L. Drobnik and A. Sondore. Anaesthesia workforce in Europe. European Journal of Anaesthesiology (27), 24: METHODS: A questionnaire was sent to all national European anaesthesia societies. Countries were grouped according to their relationship with the European Union. RESULTS: The number of anaesthesiologists per 1, population varies between 2.7 (Turkey) and 2.7 (Estonia) Anaesthesia physician training lasts between 3 yr (Armenia, Belarus, Uzbekistan) and 7 yr (Ireland, UK), and seems to positively correlate with the number of trainees... The differences between European salaries for anaesthesiologists are up to 5-fold. Most Western European countries are recipients of migrating anaesthesiologists who often originate from the new member states of the European Union. CONCLUSIONS: Westward migration of anaesthesiologists from those countries with access to the European Union labour market may be explained by substantial salary differences. There is a European-wide lack of systematic, comparable data about the anaesthesia workforce, which makes it difficult to accurately assess the supply of anaesthesiologists. Anesteesiate üldarv Eestis

6 Piirkondlikud haiglad Keskhaiglad Üld- ja kohalikud haiglad Erahaiglad Piirkondlikud haiglad SA TÜK Üldanestesioloogia (1) Günek. anestesioloogia Onkoanestesioloogia Neuroanestesioloogia Laste intensiivravi SA PERH Anesteesiaüksus Hiiu korpus (onkoloogia) (2) Tallinna Lastehaigla (7) 6

7 Keskhaiglad Ida-Tallinna Keskhaigla (3) Lääne-Tallinna Keskhaigla (4) Pärnu Haigla Ida- Viru Keskhaigla (5) (1) Üld- ja kohalikud haiglad Narva Haigla (6) Rakvere Haigla Viljandi Haigla Järvamaa Haigla Kuressaare Haigla Põlva Haigla Lõuna-Eesti Haigla Rapla Haigla Valga Haigla Läänemaa Haigla

8 Erahaiglad AS Fertilitas Nõmme Erakliinik Taastava Kirurgia i Kliinikik (8) (9) OÜ Artroskoopia Elite Erakliinik Medisfäär Medex Erapolikliinik Balneom Clinica Stigma Ars Medica Kalmer Lepiku Hambaravi Anesteesia meetodid 8

9 Üldanesteesiad Endotr. Kõrimask Mask (tavaline) I/v Regionaalanesteesiad Sakraalblokaad IVRA Pl. brachialis Epiduraalanesteesia CSA CSE Spinaalanesteesia 9

10 Protseduurid 26.a. Epiduraalkateetri asetamine a a a Kahevalendikulise toruga Intub. bronhoskoobi abil Cell-saver Kehaväline vereringe Sünnitusabi anesteesia Sünnid (?) 1

11 Keisrilõike anesteesiad Sünnituse valutustamine Regionaal Üldanest Epiduraalanalgeesia Valukliinikud PERH TÜK ITKH Pärnu Lõuna-Eesti Rakvere Artroskoopia 11

12 Surmajuhtude analüüs 27 Operatsiooni ajal suri t jooksul suri Anaesthesia related death Edwards classification I. When it is reasonably certain that event/death was caused by the anaesthetic agent or the tehnique of administration or in other ways coming directly within the anaesthetist s province Anaesthesia as the primary cause of death II. III. IV. Similar cases, but in which there is some element of doubt as to whether the agent ot the tehnique was entirely responsible for the result. Cases in which the patient s event/death was caused by both the anesthetic and the surgical tehnique Events entirely referable to surgical tehnique Anaesthesia-related deaths 12

13 Tõsised anesteesia tüsistused Vereringeseiskused, edukalt taaselustatud Maliigne neuroleptiline sündroom? Anafülaktiline šokk Perioperatiivne müokardi infarkt Täiskasvanute intensiivravi 26 osakonda 13

14 Haigete arv Voodipäevad IIIa III Kokku 14

15 Regionaalhaiglad I II III IIIa Kokku PERH Intensiivravi Postop. IRO Hiiu korpus Sept. IRO TÜK AIK AIÜI AINE AIPU AION TÜK KARKIR Regionaalhaiglad I II III IIIa PERH SA TÜK 15

16 Keskhaiglad I II III IIIa ITKH LTKH Pärnu IVKH Keskhaiglad III ja IIIa Kokku 26.a. Ida-Tallinna Keskhaigla Lääne-Tallinna Keskhaigla Pärnu Haigla Ida-Viru Keskhaigla Rakvere Haigla

17 Üldhaiglad III aste Kokku Taastava Kir Kliinik ik 75 (369) Kuressaare Haigla 295 (33) 1 54 Narva Haigla 412 (9) Viljandi Haigla Lõuna-Eesti Haigla Järvamaa Haigla Letaalsus APACHE gruppides % PERH postop PERH IRO TÜK AIÜI TÜK AIPU TÜK AINE ITKH IVKH Narva Haigla 1 < >3 17

18 PERH postop PERH IRO TÜK AIÜI TÜK AIPU TÜK AINE ITKH < >3 PERH postop ITKH TÜK AIÜI TÜK AIPU < >3 Aasta Kuu Osak ondad e arv Pt arv keskm LOS LOS enne IR Ot LOS pärast IR Ot Keskm Keskm Keskm TIS S SAPS APACH E IR O letaals us Haigla letaalsus SMR Kõik SMR v.a. neuro ja karkir Haigla lõpe puudub Estonia Tartu University Hosp , 3,8 6,8 3,7 41,6 2,4 11,7 14,9,43,48 1 Estonia Tartu University Hosp ,4 1,2 9,6 31,9 47,3 23,4 17,8 2,,47,48 1 Estonia Tartu University Hosp ,8 1,1 7,5 33,4 47,6 22,5 16,8 2,,46,46 Estonia Tartu University Hosp ,7 1,8 6,7 3,8 47, 23,1 18,4 21,2,49,53 Estonia Tartu University Hosp ,8 2,1 5,3 28,8 41,8 2,4 13,8 16,2,46,49 2 Estonia Tartu University Hosp , 1, 6,5 33,5 49,7 23,9 15,6 23,5,49,5 1 Estonia Tartu University Hosp ,6 1,4 7,9 33,1 48,1 23,7 19,8 21,9,51,54 3 Estonia Tartu University Hosp ,6 1,4 6,3 32,9 46,7 23, 15,5 24,1,55,56 1 Estonia Tartu University Hosp ,3 1,5 6,8 32,4 46,6 22,3 19,8 24,7,62,68 7 Estonia Tartu University Hosp , 1,9 3,8 31,9 44,7 21,9 16,3 22,4,58,58 25 Estonia Tartu University Hosp ,4 1,2 2,2 31, 45,7 22, 11,5 15,6,41,41 47 Estonia Tartu University Hosp ,2 2,1,2 32,8 44,1 22,1 2,8 72,2 1,23 1,2 57 Finnish University Hospitals ,7 12,1 8,6 31,4 38, 2,2 7,9 16,1,58,59 Finnish University Hospitals ,4 9,7 8, 3,7 37,3 2, 7,7 15,1,55,57 1 Finnish University Hospitals ,6 6,1 8,7 31,1 36,6 19,9 7,7 15,7,62,63 Finnish University Hospitals ,2 16,1 2,3 3,6 35,9 19,9 7, 15,8,62,62 Finnish University Hospitals ,2 4,3 8,4 3,6 35,5 19,2 9, 17,,68,69 1 Finnish University Hospitals , 6,9 8,5 3,7 36,3 19,5 8,6 14,8,59,59 Finnish i University i Hospitals ,4 65 6,5 57 5,7 31,5 37,2 2, ,7 16,2 61,61 6,6 4 Finnish University Hospitals ,2 3,5 9,3 31, 37,3 19,7 9,4 17,7,65,66 9 Finnish University Hospitals ,5 3, 9,1 3,3 36,9 19,6 6,6 14,5,53,54 2 Finnish University Hospitals ,5 3, 8,3 3,9 36,2 19,9 7,2 15,5,61,61 9 Finnish University Hospitals , 5,1 7,6 31,1 35,3 19,5 6,6 15,2,59,59 13 Finnish University Hospitals , 4,8 3,6 3,9 37,8 2,5 9,2 2,7,72, veebruaril Tallinnas 18

19 Uued Jahutamine taaselustamise järgselt Ultraheli PiCCO Arteriaalse rõhu invasiivne monitooring!. Hospitaalinfektsioonid Kliinikum IVKH ITKH Rakvere Pärnu Narva LTKH Laste intensiivravi 19

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