Породување - Ре Медика | Poroduvanje - Re Medika

ANESTHESIA AND INTENSIVE CARE - РЕ-МЕДИКА

ANESTHESIA AND INTENSIVE CARE

The vision to create a modern hospital in Macedonia, with the most sophisticated equipment and professional team in order to provide top health service is confirmed as a reality at the ReMedika Hospital.

The Department of Anesthesia and Intensive Care began operating since the establishment of Re-Medika General Hospital in April 2005, as an integral and necessary part of the hospital. Teamwork, experienced doctors, sophisticated equipment, and the latest protocols are key to Re-Medika’s success. The professional team of experienced doctors-anesthesiologists and nurses, medical technicians-anesthetists apply the most modern medical doctrines, standards and methods for anesthesia, monitoring and treatment according to evidence-based medicine.
We provide 24 hours/7 days specialist anesthesiology services in the following activities:


  • Anesthesia for elective and urgent surgery, diagnostic and interventional procedures in all patients – ambulatory and stationary in Re-Medika

  • Intensive care of critically ill patients – that underwent surgery or not, requiring special care and treatment at the Central Unit for Intensive Care with a capacity of 5 intensive care units

  • Treatment of acute and chronic pain

  • Mechanical ventilation therapy

  • Resuscitation

Re- Medika, HOSPITAL WITHOUT STRESS AND PAIN..

Sincerely, d-r Zvonko Krstevski,Head of Anesthesia and Intensive Care Department

ANESTHESIOLOGICAL SERVICES

The Department provides the following services according to the standards of professional associations such as ASA, ESA and ESRA in the following areas:


  • Pre-surgery specialist and consultative anesthesiology examination and pre-anesthesiological evaluation of health condition as a standard part of the preparation of patients undergoing all diagnostic, interventional and surgical procedures that require anesthesia

  • Observation and MAC sedation for minor surgical interventions and diagnostic procedures – X-ray imaging, CT scan, punctures, biopsies, probe placements, drains and etc

  • General anesthesia in which we use the most modern and safest short acting intravenous and inhalation anesthetics that allow patients to be swiftly awaken and vigorous even after long surgical interventions.

  • Postanesthetical monitoring of surgical patients

  • Regional types of anesthesia and analgesia – we follow the world trend and use regional anesthesia and analgesia in all surgical interventions where it is possible and desirable:

  • Spinal anesthesia

  • Epidural anesthesia

  • Combined spinal-epidural

  • Continuous epidural analgesia for the treatment of postsurgical pain

  • Remedika is the first hospital in Macedonia to use Braun PCA – patient-controlled analgesia pumps for intravenous or epidural application

  • Regional intravenous anesthesia – RIVA

  • Obstetric Anesthesia – All Types of Obstetrical Analgesia – Spinal, Epidural and Combined Spinal-Epidural “Walking Epidural” Technique. Remedika is a hospital that provides Obstetric anesthesia 24-hours, 7-days a week. More than 62% of normal child deliveries are performed in any of these types of analgesia

  • Certified resuscitation teams qualified of basic and advanced life support are available 24 hours a day

  • Perioperative pain control. In the treatment of postsurgical pain we practice multimodal approach – using more medications in lesser doses to achieve effective pain relief with fewer side effects (nausea, vomiting)

ANESTHESIA FOR YOUR CHILD

The purpose of this information is to give you answer to some of the possible anesthesia for your child related questions, to explain to you the role of the anesthesiologist and the possible side effects and complications associated with the anesthesia.

The Anesthesiology Department at Re-Medika has a team of doctors anesthesiologists and nurse anesthetists whose aim is to provide quality service to children who come to us and provide as pleasant stay during treatment by:


  • Minimizing agitation in children before surgery

  • Preparation of children and parents for anesthesia

  • Anesthesia for surgical procedures

  • Sedation for diagnostic procedures

  • Monitoring of vital functions during surgery and awakening

  • Minimizing pain and agitation after surgery

More information can be obtained at any time from an anesthesiologists at Re-Medika or phone 072/443-231.

IS THERE A DIFFERENCE BETWEEN ANESTHESIA FOR CHILDREN AND FOR ADULTS?

One of the biggest differences is the degree of fear and agitation. Sometimes children are too scared of what is expected or some previous experience. Young children are not able to understand what is happening to them, so in this situation the parents can help most. Physiological differences in children require the use of different techniques, apparatus and doses of medications.

PAINLESS DELIVERY

The birth of a baby in the embrace of a smiling, pain-free mother is one of the most exciting and noble moments in medicine. Pregnancy is the time to make some decisions for you and your baby. We hope the information provided here will help you to make the right choice so that childbirth will remain a unforgettable moment in your life. The Re-Medika Anesthesiology Team is at your disposal 24 hours / 7 days a week.

BE INFORMED, THE CHOICE IS YOURS

Facts about epidural analgesia


  • In Remedika over 70% (adjusted number) of patients giving birth spontaneously, give birth without pain with a help of an epidural analgesia.

  • It represents the most efficient method in treatment of pain during child delivery.

  • It is the only method by which child delivery can be fully painless for any woman in labor.

  • On average, every third woman in the developed countries gives birth with this method.

  • In some hospitals the percentage exceeds 90%

  • 8 out of 10 would choose the same method for the next childbirth

  • Epidural analgesia has no side effects on the newborn

Preparing for delivery

We recommend visiting prenatal pregnancy classes. A team of specialists obstetricians, pediatricians, anesthesiologists, psychologists and midwives will introduce you to the changes you may expect during pregnancy and childbirth. You will learn breathing exercises, posture during delivery, they will explain techniques for pain relief and as well as acceptance and care of the newborn. You can additionally get to know and talk anesthesiologists when you come to regular maternity care and CTG checks. The presence of the partner during childbirth, which we particularly support at ReMedika, is of invaluable importance as psychological support for the mother but also for the partner.

WHY IS THE TREATMENT OF CHILD DELIVERY PAIN SO SPECIFIC?

The childbirth act, especially for the women who give birth for the first time, may be very painful and almost always there is a need to help the woman in labour. The presence of the fetus is limiting the choice and the quantity of the analgesic that the doctor may administer to the mother. Analgesics used in the treatment of labor pain administered intramuscularly or in a vein are transmitted through the placenta and may cause some undesired effects on the baby after the birth. This is the reason why the dosage that is safe for the newborn is inefficient in treating the labor pain.

On the other hand, medications administerd through the epidural catheter reach such low concentrations in the mother’s bloodstream that they have no adverse effects on the newborn.

HOW THE LABOR PAIN BEGINS? TYPES OF PAIN RELIEF?

Childbirth is special and unique for every woman. Towards the end of pregnancy begin contractions of the uterus, which are rare in the begining, and then they are more often and stronger, which causes the labor pain, which strength is different at every woman during delivery. Towards the end of the birth itself, also, there is the pain of stretching the soft birth canals. The percentige of women in labor who do not ask for pain relief is very small, and the rest have a great benefit of the pain relief. The first time of childbirth is usually the longest and the labor pain is the strongest. There are lots of factors that impact the pain:

  • Size and position of the baby
  • Strenght of the uterus contractions
  • Pain tolerance of the woman in labor
  • Pelvis and birth canal dimensions
  • Use of stimulation by the obstetrician in order to start or speed up the process of birth

TYPES OF PAIN RELIEF

Today around 80% of the women giving birth ask for some type of pain relief.

The most efficient and mostly used techniques are the region techniques, which include epidural, spinal and the combined epidural- spinal analgesia. Their biggest advantage is the efficiency and absence of side effects for the baby. That is also the reason why they are so widely spread in the developed countries, above 90% in some hospitals.

The epidural analgesia is with no doubt the most efficient method in the treatment of labor, especially for the primipara whose childbirth lasts longer than usual. It is available to all the women in labor who are interested. The side effects are extremely rare as use of anticoagulant therapy or infection on the place where the epidural cateter is placed.

WHAT IS EPIDURAL ANALGESIA?

The method is consisted of placing a thin epidural cateter (1mm) in the part of spine known as loin after skin local anesthesia. The best time to be placed is when the rhythmical contractions are shorter and more pianful and when the opening of the cervix is 3-4 cm dilated. The procedure is done in a sitting or side position, patient’s knees are towards her abdomen and her chin towards the chest bone, so the back’s loin part should be straight up. The administration of medicine through the epidural cateter near the nerves enables to cut the conduction of pain from the uterus and soft birth paths towards the brain where every sensation is actually formed including the pain..

The effects of the pain relief may be felt after 20-30 minutes, and the medicine is administered constantly through a special pump, until the birth is finished. Mother feels warmness and light numbness in the legs and the lower body, the pain is lost, but the contractions are felt. Throughout the whole childbirth, mother’s blood pressure and her heart frequency are controlled, and through the CTG, baby’s puls and the uterus contractions are controlled.

WHEN IS SPINAL ANALGESIA APPLIED?

Spinal analgesia is a rarely used technique and the effect is after 2-3 minutes. This technique is applied only when we expect that the childbirth will be finished in the following 2 hours. Its biggest flaw is that the medicine can be administered only once and cannot be added more times, but, another punction has to be done, if the childbirth is not finished.

The combined spinal- epidural technique uses the adventages of the previous two- fast effect and duration until childbirth is finished. It is mostly used at the so called “walking” epidurals when the patient may be mobile during the childbirth.

WHAT IF THE CHILDBIRTH HAS TO BE FINISHED WITH A C-SECTION?

In case when the baby is not dropping even though the cervix is dilated, or the umbilical cord is short and holds the baby, childbirth has to be done by C-section. The epidural catheter may be used for the C-section anesthesia, and more concentrated solution of the medicine is administered that blocks in total the legs and the lower part of the abdomen, up to the chest. Thus, the general anesthesia for C-section is being avoided and the mother is awaken so she can hear the baby’s first cry and later to see and touch her baby when put on her chest by the pediatrician. Simply, a moment to remember.

ARE THERE COMPLICATIONS WHILE EPIDURAL ANALGESIA

Sometimes there might be some difficulties in locating the epidural area so a slight pain may occur on the puncture spot, it lasts for a day or two and without any complications. There are rare cases when a headache might occur after the epidural analgesia.

LOCATION OF SERVICESS


  • Surgery ward is comprised of 5 modern surgery theatres equipped with the latest apparatus and monitors for anesthesia, up-to-date equipment and complete instrumentation. Here all kinds of general, regional and combined anesthesia are performed from all branches of surgery except neuro and cardiac surgery.

  • Day hospital Re-Maedika follows the worldwide trend for a single day surgery. Its capacity is one surgery theater and 7 beds for post-anesthetic care. Previously fully examined and prepared patients are admitted to the Day Hospital for shorter surgical and diagnostic interventions, recover after them and are discharged during the day.

  • Ambulatory anesthesia are performed throughout the hospital requiring short-term anesthesia with the necessary high standard of anesthesiology care for diagnostic, therapeutic and interventional procedures including:

  • The Re-Medika Assisted Reproduction Center is a completely new department with 1 IVF intervention theater with complete set of anesthesiology equipment and pos-intervention recovery room with capacity of 8 seats. The Center uses services of Department of Anesthesia during IVF punctures, transfers, rejuvenation, TESSE procedures and so on.

  • The endoscopic ambulatory is the location where most endoscopic interventions (gastroscopies, colonoscopies, gastro-colonoscopies, endoscopic polypectomies, dilatations, biopsies) are performed with sedation or short-term anesthesia.

  • The Radiology Department uses anesthesiology services on CT and other imaging, biopsies, child imaging, coronarography and more.

  • Internal medicine procedures – drain settings, percutaneous thoracic and abdominal drains, probes etc.

  • The intensive care unit has a capacity of 7 intensive beds in 3 separate rooms. With complete monitoring and provided treatment for the most severe patients who need special intensive care and treatment in the pre- and postsurgery period, as well as internist patients

EQUIPMENT

The Department of Anesthesia, Resuscitation and Intensive Care is the first anesthesiology department in Macedonia to reach the highest world standards in anesthesiology practice in terms of accommodation, equipment, monitoring, diagnostics, mini laboratory, ventilatory support and everything else necessary for providing quality and safe anesthesia, patient satisfaction and maximum pain relief.


  • We use Datex-Ohmeda anesthesiological apparatus in the Surgery ard, Delivery theaters, Day Hospital, complete with

  • Datex-Ohmeda Ѕ5 modular monitors that provide:

  • Standard monitoring (ECG, NIBP, pulse oximetry- SaO2, Temp)

  • Invasive monitoring (CVP, IAP, PAP, PCWP, CO) (CVP, IAP, PAP, PCWP, CO)

  • Special monitoring
    • Capnography – measuring the concentration of carbon dioxide in exhaled air – ЕtCО2
    • Entropy and BIS index – control of sleep depth in anesthesia
    • Neuromuscular monitoring – to control the effect of neuromuscular relaxants – TOF
    • Spirometry – monitoring of ventilatory changes

  • Datex-Ohmeda central monitoring. All 16 monitors in the surgery theaters and Intensive care are integrated into the network via a central monitor that has the ability to store data continuously for patients vital parameters during 28 hours period.

  • Re-Medika is the only hospital in Macedonia that has a Karl Reiner Jet Ventilation Apparatus for ventilating patients without the need for intubation during throat, bronchoscopy and other interventions.

  • Severe intubation and airway control equipment – we use all kinds of laryngeal masks and fiberoptic bronchoscope and Olympus laryngoscope, video laryngoscope

  • Intensive Care Unit is equipped by most modern standards:

  • Datex-Ohmeda Ѕ5 non-invasive and invasive monitoring

  • Maquet Servo-i ventilators for ventilatory support that provide all modes of controlled, assisted and non-invasive ventilation

  • Complete parenteral and enteral nutrition

  • Oxygen therapy

  • Thoracic drainage

  • Respiratory and physiotherapy and other intensive procedures

  • Gas analyser NOVA (рН, рО2, рСО2, Na, К, Ca, Glu, Hb, Ht, Lact)

  • Braun infusion and perfusion pumps are used in the hospital for strictly controlled infusion therapy

  • Braun PCA pumps for pain relief according to the patient needs

  • Each Department is equipped with a plan and complete resuscitation equipment and defibrillators

INFORMATION FOR THE PATIENTS

Anesthesia for ambulatory surgery and diagnostic interventions

Today most patients undergoing surgery and diagnostic tests do not need to stay in the hospital overnight after the intervention is completed. In most cases patients are able to go home and recover at home with their loved ones.

Outpatient surgery and anesthesia have proven to be very safe and easy, and can be performed in a variety of conditions. It can be performed in a hospital, a specialized surgical center or in some cases in an outpatient surgery . In each case the anesthesia is performed by a special anesthesiologist.

WHAT IS OUTPATIENT ANESTHESIA?

Outpatient anesthesia is designed and devised to allow the patient soon after surgery or diagnostic intervention to go home. Short-acting anesthetic medicines and specialized anesthetic techniques as well as post-intervention care are focused on the needs of patients who have come for ambulatory anesthesia and surgery in order to make surgery or diagnostic tests as safe and comfortable as possible. Generally if the patient is in good physical condition and in good health, he is a reliable candidate for day surgery and ambulatory anesthesia.

After short recovery, you, patients, can return safely home. In most of the cases, family, friends can provide all the necessary help that you need. Adequate pain treatment is also included in your home discharge plan that will be prepared by your anesthesiologist and surgeon.

WHICH ARE THE MOST FREQUENTLY ASKED QUESTIONS RELATED TO AMBULATORY ANESTHESIA AND SINGLE DAY SURGERY?

If you already have planned a surgery, you probably have questions about the type of anesthesia, the pain that you can expect after the surgery and some other information that may interest you. The team of Remedika Anesthesiologists will help you get answers to frequently asked questions on this site. Remember though, despite the answers on this page, it is best to consult your anesthesiologist for any information about your health and the intervention that follows.

WHEN WILL I MEET WITH MY ANESTHESIOLOGIST?

Your anesthesiologist will interview you the day before the intervention and sometimes on the day of the intervention to gather all the information needed to evaluate your health. Laboratory tests as well as other medical tests can be performed to check your health status for one purpose: greater safety. During the interview you will fill out an anesthesiology questionnaire listing about your previous experiences with anesthesia, if any, your health condition, allergies, medications you regularly use. If you have any concerns you should tell the anesthesiologist and discuss them.

WHICH ARE THE RISKS OF ANESTHESIA?

All surgeries, as well as all types of anesthesia, have a certain risk. They depend on multiple factors including the type of surgery and your health condition. Luckily the adverse side effects are very rare, and the anesthesiologist takes all necessary precautions to prevent any such occurrence. When talking to the anesthesiologist you should ask about the risks of anesthesia associated with your surgery or diagnostic test.

WHAT ABOUT EATING FOOD AND DRINKING FLUIDS BEFORE ANAESTHESIA?

The general rule is that you should not eat or drink anything after midnight before your surgery or diagnostic test that requires anesthesia. In some cases you may get permission from your anesthesiologist to drink clear fluids several hours before receiving anesthesia.

SHOULD ONE TAKE MEDICATIONS THAT ARE REGULARLY USED?

Some medications should be taken regularly until the day of surgery, and some should be discontinued. It is therefore very important to tell the anesthesiologist about the medications you are taking, and he will decide which ones to continue taking and which not to. Do not take any medications without permission.

CAN NATURAL MEDICINES, VITAMINS AND OTHER SUPLEMENTS INFLUENCE ON THE ANESTHESIA?

Certain natural medicines may prolong the effect of anesthesia, and others may increase the risk of bleeding during the intervention or raise blood pressure. Some of these effects of natural medicines do not have to be very significant, but still, you have to tell the anesthesiologist about everything you are taking before your intervention.

SHOULD ONE QUIT SMOKING?

YES – it is very important to stop immediately. Your surgery may be a golden opportunity to do so. There is evidence that those who quit smoking have fewer symptoms of nicotine addiction and greater success in trying to quit. Although before our intervention or the week before, there is still a great benefit to quitting smoking.

WHY IS NECESSARY SOMEONE ELSE TO TAKE ME HOME?

The effects of the medications used in the anesthesia can sometimes stay up to 24 hours before they completely disappear. You also need someone to stay with you for the first 24 hours and provide a care. This is for your safety. Some patients feel good and strong just hours after the intervention and think they are capable of normal activities. That’s not correct! Stay safe!

WHEN CAN I GO HOME?

There are protocols and guidelines in our institution for when you can leave after finishing the intervention. But the most important thing is to get permission from the anesthesiologist after he realizes that you are capable of performing some of the normal activities such as getting up on your own, walking, going to the toilette, not feeling nausea and vomiting, and so on. Sometimes, though rarely, you will have to stay one night in the hospital and this will be arranged for you.

ANESTHESIA FOR YOUR CHILD?

The purpose of this information is to give you answer to some of the possible anesthesia for your child related questions, to explain to you the role of the anesthesiologist and the possible side effects and complications associated with the anesthesia.

The Anesthesiology Department at Re-Medika has a team of doctors anesthesiologists and nurse anesthetists whose aim is to provide quality service to children who come to us and provide as pleasant stay during treatment by:

  • Minimizing agitation in children before surgery
  • Preparation of children and parents for anesthesia
  • Anesthesia for surgical procedures
  • Sedation for diagnostic procedures
  • Monitoring of vital functions during surgery and awakening
  • Minimizing pain and agitation after surgery

IS THERE A DIFFERENCE BETWEEN ANESTHESIA FOR CHILDREN AND FOR ADULTS?

One of the biggest differences is the degree of fear and agitation. Sometimes children are too scared of what followes or some previous experience. Young children are not able to understand what is happening to them, so it is parents who can help most. Physiological differences in children require the use of different techniques, apparatus and doses of medications.

MEDICAL SERVICES IN ANESTHESIA AND INTENSIVE CARE DEPRATMENT

Anesthesia specialist examination
Anesthesia for Gastroscopy
Anesthesia for Colonoscopy
Anesthesia for Colonoscopy/Polypectomy
Painless Childbirth – Epidural Analgesia
Pain treatment in Day Hospital
Anesthesia specialist consultation
MAC Stand-by anesthesia team up to 30 minutes
Anesthesia for Gastroscopy and Colonoscopy
Painless Childbirth – Spinal Analgesia
Ambulatory anesthesia
General short-term anesthesia up to 15 minutes
Treatment of pain – epidural
Port placement
Intensive care – intermitent monitoring of ЕCG, SaO2, NIBP, Temperature, glycemia by indication – per day
Intensive therapy – continuous basic monitoring of ЕCG, SaO2, NIBP, Temperature, glycaemia per day
Hemodynamic monitoring – Intraarterial cannula placement and measurement of IAP – first day
Hemodynamic monitoring – IAP surcharge for each subsequent day
Central venous catheter CVK placement for IV Infusion Therapy
Hemodynamic monitoring – Central venous catheter CVK placement and measurement of CVP – first day
Hemodynamic monitoring – CVP surcharge for each subsequent day
Inotropic IV therapy (Dopamin, Dobutrex, Noradrenalin, etc) by pump/per day
Continuous IV Therapy (К, Мg, Heparin, Amiocordin, Insulin etc) by pump/per day
Arteficial ventilation each day
Respiratory physical therapy and RespiFlow trainer/day
Inhalations up to 6 per day/each day
Postoperative IV analgesia/each day
Postoperative analgesia PCA IV/day
Postoperative Epidural Analgesia – Placement of epidural catheter and analgesia – first day
Postoperative Epidural Analgesia – every next day
Placement and maintenance of thoracic drainage/day
Placement of a duodenal probe for nutrition
Enteral nutrition via Enteroport pump/day
Total Parenteral IV Nutrition/day
Blood and blood derivatives transfusion (surcharge for blood)

DOCTORS