Anesthesia

Anesthesia and Intensive Care

Text Box: REMEDIKA is ALL ABOUT PEOPLE hospital The General Hospital ReMedika accomplish it’s concept of making most modern general hospital in Macedonia. We believe that everyone should be able to receive highest quality healthcare in Macedonia, and Re-Medika achieved this goal. With experienced teams of doctors, sophisticated and quality equipment and latest evidence-based medicine Re-Medika we achieved this goal. Quality is a top priority of Re-Medika. Safety of our patients is our chief GOAL. Satisfaction of our patients is measure of how we have succeeded in our work. Complete team of Re-Medika work as one for prevention, diagnostic and treatment of our patients. Department of Anesthesia and Intensive Care of the Re-Medika General Hospital is vital part of the team work providing services crucial for the wellbeing of the patients. It is highly integrated, competent, collaborative group of Board Certified Anesthesiologists and very experienced certified anesthetic and intensive care nurses. It provides 24 hours, 7 days a week anesthetic, pain treatment and intensive care for all of our patients. The department is equipped with most modern anesthetic and ICU equipment and monitoring. Our mission is to provide our adult and pediatric patients requiring anesthesia, intensive care, reanimation and pain management, excellent and highest standard of anesthetic and critical care treatment based on the current evidence-based medicine protocols and guidelines. OUR ANESTHESIA AND INTENSIVE CARE TEAM: ANESTHESIOLOGISTS 1. ZVONKO KRSTEVSKI MD - Chief of the Department 2. BRANKO PETROVSKI MD 3. NATALIJA GEORGIEVSKA-CAKAR MD 4. SLAGJANA JOSEVSKA-JOVANOVSKA MD 5. MARGARITA LOVAC-CEPUJNOSKA MD 6. IVICA STEFANOVSKI MD ANESTHETIC NURSES 1. ANDRONIKI BIBOVSKA - Head nurse of the Department 2. LJUBICA MANEVSKA 3. KATERINA STANKOVSKA 4. IRENA NECOVSKA 5. MELINDA NIKOLOVSKA 6. ALEKSANDRA KUZMANOVSKA 7. ANDRIJANA IVANOVSKA 8. BILJANA VASILEVSKA 9. MARINA STOJMANOVSKA SCRUB NURSES ZORAN NIKOLOVSKI - Head scrub nurse NADA AVTOVSKA ROZA MAZAREK SONJA CINGARSKA ZORE CACESKA SNEZANA DIMKOVSKA JASMINA KOLEVSKA ELENA TRAJKOVSKA Department of Anesthesia and Intensive Care gives three main services: 1. ANESTHESIA for elective and emergency surgery, diagnostic and interventional procedures 2. INTENSIVE CARE 3. PAIN MANAGEMENT We also provide ambulatory anesthesia all over the hospital with the necessary standard of anesthesia care. OPERATIVE BLOCK has 5 completely computer-controlled Hepa-filter acclimatized operating rooms equipped with latest anesthesia equipment and monitoring, modern equipment and instruments, special electrocoagulation equipment, 3 laparoscopic towers, laser etc Our department takes care of our patients in following areas: Preanesthetic evaluation as standard part of any operative and diagnostic procedure. Administration of various types of anesthesia for elective and emergency surgery and diagnostics for which we use latest and safest short acting intravenous and inhalation anesthetics. That way our patients have quick and fast recovery within few minutes even after long surgery. There are a few types of anesthesia: Monitoring Anesthesia Care and Sedation for small operations and diagnostic procedures General Anesthesia which we provide is delivered using latest and safest short acting intravenous and inhalation anesthetics. Inhalational anesthesia – we use Sevoflurane and Isoflurane as standard on all anesthesia machines Intravenous anesthesia - Combined anesthesia We have 5 Datex-Ohmeda anesthetic machines in all operating rooms, equipped with Datex-Ohmeda complete monitoring which gives: standard monitoring (ECG, NIBP, pulse asymmetry, temperature), invasive monitoring (CVP, IAP, PAP, PCWP, CO) and most sophisticated special monitoring Capnography, measuring end-tidal concentration of expired carbon dioxide Entropy and BIS index for control of depth of anesthesia and state of consciousness during anesthesia, so chance for awareness during anesthesia has been eliminated. This is not standard even in high developed hospitals. Neuromuscular monitoring is controlling the effect of neuromuscular relaxants and Spirometry monitoring ventilator changes. All 16 monitors from the operating rooms and ITU are integrated in network through central monitor which has ability for “28 Hour Full Enclosure” storage of all the data from the patients. Most advanced airway management and control during general anesthesia in our Department of Anesthesia is main goal for safety of our patients. We use all types of Standard airways, Laryngeal Mask Airways (Classic, Proseal and intubating FastTrack LMA), Endotracheal and endobronchial double lumen tubes, introduced with direct or fiber optic laryngoscopy Regional types of Anesthesia and Analgesia using best regional techniques. We provide: Spinal anesthesia and analgesia Epidural anesthesia Combined epispinal anesthesia Continuous postoperative and labour epidural analgesia PCA – Patient Controlled Epidural and IV Analgesia RIVA – Regional Intravenous anesthesia Periphery blocks - performed by using special Braun periphery block sets and Braun Stimuplex neurostimulator Obstetric analgesia – All of regional types of labour analgesia - spinal, epidural and combined epic-spinal “walking epidural” techniques are done in ReMedika from its start and by which we become the only hospital which provides labour analgesia 24 hours, 7 days a week. More than 60% of our normal, vaginal deliveries are performed with some type of labour analgesia. Post Anesthesia Care Unit for observation of patients after anesthesia Intensive and Critical Care management is performed in Intensive Therapy Unit for most difficult patients which need special intensive care, either preoperatively, postoperatively or medical patients with complex problems. ITU has capacity of 5 ICU beds with complete standard of intensive care equipment for each bed: a. Datex-Ohmeda S5 noninvasive and invasive monitoring. b. Ventilatory support is offered with 3 Servo-i ventilators with all modes of controlled, assisted and noninvasive ventilation. c. Parenteral and enteral nutrition, d. fully controlled inotropic support, e. Thoracic drainage, f. Respiratory and physiotherapy and other intensive care procedures. Certified Reanimation Teams are available for BLS, AED and ILS throughout the ReMedika for 24 hours. Each department is equipped with complete cart for reanimation, oxygen delivery, defibrillator and other reanimation equipment. Peri and postoperative pain management as well as treating acute pain syndromes connected with renal and gallbladder abdominal pain, anginous pain, vascular ischemic diseases, cancer pain. In treatment of postoperative pain we use so called multimodal approach We use several drugs in smaller doses, so we have good pain relief with less side effects like nausea, vomiting etc. ReMedika is the only hospital in Macedonia which uses 5 Braun PCA pumps for Patient-Controlled Analgesia through IV and epidural application with self control by the patient Outpatient day clinic follows the trend in the world for one-day surgery and returning home the same day. It has capacity with 1 operating room and 7 beds. Previously examined and prepared patients come to our Day Clinic where they receive full treatment and are being operated, recovered after surgery and anesthesia and discharged the same day. FACTS & FIGURES more than 5500 anesthesia’s 500 epidural deliveries – more than 60% of normal deliveries Which operations are performed in Re-Medika

Your health is our care

Ivica Stefanovski M.D.

Spec. by Anesthesia & Reanimation

Androniki Bibovska

Head Department Nurse