HISTORY OF CROATIAN ANAESTHESIOLOGY

Marko Jukić, M.D., Ph.D.

Anaesthesiology in Croatia

•This is a short review of the historical development of anaesthesiology in Croatia from its beginning (1947) to 2008.

Introduction

•Five months after the public demonstration of ether anaesthesia in Boston (October 16, 1846), first ether anaesthesia was given in Zadar, March 13, 1847.

Ether anaesthesia in Croatia

We have information about ether anaesthesia in Croatia:

•In Dubrovnik, April 14, 1847

•In Split June 17, 1847

•In Sisak August 29, 1847

Wrote about anaesthesia in Croatia ( 19 and half 20 century):

•Dr. Miroslav Čačković

•Dr. Teodor Wickerhauser

•Dr. Dragutin Schwarz

•Dr. Ivan Maixner

•Dr. Antun Medanić

•Dr. Ante Drašćik

•Dr. Đurđa Klaić and other

Anesthetics used in Croatia in (19 and half 20 century):

•Ether

•Chloroform

•Cocaine (1-5% solution)

•Schleich solution

(cocain 0,01-0,2 %)

•Tropacocaine

•Novocaine

Schleich solution

Rp.

•Cocaine hydrochlor. 0.2

•Morph. hydrochlor. 0.025

•Sodium chlorat. Sterilisat. 0.2

•Aqua destil. sterilis. ad 100.0

•adde. solut. acid. carbol 5% gtt.2

MDS Strong solution

Schleich solution

Rp.

•Cocaine hydrochlor. 0.1

•Codein. phosphor. 0.06

•Sodium chlorat. Sterilis. 0.6

•Aqua destil. sterilis. ad 100.0

•adde sol. acid. carb. 5% gtt. 2

Schleich solution

Dr Dragutin Mašek was the first to work with this solution at the Hospital of Sisters of Mercy (Bolnica milosrdnih sestara) in Zagreb and it was later used at the same hospital by Dr Teodor Wickerhauser.

Methods of anaesthesia used before modern anaesthesia:

•General anaesthesia (Drops method)

•Local anaesthesia

•Spinal anaesthesia

•Peridular anaesthesia

The Medical Faculty

•The Medical Faculty in Zagreb was founded in December 1917. The surgical ward was opened in the hospital in Draškovic Street in 1920.

First endotracheal anaesthesia in Croatia

Dr. Risto Ivanovski give first endotracheal anesthesia at the military hospital in Zagreb, January 7, 1948.

Endotracheal anesthesia

Dr. Đurđa Klaić wrote about the experience with endotracheal anaesthesia during 1948 in Zagreb (147 anaesthesia).

Development of modern anaesthesia

•Starting from 1950

•Beginning of Croatian anaesthesiology

Modern anaesthesia

•The Centre for training in anaesthesiology in Copenhagen was founded in May 1950

•The one – year post graduate course in anaesthesiology was one of the WHO programmes

•Prof. Andrija Štampar from Zagreb, was the president of the WHO, 1950.

Croatian doctors who attended cours in Copenhagen

•Andrija Longhino (1950/1951)

•Jagoda Bolčić (1954/1955)

•Miroslav Hromadko (1960)

•Mara Biondić (1964)

•Vlasta Lederer (1967)

Post graduate courses in anaesthesiology in Zagreb

•The three course were subsequently held 1953, 1955 and 1957., each lasting six months.

•Thirty – seven people where officially enrolled in the course, while 13 attended inofficially

Specialisation in anaesthesiology (Croatia)

•Two years (according to the 1948 law)

•Three years (law from 1959)

•Four years (law from 1974)

•Five years (law from 2011)

Exam in anaesthesiology

•Dr. Darinka Soban (from Slovenia) was the first to pass the exam (March 15, 1954)

•Dr. Đurđa Klaić was the first doctor from Croatia to pass specialization exam (Aprile 7, 1955)

Old apparatus for anaesthesia

•Forreger

•Boyle

•AGA

•Sutjeska

•Draeger

The pioneers of Croatia’s anaesthesiology:

•Prof. Andrija Loghino

•Prof. Jagoda Bolčić – Wickerhauser

•Prof. Risto Ivanovski

•Dr. Đurđa Klaić

•Prof. Ljubomir Ribarić

•Prof. Vera Arko

•Prof. Ivan Janjić

Aneaesthesiological unit, ward:

•The first anaesthesiological unit at the surgery ward was set up in 1959, in Zagreb.

•The first anaesthesiological ward was set up in 1962, in Rijeka

Foreign lecturers in Croatia:

•Francis Foldes (USA)

•John Robinson (UK)

•Alfred Doenicke (Germany)

•Oto Mayrhofer (Austria) and other

Development new anaesthesiology wards:

•Clinic for urologi (anaesthesiology ward 1970, dr. Ivanka Gjajić – Broz)

•Clinic for Neurosurgery (anaesthesiology ward 1972, dr. Edvard Peruško)

•Clinic for thoracal surgery (anesthesiology ward dr. Ivan Janjić)

•Children’s hospital (anaesthesiology ward 1967, dr. Ljiljana Audy – Kolarić) and other

The pioneers of intensive therapy in Croatia

The pioneers of intensive therapy in Croatia were Jagoda Bolčić Wickerhauser, Eduard Peruško, Ivan Janjić, Maša Formanek, and Ljiljana Audy-Kolarić from Zagreb,

Ljubomir Ribarić from Rijeka,

Božena Pavičić from Split,

Nada Vuković from Varaždin, and

Ida Krleža-Jokanović and Dubravka Fantov-Jovandžikova from Osijek.

Intensive care units

•In Croatia, intensive care units (ICUs) started in 1962-1964 as single rooms, only to develop into independent units supervised by anaesthesiologists.

•In these early rooms, locally termed as recovery rooms, surgeons were in charge, but anaesthesiologists took care of mechanical ventilation, provided parenteral therapy, and monitored haemodynamic parameters.

Intensive care units

The first ICUs, supervised by anaesthesiologists, started in the early

1970s, first in Zagreb (1971/72) and Rijeka (1972/73), and then in Split

(1976), Varaždin (1978), and Osijek (1984).

Neurosurgery ICU

•The first neurosurgery ICU started in Zagreb (Rebro) in 1972. since 1981, it has provided monitoring of intracranial pressure. Brain electrical activity monitoring started in 1985. The unit now provides monitoring of

neuromuscular activity and hemodynamic monitoring as well.

Intensive care units

•Thoracic Surgery Clinic in Zagreb established an independent ICU in 1971 and extended (with new beds and monitoring) it in 1976.

•In 1971, Children’s Hospital in Zagreb established its own ICU, headed by Dr Ljiljana Audy Kolarić.

Intensive care in Croatia

Today (2008) there are 45 ICUs in Croatia, which are supervised by anaesthesiologists

(36% of total ICUs). They belong to university, clinical and regional hospitals and provide maximal care. Anaesthesiologists are in charge of 364 intensive care beds (about 40% of the total number of intensive care beds). The number of ICUs supervised by anaesthesiologists is small because new ICUs are specialised and headed by paediatricians, neurologists, psychiatrists, and internists.

Anaesthesiological service in the Republic of Croatia (1998 year)

•6 institutes for anaesthesiology and intensive care

•15 departments for anaesthesiology and intensive care

•8 anaesthesiology and intensive care service

•8 units for anaesthesia on surgery departments

Croatian anaesthesiologists

•have been using all kinds of modern techniques and methods for performing anaesthesia. A certain number of anaesthesiologist who worked in Western countries are now working in Croatia, but a majority has continued to live and work abroad (Germany, Switzerland, Austria, USA)

Society for Anaesthesiology and Intensive Care

•The Croatian Medical Association was founded in 1874 in Zagreb

•The Section of the Croatian Anaesthesiology of the Croatain Medical Association was founded in April 25, 1962.

•The name of the Section was chenged to the Croatian Medical Association for Anaesthesiology and Intensive Care

Society of Anaesthesiology and Intensive-Care Medicine

Section changed its name to the Croatian Medical Association – Croatian Society of Anaesthesiology and Intensive-Care Medicine.

The Society is now a member of the World Federation of Societies of Anaesthesiologists(WFSA), the Confederation of European National Societies of Anaesthesiology(CENSA), and other associations

Symposium and Kongress

•The first Symposium on “Intensive Care Medicine” was organised by Dr. Maša Fomanek in 1976 in Zagreb, symposium on intensive care have been held every year.

•The first congress of Croatian anaestehiologists was held in Split, 1994.

The journal of Croatian anaesthesiologists

•The first issue of the new journal “Anaesthesiologia Iugoslavica”, Zagreb 1969. The editor - in- chief of the journal was dr. Jagoda Bolčić – Wickerhauser.

•In May 1997, a new journal was brought out entitled “Acta Anaesthesiologica Croatica”.

The teaching of anaesthesiology

•In 1958 anaesthesiology was introduced at the Medical Faculty in Zagreb as part of the course on Clinical Surgery.

•On May 22, 1992. the Chair for Anesthesiology and Resuscitology of the Medical Faculty in Zagreb was set up at the Medical Faculty of Zagreb University.

•Prof. Ivan Janjić was appointed the first head of the Chair.

Post – graduate studies

Post – graduate studies in anaesthesiology were organised in 1999/2000 in Zagreb

Croatian Society of Anaesthesiology and Intensive-Care Medicine

The year 1991 was the year of open armed aggression against the Republic of Croatia and the year when the Socialist Federal Republic of Yugoslavia fell apart. This brought an end to all joint activities. TheSection changed its name to the Croatian Medical Association – Croatian Society of Anaesthesiology and Intensive-Care Medicine.

ANAESTHESIOLOGY SERVICE IN THE HOMELAND WAR (1991-1995)

•During the Croatian war of independence, also known as the Homeland War (1991-1995), 35% of anaesthesiologists were on the front lines working in mobile surgery-anaesthesiology teams or at war hospitals.

•War hospitals employed 132 anaesthesiologists and 90 medical technicians

Thank you!