Anesthesiology and Intensive Care Unit

Introduction
Perioperative care for cancer patients with limited vital organ function is a major challenge for anesthesiologists as, in general, anesthesia and surgery may cause further deterioration of physiological functions. Perioperative impairment of vital organ function has traditionally been defined as surgical stress determined quantitatively by measuring the physiological parameters representing the corresponding organs. Recent evidence suggests that such a stress response to surgery involves not only vital organs but also the neuro-endocrine-immune system and persists for days after surgery. Thus, the aim of our anesthetic management is to protect patients from surgical stress by blocking the noxious influences of surgical trauma. This is achieved by regarding anesthetic management as perioperative care.

Routine Activities
As stated above, our colleagues are working as anesthetists and intensive care physicians. Currently our division consists of four staff anesthesiologists and two to three residents. In 1997, we adminstered anesthetics on 1624 occasions including 32 cases receiving regional blocks. The annual number of patients admitted to the intensive care unit (ICU) amounted to 755. Our concern in ICU management is not only postoperative cardiorespiratory care but also the critical care of patients who have developed organ failure after medical or surgical cancer treatment. The cumulative number of patients with organ failure treated in the ICU since the establishment of the National Cancer Center Hospital East is 138.
Daily activity starts with ICU rounds and preanesthesia case presentations. ICU rounds are also made every evening after the completion of elective surgical procedures. A journal club is held twice a week to maintain up-to-date knowledge of recent advances in anesthesia and critical care medicine.

Research Activities
We are studying the effects of anesthesia and analgesia on the respiratory control system and gas exchange. Although most of our work is based on physiological measurements and analysis, we believe that such physiological considerations are always clinically relevant. Future research activities will encompass the new establishment of perioperative care medicine in the field of surgical oncology.

New Developments
Our outpatient clinic system was introduced in 1997 to improve preoperative evaluation of anesthetic risk in surgical patients and to participate in the management of intractable pain. This system will further improve patient safety and the quality of pain control.

Statistics
Prognosis of Organ Failure Treated in ICU
(1992.7. -1997.12.)
Primary malignancyNo. of ptsDischarge*Death*
Postoperative patients
Stomach28199
Pancreas & biliary tract25520
Colorectal1468
Esophagus1385
Head & neck862
Liver743
Panperitonitis543
Lung734
Others413
Post-chemo-radiotherapy
Head & neck707
GI tract624
Lung505
Others936
*Discharge is defined as discharge from the hospital. Death includes patients who recovered from organ failure but subsequently died from the primary disease during hospitalization.

Number of Patients Admitted to ICU
YearNo. of cases(Cases per month)
1995671(55.9)
1996704(58.7)
1997755(62.9)

Prognosis in Relation to the Number of Failed Organs
No. of failed organsNo. of ptsDischargeDeath
1533122
2532033
>331526

Number of Patients Managed Under General or
Spinal/Epidural Anesthesia
YearTotal no.Emergency cases
1995152483 (5.4%)
1996158462 (3.9%)
1997162451 (3.1%)

(T. Kochi)

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