Anesthesiology and Intensive Care Unit
Introduction
Perioperative care for cancer patients with limited vital organ function is a major challenge for anesthesiologists, as anesthesia and surgery may further deteriorate physiological functions in general. 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 neuroendocrine-immune system and persists for several 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 the anesthetic management as perioperative care.
Routine Activities
As stated above, our colleagues (four staff anesthesiologists and two to three residents) are working as anesthetists and intensive care physicians. In 1998, we performed 1,642 anesthetic procedures, including 22 cases of regional block. The annual number of patients admitted to the intensive care unit (ICU) amounted to 887. 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 165.
Daily activity starts with ICU rounds and pre-anesthesia case presentation. 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.
Patients with pulmonary tumors have been found to develop cardiac arrhythmias after thoracic surgery. We are studying methods of predicting and preventing such arrhythmias, and are also 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 analyses, we believe that such physiological interests should always be clinically relevant. Future research activities will be directed toward the establishment of new methods of perioperative care in the field of surgical oncology.
New Developments
An 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. In 1998, we performed analgesic nerve blocks in 16 cases, including 5 outpatients. This system will further improve patient safety and the quality of pain control.
Statistics
| Year | No. of cases | Emergency cases |
| 1995 | 1524 | 83 (5.4%) |
| 1996 | 1584 | 62 (3.9%) |
| 1997 | 1624 | 51 (3.1%) |
| 1998 | 1642 | 45 (2.6%) |
| Year | No. of cases | (Cases per month) |
| 1995 | 671 | (55.9) |
| 1996 | 704 | (58.7) |
| 1997 | 755 | (62.9) |
| 1998 | 887 | (73.9) |
| Primary malignancy | No. of pts | Discharge* | Death** |
| Postoperative patients | |||
| Stomach | 32 | 21 | 11 |
| Pancreas and biliary tract | 30 | 6 | 24 |
| Colorectal | 15 | 6 | 9 |
| Esophagus | 14 | 8 | 6 |
| Head and neck | 13 | 10 | 3 |
| Liver | 10 | 4 | 6 |
| Panperitonitis | 5 | 1 | 4 |
| Lung | 7 | 3 | 4 |
| Others | 6 | 2 | 4 |
| Post-chemoradiotherapy | |||
| Head and neck | 7 | 0 | 7 |
| Gastrointestinal tract | 7 | 2 | 5 |
| Lung | 5 | 0 | 5 |
| Others | 14 | 4 | 10 |
patients who recovered from organ failure but subsequently died from
the primary disease during hospitalization.
| No. of failed organs | No. of pts | Discharge | Death |
| 1 | 63 | 38 | 25 |
| 2 | 57 | 20 | 37 |
| 3 or more | 44 | 5 | 39 |
(A. Kochi)
