Anesthesiology and Intensive Care Unit

Introduction

Perioperative care for cancer patients with limited vital organ function is a major challenge for anesthesiologists; this is because, in general, anesthesia and surgery may cause further deterioration in physiological functions. Perioperative impairment of vital organ function has traditionally been defined as surgical stress and is determined quantitatively by measuring the physiological parameters that represent the corresponding vital organs. Recent evidence suggests that such a stress response to surgery involves not only the vital organs but also the neuro-endocrine-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 anesthetic management as a form of perioperative care.

Routine Activities

As stated above, our colleagues (3 staff anesthesiologists and 2–3 residents) work as anesthetists and intensive care physicians.
In 2007, we performed 2278 anesthetic procedures. The annual number of patients admitted to the intensive care unit (ICU) amounted to 1210. Our concern in ICU management is not only postoperative cardio-respiratory care but also the critical care of patients who have succumbed to organ failure after medical or surgical treatment for cancer. The cumulative number of patients with organ failure treated in the ICU since the establishment of the National Cancer Center Hospital East is 440.
Daily activity commences with ICU rounds and preanesthesia case presentation. ICU rounds are also conducted every evening after completion of elective surgical procedures.
A journal club meeting is conducted twice a　week to update the staff with knowledge regarding the recent advances in anesthesia and critical care medicine.

● A. Kochi ●

Number of Patients Managed Under General or Spinal/Epidural Anesthesia
Year Total no. Emergency cases
2003 2159 114 (5.3%)
2004 2265 101 (4.5%)
2005 2261 81 (3.6%)
2006 2320 75 (3.2%)
2007 2278 70 (3.1%)

Number of Patients Admitted to the ICU
Year No. of Cases (Cases per month)
2003 1065 (88.8)
2004 1033 (86.1)
2005 1049 (87.4)
2006 1191 (99.3)
2007 1210 （100.8）

Prognosis of Organ Failure Treated in the ICU (July 1992 to December 2007)
Primary malignancy No. of pts Discharge* Death*
Postoperative Patients      
Stomach 39 26 13
Pancreas & Biliary tract 53 19 34
Colorectal 35 21 14
Esophagus 40 21 199
Head & Neck 41 32  
Liver 19 9 10
Panperitonitis 8 3 5
Lung 47 20 27
Others 15 7 8
Post-chemo-radiotherapy      
Head & Neck 20 5 15
GI tract 30 10 20
Lung 31 12 19
Others 62 24  
*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.

Prognosis in Relation to the Number of Failed Organs
No. of failed organs No. of pts Discharge Death
1 217 145 72
2 137 52 85
≥3 86 12 74

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