Perioperative care for cancer patients with limited vital organ function is a major challenge for anesthesiologists since, anesthesia and surgery may cause further deterioration in 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 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 stimulations of surgical trauma. This is achieved by regarding anesthetic management as a form of perioperative care.
As stated above, our colleagues (four staff anesthesiologists, five visiting anesthesiologists and two to three residents) serve in various capacities as anesthetists and intensive care physicians.
In 2008, we performed 2183 anesthetic procedures. The annual number of patients admitted to the intensive care unit (ICU) amounted to 1163. 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 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 470.
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.
● A. Kochi ●
| Number of Patients Managed Under General or Spinal/Epidural Anesthesia | ||
| Year | Total no. | Emergency cases |
| 2004 | 2265 | 101 (4.5%) |
| 2005 | 2261 | 81 (3.6%) |
| 2006 | 2320 | 75 (3.2%) |
| 2007 | 2278 | 70 (3.1%) |
| 2008 | 2183 | 47 (2.2%) |
| Number of Patients Admitted to the ICU | ||
| Year | No. of Cases | (Cases per month) |
| 2004 | 1033 | (86.1) |
| 2005 | 1049 | (87.4) |
| 2006 | 1191 | (99.3) |
| 2007 | 1210 | （100.8） |
| 2008 | 1163 | (97.0) |
| Prognosis of Organ Failure Treated in the ICU (July 1992.7. - 2008.12.) | |||
| Primary malignancy | No. of pts | Discharge* | Death* |
| Postoperative Patients Stomach Pancreas & Biliary tract Colorectal Esophagus Head & Neck Liver Panperitonitis Lung Others | 39 53 37 45 45 23 8 52 15 | 26 19 23 24 35 9 3 22 7 | 13 34 14 21 10 14 5 30 8 |
| Post-chemo-radiotherapy Head & Neck GI tract Lung Others | 21 31 34 37 | 5 10 14 27 | 16 21 20 40 |
| *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 | 233 | 157 | 76 |
| 2 | 145 | 54 | 91 |
| ≥3 | 92 | 13 | 79 |
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