Anesthesiology and Pain Clinic Division

Introduction
The Anesthesia and Palliative Care Division consists of eleven staff doctors. We conduct all general anesthesia in 15 operating rooms in the central operation ward, one operating room of the Radiotherapy Division, and one operating room for radioisotope therapy in ward 13A. We employ several anesthetic management protocols for radical cancer surgery. We also conduct almost all patient management in the Postoperative Care Unit (HCU) and the Intensive Care Unit (ICU). Acute and chronic pain symptoms of cancer patients are treated in the Palliative Care Division, which consists of an outpatient clinic and an acupuncture clinic and room visiting service, according to requests by surgeons.

Routine Activities
In 2001, the annual number of operations was 4775 cases and 3750 (3364 in 2000) operations were performed under general anesthesia at the National Cancer Center Hospital. The number of emergent operation was 449 cases in which 247 cases were under general anesthesia. In addition to the staff anesthetist, 2 to 4 rotating residents work in our division.
Every morning, we discuss our anesthetic plans for all patients of that day, with particular attention paid to high-risk cases. For these patients, careful perioperative management in cooperation with the surgeons is essential. We are frequently consulted by surgeons about patients with high surgical risks, and we discuss these cases at the weekly conference held on Monday evening. The postoperative courses of high-risk patients are also reported and discussed at this conference.
The method of anesthesia is general anesthesia with epidural anesthesia in most cases for abdominal and thoracic surgery. For neurosurgery, Ophthal-mologic surgery, Head and Neck surgery, Breast surgery and Orthopedic surgery, only general anesthesia is used. For postoperative pain relief of abdominal and thoracic operation, epidural morphine infusion has been used in our division since 1981. With this method, good pain relief can be achieved in most cases and the incidence of postoperative respiratory complication has reduced.
Palliative Care Division performs pain clinic and palliative care which started in 1999 June. Annual number of consultations within hospital and from outpatient is about 500 cases, in which 35 cases required nerve blocks and 60 cases required acupuncture and moxa cautery. In outpatient clinic, preoperative assessments for high-risk patient of selective surgery and donor of marrow transplantation are also performed.

Research Activities
To maintain the high quality of anesthesia services, we must follow a variety of routine activities as well as stay abreast of new development. One of our routine activities is to participate in basic and clinical researches. In our hospital it is not unusual for us to encounter patients with severely damaged vital organs. Such cases are discussed in length and reported in annual anesthesia meetings. In 2001, for example, we reported several case reports in the meetings.
Our division is among the most experienced in the world in the use of epidural morphine. We have been studying its basic and clinical aspects, including the pharmacokinetics of morphine, the relationship between its concentration and analgesic effect, and adequate morphine dosages for multi-aged patients of various operations. Epidural morphine is quite useful for preventing postoperative complications, especially respiratory complication, of high-risk patients.
Our main interests in basic and clinical research are as follows:
1. Development of new perioperative management protocols for radical cancer operations such as esophagectomy, hepatectomy and pneumonial lobectomy;
2. Preoperative evaluation of surgical risks in geriatric patients;
3. Drug therapy for cancer-related neurogenic pain;
4. Establishment of oncological anesthesiology and oncological critical care medicine;
5. Study of the effects of acupuncture on cancer-related pain and central and peripheral nervous system symptoms.

M. ENDOH

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