Department of Anesthesiology and Intensive Care Unit
Hiroyuki Yamamoto, Aiko Ooshita, Kazuaki Hiraga, Kei Torigoe
The Department of Anesthesiology and Intensive Care Unit (ICU) consists of five staff members (four Japanese Society of Anesthesiologists Board Certified Anesthesiologists and a Japanese Society of Anesthesiologists (JSA) Qualified Anesthesiologist) and two or three rotating residents. Each year, we provide more than 2,600 anesthesia services in eight operating rooms and over 1,300 patients have been admitted to the ICU. A large number of operations in the head and neck surgery division and procedures involving a thoracotomy for lung and esophageal cancer are one of the features of this hospital. Accordingly, a special anesthesia induction method for difficult airways and use of the one-lung ventilation technique are often necessary for anesthesiologists. Currently, our ICU admits mainly postsurgical patients who have undergone major abdominal, thoracic and complex surgical procedures, as well as patients who have suffered from serious preoperative complications. Increasingly complex procedures are being performed on more seriously ill patients with coronary disease, chronic obstructive pulmonary disease (COPD), neurological disorders and so on. The ICU needs to play an increasingly important role in postsurgical care for such patients. The goals of the Department of Anesthesiology and Intensive Care Unit are to provide anesthetic and perioperative care to patients, with their safety being the highest priority.
Five staff members (three full-time and two visiting anesthesiologists), four rotating residents and 12 part-time anesthesiologists cover eight operating rooms. A preanesthesia case presentation is held every morning to examine the case of the day and discuss the anesthesia problem and strategy for patients with various complications. In 2015, we provided 2,834 anesthesia services (Table 1). The annual number of patients admitted to the ICU was 1,347 and more than 95% of them were postsurgical patients (Table 2).
The relationship between intraoperative blood loss and dry-side fluid management during liver resection was studied. Fluid management was performed based on the value of stroke volume variation (SVV) obtained by the FloTrac system, which has a strong correlation with central venous pressure (CVP). This technique demonstrated decreased intraoperative blood loss during liver resection.
The Department of Anesthesiology and Intensive Care Unit has no resident. For rotating residents, we provide opportunities of epidural anesthesia, one-lung ventilation technique for thoracotomy, and difficult airway management including fiberoptic intubation. A Journal club is also held once a week in addition to the everyday morning conference. We support residents who hope to obtain the qualification of anesthesiologist or JSA Qualified Anesthesiologist during rotation periods.
In 2017, a new surgical and endoscopic center will be built, which has 12 operating rooms. We expect a 20 to 25% of increase in anesthesia cases. To accomplish this, an increase of the staff is essential. Next year, two staff anesthesiologists will join our department and we are preparing to increase the number of operations with these additional members.