Search

An increasing number of cancer patients are treated with anti-cancer chemotherapy and may require not only elective but also emergency surgery. Anti-cancer agents may have adverse effects on various organs and negative effects on subsequent anesthetic management Anesthesiologists must therefore be aware of potential toxicity of anti-cancer agents. The common toxicities include cardiac, pulmonary, bone marrow, renal and hepatic effects. Cardiopulmonary toxicity caused by drugs such as anthracylines and bleomycin is of major concern for anesthesiologists. Other toxicities, however, also require special anesthetic considerations in anes- thesia. Toxicities can be cumulative and irreversible as with anthracyclines, and therefore, attention also has to be paid to the past history of chemotherapy. Preoperative assessment is key to consistent and uncomplicated management of anesthesia. Anesthesi- ologists should take a detailed history of cancer man- agement and understand precise chemotherapy regi- mens and specific side effects experienced by the patient.

To relieve or eliminate distress caused by invasive medical procedures, sedation is often used in routine clinical practice. Monitored anesthesia care (MAC) is needed in patients who receive increased doses of sedatives and/or analgesics, which may suppress the respiratory, cardiac, and/or vascular systems. Deep sedation, in particular, suppreses the nomal protective reflexes. It requires careful monitoring and intervention for patients. In Japan, sedation is performed in a large number of cases. It is unreasonable that only anesthesiologists administer MAC. In fact, sedation is often performed by non-anesthesiologists. In these circumstances, education and training for non-anesthesiologists are important

For more than 20 years morphine for spinal analgesia in patients with refractory cancer pain has been one of the cornerstones for the management of chronic, medically intractable pain. In general, most types of cancer pain are treatable following the guideline of Cancer Pain Relief well established by the WHO. However, some patient are unable to tolerate pain only following the guideline and often suffer with side-effects from high doses of opioid and from prescribed multiple adjuvant drugs. Due to the proximity to the receptor sites, the therapeutic efficacy of intrathecal opioid application lasts longer and also reduces systemic side effects. Intrathecal drug application is cost effective and can significantly improve the quality of life in selected patients with limited life expectancy. However, an intensive training of physicians, careful patient selection, awareness of specific complications, and arrangement of social back-up medical system are essential to commence intrathecal morphine application using implantable access port. This article introduces the basic idea of intrathecal morphine therapy with implantable access port (not pumps) as cost effective, alternative therapy for cancer patient suffering from intractable pain.

We experienced two cases of malignant tumors in the neck with difficulties in airway control. In case 1, difficult airway was anticipated from the CT scan taken before the operation, but the glottis was observed easily by using laryngoscope. Therefore we judged intubation easy and rapid induction was performed, but the tube did not go in farther. When we pushed it in bleeding made the ventilation impossible, and the airway had to be ensured by tracheotomy. In case 2, difficult airway was anticipated from the CT scan. Making use of our experience in case 1, tracheotomy was performed under neuroleptanesthesia, but it was a too heavy burden for the patient. There are various methods of airway control and it is necessary for us to master the skills of them, but it is much safer to anticipate difficult airway by careful preoperative evaluation and manage accordingly than to find a way out of an emergency with these skills.

Cardiology consultations are often requested preoperatively for patients with cardiovascular problems. However, there are frequently differences in the evaluation of preoperative cardiac risks among cardiologists, surgeons and anesthesiologists. In order to obtain possible solutions to this problem, we conducted a survey of preoperative cardiology consultations performed directly by cardiologists. The survey indicates a lack of interaction with anesthesiologists and insufficient information on the surgical procedures and anesthesia for cardiologists to assess compromising cardiac risks. In addition, many cardiologists suggested that exercise tolerance required for surgical procedures should be 7 METs or more for surgical patients.