Origin of oncologic anesthetic techniques.

The patient with cancer poses a challenge to the anesthesiologist for a variety of reasons including the effects of cancer (altered hemostasis, depressed immune response, and compromised airways), the effects of chemotherapy (malfunction of the myocardium, lungs, kidneys, and bone marrow; depression of pseudocholinesterase; and production of the syndrome of inappropriate secretion of antidiuretic hormone), as well as effects of radical cancer surgery (massive blood loss and the need for prolonged anesthesia). Anesthetic techniques to address these problems had their beginnings in the Department of Anesthesiology at Memorial Sloan-Kettering Cancer Center. This paper traces the development of modern oncologic anesthesia and discusses how these advances significantly reduced operative mortality.