Peri-Operative Care After Oesophago-gastric Surgery

Adult critical care is an important, high profile and high-cost area of modern healthcare provision. Postoperative management after elective oesophago-gastric surgery for cancer has a huge bearing on mortality and morbidity. Assessment of the impact of surgery requires reliable tools that assess the morbidity and mortality risks, including the severity of the surgical insult. These tools have evolved over the last century but are not patient specific. In general, intensive care provides level 3 care to patients requiring mechanical ventilation where as a high dependency unit (level 2 care), has a vital role in patients requiring support for a single failing organ system. Post-operative monitoring, analgesia and nutrition are the main tenets of critical care. Tissue injury secondary to surgical trauma produces profound changes to all body systems and triggers the stress response. Although considerable effort has gone into defining the stress response over the past century, very little advance has been made to negate or modify the stress response or its effects on the surgical patient. The surgical insult also produces inherent changes to ventilatory mechanics. The combination triggers single or multi-organ failure. The main systems affected in this cascade are the respiratory, cardiovascular and renal systems. Hepatic and coagulation systems failure tend to be late and multi-factorial. Critical care units have evolved in the multifaceted management of these failing systems.

Keywords: Anaesthesia, Analgesia, Discharge criteria, Post-operative care, Critical care, Scoring systems, Post-operative monitoring, Nutrition, The stress response, System support, Modes of ventilation.