Perioperative Care of Children with Cancer: An Overview

The prognosis and outcome for pediatric oncology patients have improved considerably over recent decades (1-12). Earlier published reports indicated pessimistic outcomes for oncology patients admitted to the pediatric intensive care unit (PICU) and some even concluded that the application of intensive care therapies was futile (1). As a result, pediatric oncology units, especially those that offered stem cell transplants, developed a very broad therapeutic repertoire. Patients with a severity-of-illness, which would have ordinarily dictated a PICU admission, remained in these units for treatment, including attempts at hemodynamic support for early septic and=or hypovolemic shock and renal replacement therapies (9). Admission to the PICU was reserved for those children requiring mechanical ventilation, usually for acute respiratory failure. This philosophy often resulted in delayed PICU admission and use of appropriately aggressive interventions until "late in the spiral of multisystem organ failure" (7), if a PICU admission was offered at all.