The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a nonprofit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. They are intended to provide guidance and assistance to anesthesia providers, their professional organizations, hospital and facility administrators, and governments for maintaining and improving the quality and safety of anesthesia care. The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document.

Hemodynamic and depth of anesthesia (DOA) monitoring are used in many high-risk surgical patients without well-defined indications and objectives. We implemented monitoring guidelines to rationalize hemodynamic and anesthesia management during major cancer surgery. In early 2014, we developed guidelines with specific targets (Mean arterial pressure > 65 mmHg, stroke volume variation < 12%, cardiac index > 2.5 l min m, central venous oxygen saturation > 70%, 40 < bispectral index < 60) for open abdominal cancer surgeries > 2 h. Pre-, intra-, and post-operative data were collected from our electronic medical record database and compared before (March-August 2013) and after (March-August 2014) guideline implementation. A total of 596 patients were studied, 313 before (Before group) and 283 after (After group) guideline implementation. The two groups were comparable for age, ASA score, physiological P-POSSUM score, and surgery duration, but the operative P-POSSUM score was higher in the after group (20 vs. 18, p = 0.009). The use of cardiac output, central venous oxygen saturation and DOA monitoring increased from 40 to 61%, 20 to 29%, and 60 to 88%, respectively (all p-values < 0.05). Intraoperative fluid volumes decreased (16.0 vs. 14.5 ml kg h, p = 0.002), whereas the use of inotropes increased (6 vs. 11%, p = 0.022). Postoperative delirium (16 vs. 8%, p = 0.005), urinary tract infections (6 vs. 2%, p = 0.012) and median hospital length of stay (9.6 vs. 8.8 days, p = 0.032) decreased. In patients undergoing major open abdominal surgery for cancer, despite an increase in surgical risk, the implementation of guidelines with predefined targets for hemodynamic and DOA monitoring was associated with a significant improvement in postoperative outcome.

Background: Gastric cancer is a complex disease and the third leading cause of cancer deaths worldwide. To date, surgery remains the only curative strategy in locally advanced gastric cancer (LAGC) patients (pt), although the results of the MAGIC trial supported the implementation of a perioperative treatment (ttx) with epirubicincisplatin-5FU (ECF). Since 2019, the FLOT4-AIO trial showed that perioperative 5FUleucovorin-oxaliplatin-docetaxel (FLOT) improved median overall survival (mOS) compared to ECF. We aimed to assess outcome differences in a non-clinical trial scenario in our LAGC cohort, according to multidisciplinary management in a highly specialized gastro-esophageal cancer functional unit (UFEG) integrating different specialists.Methods: From 2012 to 2018, 114 newly diagnosed LAGC pt were referred to our UFEG. Several UFEG specialists at this first consultation evaluated every case, in order to establish a multimodal therapeutic plan. UFEG is comprised of digestive surgeons, medical oncologists, radiation oncologists, nutritionists, advanced practice nurses, radiologists, digestive endoscopists, pathologists, supportive care physicians, and social workers. All demographic, treatment and survival data were extracted retrospectively from available electronic medical records. abstracts Annals of Oncology Volume 31 -Issue S3 -2020 S193

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