Anesthesia Service

he Anaesthesia Service plays a central and transversal role within oncological surgical pathways, ensuring high-quality, safe, and patient-centered anaesthetic care. Anaesthesia services are provided at all stages of care, from preoperative assessment to postoperative monitoring, with a particular commitment to highly complex procedures, including organ transplantation. 

A distinctive feature of the unit’s activity is the anaesthetic management of liver transplants, which represent one of the Institute’s core missions. Liver transplantation is among the most challenging clinical scenarios in anaesthesia, requiring advanced expertise in intraoperative patient management, anaesthetic risk assessment, invasive hemodynamic monitoring, fluid balance management, organ protection, and the prevention of perioperative complications. 

In addition to transplant procedures, the unit provides anaesthetic support for all oncological surgeries, both major and minor, elective and emergency. Its scope includes surgeries in several fields such as hepato-biliopancreatic, thoracic, gynecological, colorectal, urological, breast and reconstructive plastic surgery, ENT, and maxillofacial surgery. For each patient, the anaesthetic pathway is tailored based on associated comorbidities, surgical complexity, and the type of oncological treatment planned. The approach is multidisciplinary and developed in continuous collaboration with other specialist teams. 

A key moment in patient care is the preoperative assessment, which takes place during the pre-admission phase. This includes a thorough clinical evaluation supported by specialist consultations, laboratory tests, cardiological and pneumological assessments, functional tests, and, when needed, psychological and nutritional support. Preoperative optimization aims to reduce anaesthetic risk and improve clinical outcomes through careful individualized planning and comprehensive patient information. 

In line with the principles of modern perioperative medicine, the unit promotes prehabilitation programs—multidisciplinary preoperative optimization pathways for patients undergoing major surgery. These programs integrate tailored physical activity, nutritional support, psychological counseling, smoking cessation strategies, chronic disease management, and promotion of treatment adherence. The goal is to improve the patient’s functional reserve, reduce postoperative complications, and enable a faster and more sustainable recovery. 

During surgery, Anaesthesiologist employs advanced monitoring techniques, including continuous (invasive and non-invasive) hemodynamic monitoring systems, depth of anaesthesia monitoring, and neuromuscular blockade assessment. The adoption of evidence-based protocols and intraoperative optimization strategies minimizes the risk of complications and enhances patient outcomes. 

Postoperative pain management is another quality marker of the unit’s work. Through a multimodal approach that combines systemic analgesics and regional anaesthesia techniques, pain is managed effectively and individually. The use of epidural catheters, ultrasound-guided nerve blocks, and PCA (Patient-Controlled Analgesia) devices is well established. Effective pain control is a key component of ERAS (Enhanced Recovery After Surgery) protocols, improving patient comfort and enabling early mobilization. 

With a view to innovation and expanding the range of services offered, the unit also provides anaesthetic care in non-operating room settings (NORA), for complex diagnostic or therapeutic procedures in environments such as interventional radiology, endoscopy, nuclear medicine, radiotherapy, and specialist outpatient clinics. In these settings, the same safety standards as those used in the operating theatre are applied, ensuring continuity of care and access to treatments essential for the oncological pathway. 

The unit also has recognized expertise in ultrasound-guided vascular access, performing over 1,500 procedures annually both electively and in emergency settings, ensuring technical precision and patient safety. The unit also manages complications (mechanical and infectious) after the implant and collaborates with hospital wards to ensure surveillance and maintenance of the devices. 

Special attention is given to pediatric anaesthesia, with trained personnel and dedicated protocols for managing anaesthesia in pediatric oncology patients. Activities include surgical procedures, diagnostic tests, and NORA-related sedation. The approach priorities are child protection, effective pain control, and good interaction with families. 

To offer increasingly personalized care focused on quality of life, the unit has introduced a dedicated acupuncture service for patients following the breast cancer treatments. Acupuncture, recognized as a complementary therapy, is offered to support the management of symptoms related to oncological treatments, including nausea, insomnia, anxiety, hot flushes, and neuropathic pain. The service is an integral part of the Institute’s care offering established in collaboration with other professionals in the oncology network to improve overall well-being and support patients throughout their treatment journey. 

From a training perspective, the unit is an accredited teaching site for medical residents in Anaesthesia, Intensive Care, and Pain Therapy at the University of Milan. Trainees actively participate in clinical activities under the supervision of experienced tutors in a highly stimulating environment that fosters the development of both technical and interpersonal skills. 

The unit also promotes a culture of quality, actively participating in clinical audits, accreditation processes, risk management, and continuous staff training. Its commitment to continuous improvement is reflected in the adoption of up-to-date guidelines, process standardization, and the implementation of clinical and technological innovations.