1/6. Perianaesthetic risks and outcomes of abdominal surgery for metastatic carcinoid tumours.patients with metastatic carcinoid tumours often undergo surgical procedures to reduce the tumour burden and associated debilitating symptoms. These procedures and anaesthesia can precipitate a life-threatening carcinoid crisis. To assess perioperative outcomes, we studied retrospectively the medical records of adult patients from 1983 to 1996 who underwent abdominal surgery for metastatic carcinoid tumours. Preoperative risk factors, intraoperative complications and complications occurring in the 30 days after surgery were recorded. Perioperative complications or death occurred in 15 of 119 patients (12.6%, exact confidence interval 7.2-19.9). None of the 45 patients who received octreotide intraoperatively experienced intraoperative complications compared with eight of the 73 patients (11.0%) who did not receive octreotide (P=0.023). The presence of carcinoid heart disease and high urinary output of 5-hydroxyindoleacetic acid preoperatively were statistically significant risk factors for perioperative complications.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Anaesthetic considerations in bronchial adenoma.The patient with bronchial adenoma can present a puzzling diagnostic dilemma as well as challenging problems in anaesthetic management. Several aspects are reviewed in this report. Diagnostically these include chest roentgenographic findings and unique pulmonary function test. Problems in anaesthetic management include possible development of acute carcinoid syndrome, as this tumour is usually of the carcinoid variety. In addition, the tumour may act as a ball valve, causing uneven ventilation of affected lung with expiratory air trapping. Several factors may necessitate prolonged bronchial blockage during anaesthesia. These include a friable mass which may bleed profusely upon manipulation, infected and atelectatic parenchymal tissue beyond the obstruction, copious volumes of purulent secretions, and one lung ventilation during resection.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/6. The prophylactic use of octreotide in a patient with ovarian carcinoid and valvular heart disease.This case report describes the use of octreotide, a long-acting somatostatin analogue, in the management of a patient with an ovarian carcinoid tumour and severe cardiac valvular disease. This patient underwent laparotomy and tumour resection without complication. Anaesthesia was induced with midazolam, fentanyl, and vecuronium, and maintained with isoflurane as well as additional fentanyl and vecuronium. However, we feel that it was the use of octreotide that prevented a life-threatening crisis intraoperatively, and recommend its use in patients with carcinoid syndrome undergoing anaesthesia and surgery.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/6. Severe hypertension and flushing in a patient with a non-metastatic carcinoid tumour. hypertension and flushing with a solitary carcinoid tumour.A case of multiple endocrine adenopathy type I associated with a solitary carcinoid tumour is described. During anaesthesia and characteristic syndrome consisting of hypertension, tachycardia and flushing occurred. The possible mechanism for this are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/6. Anaesthetic management of a patient with carcinoid tumor undergoing myocardial revascularization.Carcinoid tumors with hepatic involvement can produce intense flushing, tachycardia, hypotension or hypertension and diarrhoea. patients with limited cardiac reserve may not tolerate these effects under anaesthesia. Valvular heart disease associated with carcinoid tumors has been reported, but there is no record in the literature of such an association with coronary artery disease. This report presents the anaesthetic management of a patient with coronary artery disease and carcinoid tumor undergoing myocardial revascularization. Emphasis is placed on the rational use of anaesthetic and adjunctive agents which will minimize the incidence of carcinoid symptons. The salient features of the management are prevention of release of vasoactive substances by the use of promethazine hydrochloride during operation, the avoidance of stropine, prophylactic administration of corticosteroids and smooth induction of anaesthesia by the use of diazepam and dimethyl-tubocurarine iodide (Metocurine).- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
6/6. Resection of distal tracheal and carinal tumours with the aid of cardiopulmonary bypass.Two cases of carinal and tracheal reconstruction with the aid of cardiopulmonary bypass (CPB) are presented. The technical problems of surgery and anaesthesia which necessitated CPB in these two patients are discussed. CPB provides both adequate oxygenation and an unobstructed surgical field with optimal access to the trachea and carina. It permits atraumatic handling of the airways and reduction of anastomotic tension during the repair.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |