1/11. 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) |
2/11. Remifentanil and anaesthesia for carcinoid syndrome.Carcinoid syndrome creates many challenges during anaesthesia, including hypertension, hypotension and bronchospasm. These challenges are less common and less severe after the routine use of octreotide. We describe the use of remifentanil as part of the anaesthetic management of a 67-yr-old man undergoing resection of a carcinoid tumour of the terminal ileum. The combination of perioperative octreotide administration, intraoperative remifentanil infusion and sevoflurane anaesthesia, with postoperative epidural analgesia proved satisfactory. We review the recent literature and suggest that remifentanil is a useful addition to the armamentarium of the anaesthetist in the management of a patient with carcinoid syndrome.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
3/11. Epidural anaesthesia for transurethral resection of the prostate in a patient with carcinoid syndrome.The anaesthetic management of a 63-year-old patient with carcinoid syndrome presenting for transurethral resection of the prostate (TURP) is described. Before surgery antibradykinin, antiserotonin and antihistamine drugs were used in addition to SMS 201-995, a long-acting somatostatin analogue, to prevent the intraoperative release of hormones associated with this syndrome. Several techniques of general anaesthesia have achieved successful patient outcomes. Monitoring included pulse oximetry and radial artery cannulation. After infusion of Ringer's lactate, 750 ml, and 25 per cent albumin, 150 ml, an incremental epidural block with xylocaine two per cent without adrenaline was administered to achieve ideal operating conditions without any change in haemodynamic variables or oxygen haemoglobin saturation. Epidural anaesthesia seems to be a safe alternative to general anaesthesia in patients with carcinoid syndrome presenting for TURP.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |
4/11. somatostatin, anaesthesia, and the carcinoid syndrome. Peri-operative administration of a somatostatin analogue to suppress carcinoid tumour activity.A patient with carcinoid syndrome on long-term antiserotonin therapy with parachlorophenylalanine, experienced a flushing attack with hypotension during the prophylactic administration of aprotonin prior to the induction of anaesthesia. When she was subsequently prepared with a long-acting somatostatin analogue, octreotide (Sandostatin, Sandoz SMS 201-995), plasma levels of tumour-released hormones were reduced and anaesthesia for resection of hepatic metastases was uneventful. The advantages of an anaesthetic approach based on inhibition of carcinoid tumour activity, rather than antagonism of released hormones, are discussed.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
5/11. Pre-treatment with somatostatin in the anaesthetic management of a patient with carcinoid syndrome.Carcinoid syndrome produces flushing, bronchoconstriction and gastrointestinal hypermotility secondary to serotonin, histamine, bradykinin and prostaglandin release. A variety of drugs, foods and anaesthetic agents may provoke this syndrome. Under anaesthesia, the flushing produced may be associated with acute hypotension and cardiovascular collapse; this phenomenon is called a carcinoid crisis. Recently, somatostatin analogue has been used successfully to treat intraoperative carcinoid crisis. In this report, we present a 66-year-old lady with carcinoid syndrome who was pre-treated with 50 micrograms somatostatin analogue IV and IM prior to surgical manipulation. The anaesthetic course was relatively uneventful and the patient did well postoperatively.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/11. Carcinoid syndrome: comparison of pretreatment regimes in the same patient.Severe difficulties were encountered when a 47 year old man, with symptomatic carcinoid pretreated with ketanserin 80 mg twice daily was anaesthetised for hepatic arterial embolisation. The same patient, having had three days pretreatment with parachlorophenylalanine 500 mg four times daily and cyproheptadine 4 mg three times daily in addition to the ketanserin, was anaesthetised a week later without any difficulties. On the second occasion much better symptom control had been achieved. It is suggested that pretreatment with ketanserin alone is insufficient in severely symptomatic carcinoid and that the best possible medical control of symptoms should be achieved before anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/11. Valve replacement in carcinoid syndrome. Anaesthetic management for tricuspid and pulmonary valve surgery.This report describes the anaesthetic management of a patient with carcinoid syndrome for cardiac catheterisation followed by replacement of the tricuspid and pulmonary valves. Apart from the precautionary use of aprotinin and steroids, routine techniques of anaesthesia and monitoring were used without complications attributable to secretions from tumour tissue.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
8/11. 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) |
9/11. ketamine-diazepam anaesthesia in a patient with carcinoid syndrome.The use of ketamine in patients with carcinoid syndrome is controversial because of the catecholamine response to this agent. Prior administration of diazepam modifies the catecholamine response to ketamine and may make its use in such patients safe. The successful use of a diazepam-ketamine technique for anaesthesia of a patient with malignant carcinoid syndrome and associated tricuspid valve disease who underwent laparotomy and hepatic artery ligation is described. The theoretical advantages of safe ketamine anaesthesia in carcinoid patients are discussed and the relevant literature reviewed. To the authors' knowledge the successful use of ketamine anaesthesia in carcinoid syndrome has not previously been reported.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |
10/11. Anaesthesia for removal of carcinoid metastases. A case of serotonin-secreting secondary tumour in the lumbar spine.A case of general anaesthesia for removal of carcinoid metastases is presented. Evidence of serotonin hypersecretion was shown by raised levels of 5-hydroxyindoleacetic acid, hypertension and tachycardia. The rarity of osteoblastic carcinoid metastases is discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
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