Carcinoid syndrome and perioperative anesthetic considerations

Carcinoid Heart Disease with Right to Left Shunt across a Patent Foramen Ovale: A Case Report and Review of Literature

“…Other therapies that have reported benefit include steroids, antihistamines, and H2 blockers. 19 Given the relatively high rate of postoperative mortality associated with cardiac surgery for CHD, other modalities such as percutaneous transcatheter closure of PFO have been evaluated. 20 Mansencal et al reported that percutaneous closure of PFO is feasible for CHD and systemic deoxygenation due to PFO and resulted in symptom improvement at 6 months with only residual shunting.…”

Intra-operative carcinoid crisis: Revised anaesthesia management

“…[3] Histamine-releasing drugs and succinylcholine which can release peptides should be avoided. [4] Bronchospasm and hypotension can occur perioperatively.…”

Experience of significant hemodynamic instability that occurred during excisional biopsy in a patient with unrecognized bronchial carcinoid tumor

“…It binds tightly to the type 2 somatostatin receptor on tumor cells. It prevents the tumor from releasing a mediator and counteracts the activities of the circulating peptides by inhibiting either phosphatidylinositol or adenylate cyclase [3]. …”

“…In our case, it was hypothesized that the carcinoid crisis might have been triggered by the surgeon's manipulation of the tumor. When unstable hemodynamic conditions occur, it is important for the operating surgeon to cease the manipulation of the tumor until the vital signs are stabilized [3]. Thus we should have asked the surgeon to stop the operation at the onset of the carcinoid crisis and administered an experimental IV injection of octreotide.…”

“…The pathophysiology of carcinoid is well known, but intraoperative carcinoid events are difficult to predict [3]. Presently, octreotide plays a pivotal role both in managing carcinoid symptoms before surgery and in controlling acute symptoms of carcinoid crisis during surgery.…”