Pre-treatment with somatostatin in the anaesthetic management of a patient with carcinoid syndrome

Parris, Winston C. V.; Oates, John A.; Kambam, J. R.; Shmerling, Richard; Sawyers, John F.

doi:10.1007/bf03010865

Cited by 28 publications

(14 citation statements)

References 17 publications

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“…SSTA have been shown to be effective in preventing and reversing carcinoid crisis during clinical experinces. (Parris et al, 1988;Watson et al, 1990). Release of bioactive mediators both under spontaneous and evoked condition such as adrenoceptor agonist and pentagastrin have also been inhibited by SSTA in vitro study.…”

Section: Discussionmentioning

confidence: 94%

Somatostatin Analogues Do Not Prevent Carcinoid Crisis

Guo

Tang²

2014

Asian Pacific Journal of Cancer Prevention

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Background: Carcinoid crisis is a life-threating syndrome of neuroendocrine tumors (NETs) characterized by dramatic blood pressure fluctuation, arrhythmias, and bronchospasm. In the era of booming anti-tumor therapeutics, this has become more important since associated stresses can trigger carcinoid crisis. Somatostatin analogues (SSTA) have been recommended for prophylactic administration before intervention procedures for functioning NETs. However, the efficacy is still controversial. The aim of this article is to review efficacy of SSTA for preventing carcinoid crisis. Materials and Methods: PubMed, Cochrane Controlled trials Register, and EMBASE were searched using 'carcinoid crisis' as a search term combining terms with 'somatostatin'; 'octreotide'; 'lanreotide' and 'pasireotide' until December 2013. Results: Twenty-eight articles were retrieved with a total of fifty-three unique patients identified for carcinoid crisis. The most common primary sites of NETs were the small intestine and respiratory tract. The triggering factors for carcinoid crisis included anesthesia/ surgery (63.5%), interventional therapy (11.5%), radionuclide therapy (9.6%), examination (7.7%), medication (3.8%), biopsy (2%) and spontaneous (2%). No randomized controlled trials (RCTs) were identified and two case-control studies were included to assess the efficacy of SSTA for preventing carcinoid crisis by meta-analysis. The overall pooled risk of perioperative carcinoid crisis was similar despite the prophylactic administration of SSTA (OR 0.44, 95% CI: 0.14 to 1.35, p=0.15). Conclusions: SSTA wasnot helpful for preventing carcinoid crisis based on a meta-analysis of retrospective studies. Attentive monitoring and careful intervention are essential. Future studies with better quality are needed to clarify any effect of SSTA for preventing carcinoid crisis.

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Section: Discussionmentioning

confidence: 94%

Somatostatin Analogues Do Not Prevent Carcinoid Crisis

Guo

Tang²

2014

Asian Pacific Journal of Cancer Prevention

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“…It has been suggested that the use of octreotide renders the administration of drugs previously used in the management of carcinoid syndrome superfluous. 12,13 These drugs were used to block the action of mediators already released into the circulation and included serotonin and histamine antagonists, kallikrein inhibitors, and steroids among others. 3,4 However, octreotide appears to be the most efficacious treatment for carcinoid syndrome reducing symptoms in more than 70% of patients.…”

Section: Discussionmentioning

confidence: 99%

Orthotopic liver transplantation for carcinoid tumour metastatic to the liver: anesthetic management

Claure

Drover

Haddow

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To report the anesthetic management of a patient with carcinoid tumour metastatic to the liver who presented for orthotopic liver transplantation. Anesthetic implications of metastatic carcinoid tumour on liver transplantation and the use of octreotide are discussed.Clinical features: A 51-yr-old woman with intestinal carcinoid tumour metastatic to the liver presented for orthotopic liver transplantation, a recent treatment option for patients with extensive hepatic carcinoid metastases and disabling symptoms unresponsive to conventional therapy. Despite continuous administration of the somatostatin analogue octreotide via a hepatic artery infusate pump, the patient suffered from daily break through symptoms, which included flushing, palpitations, paroxysmal hypertension, and dyspnea. The patient presented to the operating room with sinus tachycardia and severe arterial hypertension. Octreotide and phentolamine were used to prevent further mediator release and to control the paroxysmal hypertension. Midazolam, fentanyl, thiopental, succinylcholine, vecuronium, and isoflurane were used to induce and maintain anesthesia safely. An intravenous octreotide infusion was initiated after induction and continued throughout the case. Infrequent and non-threatening peaks in arterial blood pressure were readily treated with small intravenous doses of vasoactive drugs and octreotide. No other manifestations of the carcinoid syndrome occurred. The patient had an uneventful recovery and was discharged on postoperative day #6. Conclusion:The patient safely underwent orthotopic liver transplantation for treatment of symptomatic carcinoid tumour metastatic to the liver. The anesthetic management followed recent recommendations favouring the use of octreotide to prevent patients from becoming symptomatic. Outlined dosing regimen for octreotide provided satisfactory hemodynamic stability.Objectif : Présenter le traitement anesthésique d'une patiente atteinte d'une tumeur carcinoïde, avec métastase au foie, admise pour une transplantation hépatique orthotopique. Les implications anesthésiques de la tumeur sur la transplantation du foie et l'usage d'octréotide sont étudiées. Éléments cliniques : Une femme de 51 ans souffrant d'une tumeur intestinale carcinoïde, avec métastase au foie, s'est présentée pour une transplantation du foie orthotopique, une nouvelle option thérapeutique pour les patients chez qui les métastases carcinoïdes du foie sont étendues et les symptômes invalidants ne sont pas éliminés par la thérapie traditionnelle. Malgré l'administration continue d'un analogue de la somatostatine, l'octréotide, au moyen d'une perfusion insérée dans l'artère hépatique, la patiente souffrait d'une poussée quotidienne de symptômes qui comprenaient des bouffées vasomotrices, des palpitations, de l'hypertension paroxystique et de la dyspnée. À son arrivée à la salle d'opération, la patiente présentait une tachycardie sinusale et une hypertension artérielle sévère. Conclusion : La patiente a subi en toute sécurité une transpla...

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“…Preventive administration of octreotide is usually enough for minor surgeries (15). For major surgeries, a preoperative dose of octreotide is followed by a continuous infusion during surgery that should be doubled in the case of carcinoid crisis.…”

Section: Preoperative Carementioning

confidence: 99%