Carcinoid syndrome
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Look for evidence of right ventricular-failure as a consequence of endocardial fibrosis affecting pulmonary and tricuspid valves.
These mediators are largely metabolised in the lungs prior to reaching the left side of the heart. (although ~10% of patients develop LVF) #ref

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Nov 14, 2012
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If patient has diarrheoa as part of their symptom profile, ensure electrolyte abnormalities are ruled out.

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Sep 10, 2011
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Anxiety can trigger release of mediators. Consider pretreatment with anxiolytics. refl.in/8i

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Jul 02, 2011
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Octreotide SC tds 2wks prior to surgery & IV at induction. Intraop IV infusion. Boluses may be req’d intraop to treat severe hypotension. Wean octreotide over 7-10 days following tumour resection #ref

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Jul 03, 2011
50-500mcg tds SC 2weeks preop, 100mcg IV at induction, IV infusion 100mcg/hr, 10-20mcg boluses intraop for severe hypotension. #ref
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Octreotide should be administered 24-48hrs prior to stressful events (surgery, anaesthesia, chemotherapy) and continued throughout the procedure. Stoelting Anaes Coext Dis p290 refl.in/8k

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May 18, 2011
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Consider arterial line to manage haemodynamic lability. Hypotension may result from release of bradykinins (vasodilation) whilst hypertension may result from release of 5HT (vasoconstriction).

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Jul 02, 2011
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Bronchospasm & haemodynamic effects are of most concern.

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Sep 10, 2011
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Elevated serotonin levels have been associated with delayed awakening. refl.in/8w

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May 18, 2011
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Aim for smooth induction minimising hypo/hypertension & hypercapnia which can trigger carcinoid crisis. refl.in/8i

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Jul 02, 2011
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Administer octreotide at induction. This will attentuate most haemodynamic fluctuations. refl.in/8j refl.in/8i

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100mcg (s/c or iv?) refl.in/8i
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Bolus 25-50mcg octreotide may help if intraoperative hypertension occurs #ref

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Dec 06, 2011
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Bronchospasm may be resistant to Rx & be life threatening. Adrenaline is not recommended for severe bronchospasm if assoc. w/ carcinoid crisis. Octreotide should be administered instead. #ref

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Jul 02, 2011
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Caution with drugs that can cause histamine release (Thiopentone, Succinylcholine/Suxamethonium, Morphine) refl.in/8i

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Opioids (fentanil or remifentanil) may result in less histamine release than morphine. refl.in/8i

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Symptoms mediated by various humoral factors elaborated by some carcinoid tumors. Polypeptides, biogenic amines (histamine, serotonin), and prostaglandins. refl.in/8h

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Sep 10, 2011
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Regular BSL monitoring to monitor for hyperglycaemia. 5HT mimics the metabolic effects of adrenaline to stimulate glycogenolysis. #ref

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Dec 03, 2011
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Removal of tumour may not eliminate the risk of ongoing symptoms as metastatic lesions may remain.

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Sep 10, 2011
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Syndrome resulting from tumour production of vasoactive substances including histamine, serotonin, and others. Anesthetic principles are preoperative symptom control, prevention of perioperative mediator release which may result in a carcinoid crisis, symptom control with octreotide, and the potential for delayed wakening.

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