General Anesthesia in a patient with a lung carcinoid tumor with hepatic and bone metastases: a case report
DOI:
https://doi.org/10.25751/rspa.25866Keywords:
Anestesia Geral, Tumor carcinóide, Metástases, OctreotidoAbstract
Introduction: Carcinoid tumors have the potential to metastasize and the ability to secrete bioactive substances. Carcinoid crisis is a serious event that may be triggered during anesthesia. It is a challenge to the anesthesiologist because it can provoke oscillations of blood pressure, flushing, bronchospasm and arrhythmias.
Case Report: We report our anesthetic management of a 63-year-old male with a lung carcinoid tumor with liver and bone metastases that was submitted to surgical correction of bilateral inguinal hernia. Octreotide infusion was initiated at 25 µg/h preoperatively and was maintained for 24 hours after the surgery. There were no complications, with hemodynamic and ventilatory stability.
Discussion: Carcinoid crisis is a life-threatening complication. The anesthesiologist must focus on preventing stressful situations that can provoke the release of bioactive substances. Octreotide is the drug of choice to prevent and treat carcinoid crisis and should be readily available for patients with carcinoid tumors.
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References
Mancuso K, Kaye AD, Boudreaux JP, Fox CJ, Lang P, Kalarickal PL, et al. Carcinoid syndrome and perioperative anesthetic considerations. J. Clin. Anesth. 2011. 23, p. 329–41.
Castillo J, Silvay G, Weiner M. Anesthetic Management of Patients With Carcinoid Syndrome and Carcinoid Heart Disease: The Mount Sinai Algorithm. J Cardiothorac Vasc Anesth. 2018. 32, p. 1023–31.
Peramunage D, Nikravan S. Anesthesia for Endocrine Emergencies. Anesthesiol Clin. 2020. 38(1):149-163.
Dierdorf SF. Carcinoid tumor and carcinoid syndrome. Curr Opin Anaesthesiol. 2003. 16(3):343-7.
Patel C, Mathur M, Escarcega RO, Bove AA. Carcinoid heart disease: current understanding and future directions. Am. Heart J. 2014. 167(6):789–95.
Borna RM, Jahr JS, Kmiecik S, Mancuso KF, Kaye AD. Pharmacology of Octreotide: Clinical Implications for Anesthesiologists and Associated Risks. Anesthesiol Clin. 2017. 35, p. 327–39.
Woltering EA, Wright AE, Stevens MA, Wang YZ, Boudreaux JP, Mamikunian G, et al. Development of effective prophylaxis against intraoperative carcinoid crisis. J. Clin. Anesth. 2016. 32:189–93.
Powell B, Mukhtar AA, Mills GH. Carcinoid: the disease and its implications for anaesthesia. Continuing Education in Anesthesia Crit Care Pain. 2011. 11(1):9-13.
Massimino K, Harrskog O, Pommier S, Pommier R. Octreotide LAR and bolus octreotide are insufficient for preventing intraoperative complications in carcinoid patients. J. Surg. Oncol. 2013.107(8):842–6.
Davar J, Connolly HM, Caplin ME, Pavel M, Zacks J, Bhattacharyya S, et al. Diagnosing and Managing Carcinoid Heart Disease in Patients With Neuroendocrine Tumors: An Expert Statement. J. Am. Coll. Cardiol. 2017. 69(10):1288–304.
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