Carcinoid syndrome - Revision history

Nkamdar at 21:43, 3 May 2021

2021-05-03T21:43:30Z

← Older revision		Revision as of 14:43, 3 May 2021
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	*#Consider pre-operative echocardiography to assess right heart function and tricuspid valve		*#Consider pre-operative echocardiography to assess right heart function and tricuspid valve
	*#Octreotide therapy instituted at least 24 hours prior to surgery.		*#Octreotide therapy instituted at least 24 hours prior to surgery.
	*#~~Oral or subcutaneous~~ therapy can be administered perioperatively. If the patient is inpatient, octreotide infusions can be used.		*#Subcutaneous therapy (lanreotide) can be administered perioperatively. If the patient is inpatient, octreotide infusions can be used.
			*Begin octreotide infusion at 50 μg/hr and titrate up to maximum of 200 μg/hr.

	===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===		===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===

	*~~Begin~~ octreotide infusion ~~and~~ titrate up to maximum of ~~500~~ μg/hr.		*Continue octreotide infusion at titrate up to maximum of 300 μg/hr.
	*Treat with anxiolysis medication as anxiety can exacerbate vasoactive neuropeptide release.		*Treat with anxiolysis medication as anxiety can exacerbate vasoactive neuropeptide release.
	*Avoid using medications that can cause a histamine release (morphine, meperidine, and succinylcholine)		*Avoid using medications that can cause a histamine release (morphine, meperidine, and succinylcholine)
			*Bolus doses of octreotide (50-100 μg) may be necessary during induction and maintenance and if hemodynamic instability ensues

	===Postoperative management<!-- Describe how this comorbidity may influence postoperative management. -->===		===Postoperative management<!-- Describe how this comorbidity may influence postoperative management. -->===

Nkamdar at 21:35, 3 May 2021

2021-05-03T21:35:03Z

← Older revision		Revision as of 14:35, 3 May 2021
Line 21:		Line 21:
	*#Consider pre-operative echocardiography to assess right heart function and tricuspid valve		*#Consider pre-operative echocardiography to assess right heart function and tricuspid valve
	*#Octreotide therapy instituted at least 24 hours prior to surgery.		*#Octreotide therapy instituted at least 24 hours prior to surgery.
	*#Oral or ~~intramuscular~~ therapy can be administered perioperatively. If the patient is inpatient, octreotide infusions can be used.		*#Oral or subcutaneous therapy can be administered perioperatively. If the patient is inpatient, octreotide infusions can be used.

	===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===		===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===

Nkamdar: formatting changes.

2021-05-03T21:09:39Z

formatting changes.

Nkamdar: Updated anesthetic implications

2021-05-03T21:08:36Z

Updated anesthetic implications

← Older revision		Revision as of 14:08, 3 May 2021
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	== Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> ==		== Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> ==
			Carcinoid syndrome affects several organ systems that have relevance to the anesthesiologist including cardiac pathology, airway pressures, hemodynamics and electrolytes.

	=== Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --> ===		=== Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --> ===
	~~Identify signs of carcinoid-induced cardiac disease and symptoms of neurpeptide release (as well as associated triggers)~~

	Consider pre-operative echocardiography to assess right heart function and tricuspid valve		* Identify signs of carcinoid-induced cardiac disease and symptoms of neuropeptide release (as well as associated triggers)
			* 50% of patients with carcinoid syndrome develop carcinoid heart disease
			* Consider pre-operative echocardiography to assess right heart function and tricuspid valve
			* Octreotide therapy instituted at least 24 hours prior to surgery.
			* Oral or intramuscular therapy can be administered perioperatively. If the patient is inpatient, octreotide infusions can be used.

	=== Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. --> ===		=== Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. --> ===

			* Begin octreotide infusion and titrate up to maximum of 500 μg/hr.
			* Treat with anxiolysis medication as anxiety can exacerbate vasoactive neuropeptide release.
			* Avoid using medications that can cause a histamine release (morphine, meperidine, and succinylcholine)

	=== Postoperative management<!-- Describe how this comorbidity may influence postoperative management. --> ===		=== Postoperative management<!-- Describe how this comorbidity may influence postoperative management. --> ===

			* Patients will likely require intensive care unit admission for octreotide infusion and hemodynamic monitoring

	== Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --> ==		== Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --> ==

Nkamdar: Introduction and anesthetic implications

2021-05-03T18:26:02Z

Introduction and anesthetic implications

New page

Carcinoid syndrome is caused by neoplasms from neuroendocrine cells that can release vasoactive substances such as serotonin, histamine, dopamine, substance P, prostaglandins, and kallikreins. Systemic manifestations of circulating vasoactive peptides from carcinoid tumors include flushing, wheezing, and diarrhea in addition to hemodynamic changes such as hypertension and hypotension. Carcinoid syndrome can also exacerbate cardiac and right-sided valvular problems.

{{Infobox comorbidity
| other_names =
| anesthetic_relevance =
| specialty =
| signs_symptoms =
| diagnosis =
| treatment =
| image =
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}}

== Anesthetic implications ==

=== Preoperative optimization ===
Identify signs of carcinoid-induced cardiac disease and symptoms of neurpeptide release (as well as associated triggers)

Consider pre-operative echocardiography to assess right heart function and tricuspid valve

=== Intraoperative management ===

=== Postoperative management ===

== Related surgical procedures ==

== Pathophysiology ==

== Signs and symptoms ==

== Diagnosis ==

== Treatment ==

=== Medication ===

=== Surgery ===

=== Prognosis ===

== Epidemiology ==

== References ==

[[Category:Comorbidities]]

← Older revision		Revision as of 14:09, 3 May 2021
Line 18:		Line 18:

	* Identify signs of carcinoid-induced cardiac disease and symptoms of neuropeptide release (as well as associated triggers)		* Identify signs of carcinoid-induced cardiac disease and symptoms of neuropeptide release (as well as associated triggers)
	* 50% of patients with carcinoid syndrome develop carcinoid heart disease		*#50% of patients with carcinoid syndrome develop carcinoid heart disease
	* Consider pre-operative echocardiography to assess right heart function and tricuspid valve		*#Consider pre-operative echocardiography to assess right heart function and tricuspid valve
	* Octreotide therapy instituted at least 24 hours prior to surgery.		*#Octreotide therapy instituted at least 24 hours prior to surgery.
	* Oral or intramuscular therapy can be administered perioperatively. If the patient is inpatient, octreotide infusions can be used.		*#Oral or intramuscular therapy can be administered perioperatively. If the patient is inpatient, octreotide infusions can be used.

	=== Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. --> ===		===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===

	* Begin octreotide infusion and titrate up to maximum of 500 μg/hr.		*Begin octreotide infusion and titrate up to maximum of 500 μg/hr.
	* Treat with anxiolysis medication as anxiety can exacerbate vasoactive neuropeptide release.		*Treat with anxiolysis medication as anxiety can exacerbate vasoactive neuropeptide release.
	* Avoid using medications that can cause a histamine release (morphine, meperidine, and succinylcholine)		*Avoid using medications that can cause a histamine release (morphine, meperidine, and succinylcholine)

	=== Postoperative management<!-- Describe how this comorbidity may influence postoperative management. --> ===		===Postoperative management<!-- Describe how this comorbidity may influence postoperative management. -->===

	* Patients will likely require intensive care unit admission for octreotide infusion and hemodynamic monitoring		*Patients will likely require intensive care unit admission for octreotide infusion and hemodynamic monitoring

	== Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. --> ==		==Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. -->==

	== Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. --> ==		==Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. -->==

	== Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. --> ==		==Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. -->==

	== Diagnosis<!-- Describe how this comorbidity is diagnosed. --> ==		==Diagnosis<!-- Describe how this comorbidity is diagnosed. -->==

	== Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. --> ==		==Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. -->==

	=== Medication<!-- Describe medications used to manage this comorbidity. --> ===		===Medication<!-- Describe medications used to manage this comorbidity. -->===

	=== Surgery<!-- Describe surgical procedures used to treat this comorbidity. --> ===		===Surgery<!-- Describe surgical procedures used to treat this comorbidity. -->===

	=== Prognosis<!-- Describe the prognosis of this comorbidity --> ===		===Prognosis<!-- Describe the prognosis of this comorbidity -->===

	== Epidemiology<!-- Describe the epidemiology of this comorbidity --> ==		==Epidemiology<!-- Describe the epidemiology of this comorbidity -->==

	== References ==		==References==

	[[Category:Comorbidities]]		[[Category:Comorbidities]]