Carcinoid syndrome

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.

Carcinoid syndrome

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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