Difference between revisions of "Carcinoid syndrome"
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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. --> === | ||
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. | |||
*#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. -->=== | ||
*Continue octreotide infusion at titrate up to maximum of 300 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) | |||
*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. -->=== | ||
*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. -->== | ||
== | ==Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. -->== | ||
== | ==Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. -->== | ||
== | ==Diagnosis<!-- Describe how this comorbidity is diagnosed. -->== | ||
== | ==Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. -->== | ||
=== | ===Medication<!-- Describe medications used to manage this comorbidity. -->=== | ||
== | ===Surgery<!-- Describe surgical procedures used to treat this comorbidity. -->=== | ||
== References == | ===Prognosis<!-- Describe the prognosis of this comorbidity -->=== | ||
==Epidemiology<!-- Describe the epidemiology of this comorbidity -->== | |||
==References== | |||
[[Category:Comorbidities]] | [[Category:Comorbidities]] | ||
Latest revision as of 14:43, 3 May 2021
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
Carcinoid syndrome affects several organ systems that have relevance to the anesthesiologist including cardiac pathology, airway pressures, hemodynamics and electrolytes.
Preoperative optimization
- 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.
- 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
- Continue octreotide infusion at titrate up to maximum of 300 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)
- Bolus doses of octreotide (50-100 μg) may be necessary during induction and maintenance and if hemodynamic instability ensues
Postoperative management
- Patients will likely require intensive care unit admission for octreotide infusion and hemodynamic monitoring
Related surgical procedures
Pathophysiology
Signs and symptoms
Diagnosis
Treatment
Medication
Surgery
Prognosis
Epidemiology
References
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