Carcinoid crisis: treatment

Clinical - Endocrine/Metabolic

Carcinoid tumors release a variety of subtances (ex. serotonin, catecholamines, histamine) which can cause both hypertension and hypotension. Anesthetic management became significantly easier in the post-somatostatin era (ex. octreotide). Appropriate somatostatin analog therapy is the mainstay of initial perioperative management in these patients.

Still, somatostatin analogs are not perfect, and avoidance of stimulation as well as indirect acting agents may still be adviseable. The anesthesiologist should still be prepared with α and β-adrenergic receptor blockers to treat hypertension, as well as vasopressin to treat refractory hypotension. The anesthesiologist should still be prepared for rapid changes in blood pressure, as preoperative stability is not at all related to the risk of intraoperative misadventures.

Carcinoid tumors release substances which may cause pulmonic stenosis or tricuspid insufficiency, thus pulmonary vascular resistance may need to be monitored and medications adjusted accordingly.

Note that beta agonists may increase the release of vasoactive substances from carcinoid tumors. Alpha agonists (ex. phenylephrine) have not been shown to have such an effect.

Carcinoid

  • Perioperative Management: somatostatin analog therapy
  • Hypotension: vasopressin (β-agonists may increase the release of vasoactive substances) or phenylephrine
  • Hypertension: α and β-adrenergic receptor blockers

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2010

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