Abstract
The anaesthetic management of a 63-year-old patient with carcinoid syndrome presenting for transurethral resection of the prostate (TURP) is described. Before surgery antibradykinin, antiserotonin and antihistamine drugs were used in addition to SMS 201–995, a long-acting somatostatin analogue, to prevent the intraoperative release of hormones associated with this syndrome. Several techniques of general anaesthesia have achieved successful patient outcomes. Monitoring included pulse oximetry and radial artery cannulation. After infusion of Ringer’s lactate, 750 ml, and 25 per cent albumin, 150 ml, an incremental epidural block with xylocaine two per cent without adrenaline was administered to achieve ideal operating conditions without any change in haemodynamic variables or oxygen haemoglobin saturation. Epidural anaesthesia seems to be a safe alternative to general anaesthesia in patients with carcinoid syndrome presenting for TURP.
Résumé
En association avec l’utilisation périopératoire d’antagonistes des bradykinines, de la sérotonine et de l’histamine, on peut prévenir la libération peropératoire des hormones propres au syndrome carcinoïde en employant le SMS 201–995, un analogue de la somatostatine à longue action. Alors que plusieurs techniques d’anesthésie générale ont été utilisées avec succès, nous avons employé une anesthésie épidurale lors de la résection trans-uréthrale de la prostate (RTUP) d’un homme de 63 ans, porteur d’un carcinoïde. Le monitoring comprenait entre autres, l’usage d’un oxymètre de pouls et d’une canule dans l’artère radiale. Après la perfusion de 750 ml de Lactate Ringer et de 150 ml d’albumine à 25 pour cent, nous avons progressivement injecté de la lidocaïne à deux pour cent avec adrénaline dans le cathéter épidural et obtenu un bloc approprié, sans changement de la saturation artérielle en oxygène ou des variables hémodynamiques. L’anesthésie épidurale constitue done une alternative valable à l’anesthésie générale pour la RTUP de patients porteurs d’un syndrome carcinoïde.
Article PDF
Avoid common mistakes on your manuscript.
References
Thorson A, Biorck G, Bjorkman G, Waldenstram J. Malignant carcinoid of the small intestine with metastases to the liver, valvular disease of the right side of the heart, peripheral vasomotor symptoms, bronchoconstriction and an unusual type of cyanosis; clinical and pathologic syndrome. Am Heart J 1954; 47: 795–817.
Rambaud JC, Hautefeuille M, Ruskone M, Jacquenod P. Diarrhea due to circulating agents. Clinics in Gastroenterology 1986; 15: 603–29.
Dhodanand Kowlessar O. The Carcinoid Syndrome. In: Sleisenger MH, Fortran JS (Eds.). Gastrointestinal Disease, 4th ed., Philadelphia: W.B. Saunders Co., 1989: 1560–70.
Mason RA, Steane PA. Carcinoid syndrome: its relevance to the anaesthetist. Anaesthesia 1976; 31: 228–42.
Miller R, Patel AU, Warner RRP, Parnes H. Anaesthesia for the carcinoid syndrome: a report of nine cases. Can Anaesth Soc J 1978; 25: 240–4.
Ward DS, Iwamoto K. Anaesthesia for the unusual carcinoid metastasis. Anaesthesia 1981; 36: 293–5.
Nielsen MS, Manners JM. Valve replacement in carcinoid syndrome: anaesthetic management for tricuspid and pulmonary valve surgery. Anaesthesia 1979; 34: 494–9.
Eisenkraft JB, Dimich I, Miller R. Ketamine-diazepam anaesthesia in a patient with carcinoid syndrome. Anaesthesia 1981; 36: 881–5.
Grahame-Smith DG. What is the cause of the carcinoid flush? Gut 1987; 28: 1413–6.
Gustafsen J, Boesby S, Nielsen F, Giese J. Bradykinin in carcinoid syndrome. Gut 1987; 28: 1417–9.
Oates JA, Jackson Roberts II L. Carcinoid Syndrome. In: Braunwald E (Ed.). Harrison’s Principles of Internal Medicine. 11th ed., New York: McGraw Hill Inc., 1987: 1585–8.
Jackson Roberts II L, Bloomgarden ZT, Marney SR, Rabin D, Oates JA. Histamine release from a gastric carcinoid: provocation by pentagastrin and inhibition by somatostatin. Gastroenterology 1983; 84: 272–5.
Kvols LK, Moertel CG, O’Connell MJ, Schutt AJ, Rubin J, Hahn RG. Treatment of the malignant carcinoid syndrome-evaluation of a long-acting somatostatin analogue. N Engl J Med 1986; 315: 663–6.
Roy RC, Carter RF, Wright PD. Somatostatin, anaesthesia, and the carcinoid syndrome-peri-operative administration of a somatostatin analogue to suppress carcinoid tumour activity. Anaesthesia 1987; 42: 627–32.
Parris NVC, Oates JA, Kambam J, Shmerling R, Sawyers JF. Pre-treatment with somatostatin in the anaesthetic management of a patient with carcinoid syndrome. Can J Anaesth 1988; 35: 413–6.
Marsh HM, Martin JK, Kvols LK et al. Carcinoid crisis during anaesthesia: successful treatment with a somatostatin analogue. Anesthesiology 1987; 66: 89–91.
Lucey MR, Yamada T. Biochemistry and physiology of gastrointestinal somatostatin. Dig Dis Sci 1989; 34: 5S-13S.
Reichlin S. Somatostatin. N Engl J Med 1983; 309: 1495–1501 (Part I); 1983; 309: 1556–63 (Part II).
Vinik A, Moattari AR. Use of somatostatin analogue in the management of carcinoid syndrome. Dig Dis Sci 1989; 34: 14S-27S.
Kehlet H. Surgical stress: the role of pain and analgesia. BrJ Anaesth 1989; 63: 189–95.
Scott NB, Kehlet H. Regional anaesthesia and surgical morbidity. Br J Surg 1988; 75: 299–304.
Mazze RI. Anesthesia for patients with abnormal renal function and genitourinary operations. In: Miller RD (Ed.). Anesthesia, 2nd edition. New York: Churchill Livingstone, 1986: 1657–9.
Derbyshire DR, Chmielewski A, Fell D, Vater M, Achola K, Smith G. Plasma catecholamine responses to tracheal intubation. Br J Anaesth 1983; 55: 855–60.
Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987; 59: 295–9.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Monteith, K., Roaseg, O.P. Epidural anaesthesia for transurethral resection of the prostate in a patient with carcinoid syndrome. Can J Anaesth 37, 349–352 (1990). https://doi.org/10.1007/BF03005589
Issue Date:
DOI: https://doi.org/10.1007/BF03005589