What precautions are prudent for anesthetizing patients with carcinoid syndrome?
The severity of the symptoms does not predict difficul-ties encountered during the anesthetic or complications that may follow. Patients with minor signs and symptoms may have significant intraoperative problems. 5-HIAA levels provide an indicator of the disease progression; however, they do not predict the physiologic response to tumor manipulation during surgery.
The anesthetic technique should minimize mediator release in response to the stress of induction, tracheal intubation, and emergence. It is prudent to premedicate patients with octreotide. If succinylcholine is used, a defas-ciculating dose of a nondepolarizer should be administered to prevent the increase in intra-abdominal pressure that can lead to squeezing of the tumor thereby releasing additional vasoactive polypeptide. Administration of topical local anesthetics or intravenous lidocaine helps prevent cate-cholamine responses to intubation and extubation. Cardiovascular instability, especially hypotension, is com-mon, so that invasive monitoring such as arterial lines, central venous pressure monitoring, or pulmonary artery catheters may be necessary. Anesthetic maintenance should be performed with a nitrous oxide–narcotic technique to maintain hemodynamic stability.