Canadian Journal of Anesthesia, Vol 27, 260-263, Copyright © 1980 by Canadian Anesthesiologists' Society

Anaesthetic Management of a Patient with Carcinoid Tumor Undergoing Myocardial Revascularization

¹ Department of Anesthesiology, Mount Sinai Medical Center, The Medical College of Wisconsin, Milwaukee, WI. 53201 U.S.A.

Address Correspondence to: Kita D. Patel, M.D., Acting Chief, Department of Anesthesiology, Mount Sinai Medical Center, 950 North Twelfth Street, Milwaukee, Wisconsin, 53201 U.S.A.

Carcinoid tumors with hepatic involvement can produce intense flushing, tachycardia, hypotension or hypertension and diarrhoea. Patients with limited cardiac reserve may not tolerate these effects under anaesthesia.

Valvular heart disease associated with carcinoid tumors has been reported, but there is no record in the literature of such an association with coronary artery disease. This report presents the anaesthetic management of a patient with coronary artery disease and carcinoid tumor undergoing myocardial revascularization. Emphasis is placed on the rational use of anaesthetic and adjunctive agents which will minimize the incidence of carcinoid symptoms. The salient features of the management are prevention of release of vasoactive substances by the use of promethazine hydrochloride during operation, the avoidance of atropine, prophylactic administration of corticosteroids and smooth induction of anaesthesia by the use of diazepam and dimethyl-tubocurarine iodide (Metocurine).