This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Orbach-Zinger, S. Articles by Eidelman, L. A. Search for Related Content PubMed PubMed Citation Articles by Orbach-Zinger, S. Articles by Eidelman, L. A.

Uneventful spinal anesthesia for a patient with carcinoid syndrome managed with long-acting octreotide

[Une rachianesthésie sans incident réalisée avec l’octréotide à action prolongée chez un patient atteint d’un syndrome carcinoïde]

Sharon Orbach-Zinger, MD^*, Raphael Lombroso, MD and Leonid A. Eidelman, MD^*

^* From the Departments of Anesthesiology, and Surgery
A, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.

Address correspondence to: Dr. L.A. Eidelman, Department of Anesthesiology, Rabin Medical Center-Beilinson campus, Petach Tikva 49100, Israel, Phone: 972-3-937-6850; Fax: 972-3-937-6851; E-mail: leidelman{at}clalit.org.il

Purpose: To present a case of spinal anesthesia in a patient suffering from carcinoid syndrome undergoing an inguinal hernia repair. In the past, regional anesthesia was considered unacceptable in these patients because of the possibility of intraoperative hypotension, hypertension, or bronchospasm. Recently, however, the preoperative use of octreotide, the synthetic analogue of the naturally occurring hormone somastatin, has been found to prevent these complications. Nevertheless, it remains unclear whether the use of this drug in patients with carcinoid syndrome allows the possibility of regional anesthesia.

Clinical findings: We report the uneventful use of spinal anesthesia in a patient suffering from carcinoid syndrome treated with long-acting octreotide. With careful attention to volume status of the patient and low volume of local anesthetics (10 mg hyperbaric bupivacaine 0.5%) supplemented with intrathecal narcotics (fentanyl 20 µg), we were able to prevent any episodes of intraoperative hypotension in this patient. Octreotide was available in the operating theatre in case of an emergency. One of the original aspects of this case report is that the patient received long-acting octreotide (once a month administration) instead of the usual daily dose. In addition this is one of the few reports of spinal anesthesia administered to a patient with carcinoid syndrome.

Conclusion: Preoperative octreotide may result in more favourable conditions for regional anesthesia in patients with carcinoid syndrome. However, further studies will be required to confirm the favourable outcome observed in this patient.