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Anaphylactoid or carcinoid?

A M Batchelor1, I D Conacher

  • 1Department of Anaesthesia, Freeman Hospital, Newcastle upon Tyne.

British Journal of Anaesthesia
|September 1, 1992
PubMed
Summary

A patient experienced cardiovascular collapse during anesthesia, possibly due to a suxamethonium reaction mimicking carcinoid crisis. Careful planning is crucial for future anesthetics in such cases.

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Area of Science:

  • Anesthesiology
  • Oncology
  • Immunology

Background:

  • Carcinoid syndrome, a rare condition caused by neuroendocrine tumors, can present with complex symptoms.
  • Anesthesia management in patients with suspected carcinoid syndrome requires careful consideration due to potential complications.
  • Suxamethonium, a muscle relaxant, can rarely cause anaphylactoid reactions.

Observation:

  • A patient with a history suggestive of carcinoid syndrome, but lacking biochemical confirmation, experienced cardiovascular collapse during anesthesia.
  • The collapse occurred during the administration of propofol and suxamethonium.
  • The patient's presentation shared features with both a carcinoid crisis and an anaphylactoid reaction to suxamethonium.

Findings:

  • Investigations suggested an anaphylactoid reaction to suxamethonium as the likely cause of the cardiovascular collapse.
  • The clinical features observed were also consistent with a carcinoid crisis, highlighting diagnostic challenges.
  • The patient required a second anesthetic soon after, posing a significant management dilemma.

Implications:

  • This case underscores the importance of considering rare drug reactions during anesthesia, especially in patients with underlying conditions.
  • A pre-anesthetic management plan is essential for patients with a history of carcinoid syndrome or suspected reactions.
  • The plan should include readily available emergency drugs and the judicious use of sympathomimetic agents to mitigate risks.

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