[Update on the anesthetic management of patients with malignant carcinoid syndrome]

Carcinoid crisis during surgery can lead to severe hemodynamic alterations (hypo- and hypertension) and bronchospasm. Intravenous infusion of octreotide, preceded by preoperative subcutaneous administration, can allow such crises to be brought under control quickly. Given the high prevalence of carcinoid cardiopathy, which increases the risk of a crisis in these patients, a preoperative echocardiogram should be performed. General anesthesia combined with epidural blockade is effective in this context. Block onset should be gradual to avoid the development of hypotension, which is difficult to treat. The pharmacodynamic profile of remifentanil, its elevated potency, and low histamine releasing potential mean that this opioid offers novel advantages during general anesthesia.