Carcinoid syndrome: comparison of pretreatment regimes in the same patient

Severe difficulties were encountered when a 47 year old man, with symptomatic carcinoid pretreated with ketanserin 80 mg twice daily was anaesthetised for hepatic arterial embolisation. The same patient, having had three days pretreatment with parachlorophenylalanine 500 mg four times daily and cyproheptadine 4 mg three times daily in addition to the ketanserin, was anaesthetised a week later without any difficulties. On the second occasion much better symptom control had been achieved. It is suggested that pretreatment with ketanserin alone is insufficient in severely symptomatic carcinoid and that the best possible medical control of symptoms should be achieved before anaesthesia.