[Anesthetic management of a patient with carcinoid syndrome]

Anesthetic management of a 75-year-old female with carcinoid syndrome is reported. She had a tumor on the ileum and multiple metastatic tumors in the both lobes of the liver. Levels of both plasma serotonin and urinary 5-hydroxyindole acetic acid (5-HIAA) were significantly elevated before the operation. Although she was treated with somatostatin-analogue percutaneously, the levels of these hormones did not decrease significantly. The partial resection of the small intestine was scheduled under general anesthesia. Before induction of general anesthesia, hydrocortisone and ulinastatin were administered intravenously to prevent the release of chemical mediators. Anesthesia was induced with ketamine, diazepam, and vecuronium, and maintained with nitrous oxide, oxygen and enflurane. There was mild bronchospasm at the beginning of the surgery and the blood pressure was unstable during the operation, but anesthetic course was relatively uneventful. Although the patient recovered from anesthesia smoothly, she developed respiratory acidosis 45 minutes after extubation. She was intubated again and ventilated artificially with pressure support ventilation whose support level was 15 cmH2O for only three hours. We conclude that we should pay much attention not only during anesthesia but also after surgery, especially to respiratory system in patients with carcinoid syndrome.