Abstract
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 longacting 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 20μg), 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.
Résumé
Objectif
Présenter un cas de rachianesthésie chez un patient, atteint d’un syndrome carcinoïde, qui devait subir une herniorraphie inguinale. Dans le passé, on considérait l’anesthésie régionale comme inacceptable chez ce type de patient, étant donné la possibilité d’hypotension peropératoire, d’hypertension ou de bronchospasme. Récemment, toutefois, l’usage préopératoire d’octréotide, analogue synthétique de la somastatine naturelle, a montré qu’il prévient ces complications. Néanmoins, on ne sait pas encore avec certitude si l’emploi de ce médicament chez des patients atteints de carcinoïde permet d’utiliser une anesthésie régionale.
Constatations principales
Un examen consciencieux de l’état volumique du patient et l’administration d’un faible volume d’anesthésiques locaux (10 mg de bupivacaïne hyperbare à 0,5 %) complétés par un narcotique intrathécal (20 μg de fentanyl), ont permis de prévenir tout épisode d’hypotension peropératoire. L’octréotide était disponible en salle d’opération en cas d’urgence. L’originalité de cette présentation de cas est que le patient a reçu de l’octréotide à action prolongée une fois par mois plutôt que la dose quotidienne habituelle. C’est aussi l’un des rares articles sur la rachianesthésie administrée à un patient atteint d’un syndrome carcinoïde.
Conclusion
L’octréotide préopératoire peut améliorer les conditions de l’anesthésie régionale chez des patients atteints d’un syndrome carcinoïde. Cependant, d’autres études devront confirmer l’évolution positive observée chez ce patient.
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Orbach-Zinger, S., Lombroso, R. & Eidelman, L.A. Uneventful spinal anesthesia for a patient with carcinoid syndrome managed with long-acting octreotide. Can J Anesth 49, 678–681 (2002). https://doi.org/10.1007/BF03017444
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DOI: https://doi.org/10.1007/BF03017444