Intra-operative carcinoid crisis: Revised anaesthesia management

A 31-year-old lady with chest pain, new onset asthma and right-sided perihilar mass was diagnosed as carcinoid tumour with biopsy. After an initial unsuccessful attempt using a Macintosh (MAC) 3 blade, a video laryngoscope was used to place a cuffed endotracheal tube, which was exchanged to left-sided double lumen tube (DLT). Breath sounds as well as end-tidal carbon dioxide were appreciated, and the position confirmed using fibre-optic bronchoscopy. A presumptive diagnosis of carcinoid crisis was made, and a 150 μg bolus of octreotide was given which stabilised the blood pressure and the respiratory status. [5] Sympathomimetic drugs and bronchodilators, such as β2 agonists, can activate kallikrein leading to synthesis and release of bradykinin resulting in vasodilatation and hypotension. [2],[6] A 250-500 μg bolus of octreotide for suspected carcinoid syndrome for minor procedures, and a bolus followed by an infusion of 100-500 μg/h for major procedures has been recommended by the...