title: Anesthetic management of patients undergoing resection of carcinoid metastasis to the brain.
abstract: BACKGROUND
  Carcinoid tumors are derived from enterochromaffin cells and may release physiologically active compounds into the systemic circulation, leading to the development of carcinoid syndrome. Occasionally, these tumors metastasize to the brain, warranting biopsy or resection. In these surgical patients, the perioperative implications for anesthetic management are not heretofore defined in the indexed literature.
  
  
  METHODS
  Patients who had craniotomy for biopsy or resection of intracranial carcinoid tumors were retrospectively identified at a single medical center. Patient demographics, perioperative anesthetic management, adverse events, and outcome were summarized in this case series.
  
  
  RESULTS
  Eleven patients were identified; median age was 60 years (range = 42-78 years), and 45% were male. Immediately before surgery, 4 patients (36%) were receiving a somatostatin analog drug, and no patient had unchecked carcinoid syndrome. All patients received general anesthesia that included inhaled isoflurane and nitrous oxide, and all had invasive arterial blood pressure monitoring. One patient developed sustained hypotension after induction of anesthesia, likely related to hypovolemia and anesthetic drugs, but the possibility of carcinoid mediator release cannot be excluded. There were no other signs or symptoms of carcinoid syndrome in this or any other patient. Of all 11 patients, 10 (91%) experienced either significant disease progression (n = 2; 18%) or death (n = 8; 73%) from carcinoid disease, its sequelae, or an undetermined cause within 3 years after surgery. Of note, 3 of the deaths occurred shortly after surgery, on postoperative days 3, 7, and 8.
  
  
  CONCLUSIONS
  In our experience, carcinoid tumor metastasis to the brain-whether because of tumor makeup or prior treatment-is unlikely to produce symptoms of new-onset carcinoid syndrome intraoperatively; however, the risk cannot be completely excluded. Postsurgical prognosis was poor, both within the hospital and after hospital discharge.
authors.affiliation: Mayo Clinic, Department of Anesthesiology, 200 First St SW, Rochester, MN 55901, USA.
authors.forename: Tasha L
authors.initials: TL
authors.lastname: Welch
authors.affiliation: Mayo Clinic, Department of Anesthesiology, 200 First St SW, Rochester, MN 55901, USA. Electronic address: Pasternak.jeffrey@mayo.edu.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Pasternak
authors.affiliation: Mayo Clinic, Department of Anesthesiology, 200 First St SW, Rochester, MN 55901, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Lanier
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D018685:Anesthetics, Inhalation; D001921:Brain / Q000601:surgery; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D002276:Carcinoid Tumor / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide; D012189:Retrospective Studies
chemical_list: D018685:Anesthetics, Inhalation; D007530:Isoflurane; D009609:Nitrous Oxide
keywords: Anesthetic management; Brain metastasis; Carcinoid