Development of effective prophylaxis against intraoperative carcinoid crisis.
OBJECTIVE
The prophylactic use of a preoperative, intraoperative, and postoperative high-dose continuous octreotide acetate infusion was evaluated for its ability to minimize the incidence of carcinoid crises during neuroendocrine tumor (NET) cytoreductive surgeries.


METHODS
A retrospective study was approved by the institutional review boards at Ochsner Medical Center-Kenner and Louisiana State University Health Sciences Center.


METHODS
Ochsner Medical Center-Kenner operating room and multispecialty NET clinic.


METHODS
One hundred fifty consecutive patients who underwent a total of 179 cytoreductive surgeries for stage IV, small bowel NETs.


METHODS
All patients received a 500-μg/h infusion of octreotide acetate preoperatively, intraoperatively, and postoperatively.


METHODS
Anesthesia and surgical records were reviewed. Carcinoid crisis was defined as a systolic blood pressure of less than 80mm Hg for greater than 10minutes. Patients who experienced intraoperative hypertension or hypotension, profound tachycardia, or a "crisis" according to the operative note were also reviewed.


RESULTS
One hundred sixty-nine (169/179; 94%) patients had normal anesthesia courses. The medical records of 10 patients were further investigated for a potential intraoperative crisis using the aforementioned criteria. Upon review, 6 patients were determined to have had a crisis. The final incidence of intraoperative crisis was 3.4% (6/179).


CONCLUSIONS
A continuous high-dose infusion of octreotide acetate intraoperatively minimizes the incidence of carcinoid crisis. We believe that the low cost and excellent safety profile of octreotide warrant the use of this therapy during extensive surgical procedures for midgut and foregut NETs.
Department of Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Ave, 7th Floor, New Orleans, LA 70112, USA. Electronic address: ewolte@lsuhsc.edu.
Eugene A
EA
Woltering
Children's Hospital New Orleans, 200 Henry Clay Ave, New Orleans, LA 70118, USA. Electronic address: adiebold001@gmail.com.
Anne E
AE
Wright
Department of Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Ave, 7th Floor, New Orleans, LA 70112, USA. Electronic address: mstevensmph@gmail.com.
Melissa A
MA
Stevens
Department of Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Ave, 7th Floor, New Orleans, LA 70112, USA. Electronic address: ywang@lsuhsc.edu.
Yi-Zarn
YZ
Wang
Department of Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Ave, 7th Floor, New Orleans, LA 70112, USA. Electronic address: jboudr4@lsuhsc.edu.
John P
JP
Boudreaux
Inter Science Institute, 944 West Hyde Park Boulevard, Inglewood, CA 90302, USA. Electronic address: gmisi@earthlink.net.
Gregg
G
Mamikunian
Department of Anesthesiology, Louisiana State University Health Sciences Center, 1542 Tulane Ave, Room 659, New Orleans, LA 70112, USA. Electronic address: jriope@lsuhsc.edu.
James M
JM
Riopelle
Department of Anesthesiology, Louisiana State University Health Sciences Center, 1542 Tulane Ave, Room 659, New Orleans, LA 70112, USA. Electronic address: akaye@lsuhsc.edu.
Alan D
AD
Kaye
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects*; D002276:Carcinoid Tumor / Q000601:surgery*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D007414:Intestinal Neoplasms / Q000601:surgery*; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008303:Malignant Carcinoid Syndrome / Q000517:prevention & control*; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D012189:Retrospective Studies; D013577:Syndrome; D013610:Tachycardia / Q000517:prevention & control
D005765:Gastrointestinal Agents; D015282:Octreotide
Anesthesia; Carcinoid crisis; Flushing; Hypotension; Neuroendocrine tumor (NET); Surgery