Uneventful spinal anesthesia for a patient with carcinoid syndrome managed with long-acting octreotide.

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 long-acting 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 20 micro g), 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.