Document Detail


Management of patients undergoing multivalvular surgery for carcinoid heart disease: the role of the anaesthetist.
MedLine Citation:
PMID:  18689806     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The management of patients with carcinoid heart disease poses two major challenges for the anaesthetist: carcinoid crisis and low cardiac output secondary to right ventricular (RV) failure. Carcinoid crises may be precipitated by the administration of catecholamines and histamine-releasing drugs. METHODS: We analysed a series of 11 patients [six males, median (range) age 60 (42-73) yr] with severe symptomatic carcinoid heart disease who underwent multivalve surgery (right-sided valves, n=8; right- and left-sided valves, n=3) between 2001 and 2007. RESULTS: All patients received octreotide intraoperatively [650 (300-1050) microg] to prevent carcinoid symptoms and vasoplegia. Those patients on a greater preoperative octreotide regime required additional intraoperative octreotide [median (range) dose 320 (300-850) vs 750 (650-1050) mug]. Similarly, the use of greater doses of aprotinin (> 5 KIU) was associated with greater requirements for octreotide [475 (300-700) vs 750 (320-1050) microg] and higher glucose levels (> or =8.5 mmol litre(-1)). Catecholamines were generally required in those patients who presented with a worse New York Heart Association functional class. Overall mortality was 18% (n=2) and only one episode of mild intraoperative carcinoid crisis was observed. CONCLUSIONS: Carcinoid crisis and RV failure still remain the primary challenges for the anaesthesiologist while managing patients with carcinoid heart disease. Our study supports the administration of catecholamines to wean patients off cardiopulmonary bypass, particularly in the presence of myocardial dysfunction. Those patients on higher octreotide dosages may require close intraoperative glucose monitoring. Despite high operative mortality, surgical outcome has been improved potentially due to earlier patient referral and better perioperative management.
Authors:
J G Castillo; F Filsoufi; D H Adams; J Raikhelkar; B Zaku; G W Fischer
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Publication Detail:
Type:  Journal Article     Date:  2008-08-08
Journal Detail:
Title:  British journal of anaesthesia     Volume:  101     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-15     Completed Date:  2008-11-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  618-26     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, 1190 Fifth Avenue, Box 1028, New York, NY 10029, USA. javier.castillo@mountsinai.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anesthesia, General / methods*
Antineoplastic Agents, Hormonal / therapeutic use
Aprotinin / therapeutic use
Carcinoid Heart Disease / complications,  drug therapy,  surgery*,  ultrasonography
Cardiopulmonary Bypass
Echocardiography, Doppler / methods
Female
Follow-Up Studies
Heart Valve Diseases / surgery*,  ultrasonography
Hemostatics / therapeutic use
Humans
Intraoperative Care / methods
Intraoperative Complications / prevention & control
Male
Middle Aged
Octreotide / therapeutic use
Retrospective Studies
Treatment Outcome
Vasoconstrictor Agents / therapeutic use
Ventricular Dysfunction, Right / prevention & control
Chemical
Reg. No./Substance:
0/Antineoplastic Agents, Hormonal; 0/Hemostatics; 0/Vasoconstrictor Agents; 83150-76-9/Octreotide; 9087-70-1/Aprotinin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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