In February 2013, I blogged information about Carcinoid Crisis which is a deadly condition that can occur when a NETS patient undergoes anesthesiology and surgery or other invasive procedures (Carcinoid crisis protocols).
There is a link in that article to Dr. Rodney Pommier’s paper (Carcinoid/NET Cancer Specialist Rodney F. Pommier, MD on Carcinoid Crisis and Surgery). This was used for my surgery and deserves a close look by patients, their surgeons and their anesthesiologists especially if the patient has carcinoid syndrome.
I have just run across Dr. Eugene Woltering’s protocol for preventing crisis during surgery. Dr. Woltering is Professor of Surgery and Neurosciences, Chief of Surgical Endocrinology, Director of Surgical Research, LSUHSC Neuroendocrine — Carcinoid tumors. He works at NOLA NETS : The Neuroendocrine Tumor Clinic. Here are the protocols:
“The NOLA NETS group uses this–others use less–can’t speak to their
results but even with these “higher than others” type dosing we have had 2
carcinoid crisis out of about 300 OR visits–
Two hours before surgery give 500 micrograms of octreotide acetate IV Push
Then start a 500 microgram per hour IV infusion —– start this
immediately after the IV push and
continue infusion during and after surgery
Depending on the severity and duration of surgery—– taper the infusion
over 1-24 hours–say for
colonoscopy taper over 1 hour– after huge liver cases taper over 12-24
If patient crashes don’t use pressors (except as a last resort if the
following fails)– use fluids and 1-5 mg bolus of octreotide (can repeat)–
for malignant hyperthermia use dantrolene in normal doses
If all else fails print this out and hand it to your anesthesia person
my cell phone number 504-884-3555-if the get into trouble have ‘em call me
day or night.”
The above is also an important piece of knowledge for the patient, surgeon and anesthesiologist. The Doctors should review both of these protocols when planning surgery on a patient with carcinoid syndrome or any carcinoid condition.
EDIT: As Paula reminds me below in the comments section, we carcinoids need to tell our doctors, dentists and anesthesiologists that epinephrine is an allergy and should only be used as a last resort. I have done this and have not had problems. It might not be true if you do not have carcinoid syndrome, but it won’t hurt.
I believe that patients must be proactive here because any surgical team that does not normally handle carcinoids will not be aware of the potentially deadly carcinoid crisis and how to prevent and/or treat it.
As usual, the patient is their own best advocate.
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