Rodríguez-Cosmen C, Trillo Urrutia L, Pacreu Terradas S, Comps Vicente O, Escolano Villén F
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Mar-Esperança, Instituto Municipal de Asistencia Sanitaria, Barcelona.
Rev Esp Anestesiol Reanim. 2005 May;52(5):291-4.
Carcinoid crisis during surgery can lead to severe hemodynamic alterations (hypo- and hypertension) and bronchospasm. Intravenous infusion of octreotide, preceded by preoperative subcutaneous administration, can allow such crises to be brought under control quickly. Given the high prevalence of carcinoid cardiopathy, which increases the risk of a crisis in these patients, a preoperative echocardiogram should be performed. General anesthesia combined with epidural blockade is effective in this context. Block onset should be gradual to avoid the development of hypotension, which is difficult to treat. The pharmacodynamic profile of remifentanil, its elevated potency, and low histamine releasing potential mean that this opioid offers novel advantages during general anesthesia.
手术期间类癌危象可导致严重的血流动力学改变（低血压和高血压）及支气管痉挛。术前皮下注射奥曲肽后进行静脉输注，可使此类危象迅速得到控制。鉴于类癌性心脏病的高患病率会增加这些患者发生危象的风险，应进行术前超声心动图检查。在这种情况下，全身麻醉联合硬膜外阻滞是有效的。阻滞起效应缓慢，以避免发生难以治疗的低血压。瑞芬太尼的药效学特性、高效能及低组胺释放潜力意味着这种阿片类药物在全身麻醉期间具有新的优势。
