Tachibana R, Yasumoto K, Hosoyamada A, Washizawa N
Department of Anesthesiology, Showa University School of Medicine, Tokyo.
Masui. 1993 Jul;42(7):1047-52.
Anesthetic management of a 75-year-old female with carcinoid syndrome is reported. She had a tumor on the ileum and multiple metastatic tumors in the both lobes of the liver. Levels of both plasma serotonin and urinary 5-hydroxyindole acetic acid (5-HIAA) were significantly elevated before the operation. Although she was treated with somatostatin-analogue percutaneously, the levels of these hormones did not decrease significantly. The partial resection of the small intestine was scheduled under general anesthesia. Before induction of general anesthesia, hydrocortisone and ulinastatin were administered intravenously to prevent the release of chemical mediators. Anesthesia was induced with ketamine, diazepam, and vecuronium, and maintained with nitrous oxide, oxygen and enflurane. There was mild bronchospasm at the beginning of the surgery and the blood pressure was unstable during the operation, but anesthetic course was relatively uneventful. Although the patient recovered from anesthesia smoothly, she developed respiratory acidosis 45 minutes after extubation. She was intubated again and ventilated artificially with pressure support ventilation whose support level was 15 cmH2O for only three hours. We conclude that we should pay much attention not only during anesthesia but also after surgery, especially to respiratory system in patients with carcinoid syndrome.
本文报道了一名75岁类癌综合征女性患者的麻醉管理情况。她患有回肠肿瘤及肝脏两叶多发转移瘤。术前血浆5-羟色胺及尿5-羟吲哚乙酸（5-HIAA）水平均显著升高。尽管已对其进行了皮下注射生长抑素类似物治疗，但这些激素水平并未显著下降。计划在全身麻醉下进行小肠部分切除术。在全身麻醉诱导前，静脉注射氢化可的松和乌司他丁以防止化学介质释放。麻醉诱导采用氯胺酮、地西泮和维库溴铵，维持采用氧化亚氮、氧气和恩氟烷。手术开始时出现轻度支气管痉挛，术中血压不稳定，但麻醉过程相对平稳。尽管患者顺利从麻醉中苏醒，但拔管后45分钟出现呼吸性酸中毒。再次插管并采用压力支持通气进行人工通气，支持水平为15 cmH₂O，仅持续了3小时。我们得出结论，对于类癌综合征患者，不仅在麻醉期间而且在术后都应予以高度关注，尤其是呼吸系统。
