Successful anesthetic management of a 14 year old boy undergoing tricuspid valvular surgery for carcinoid heart disease

Abstract

Objective: We present our strategy for successful management of pediatric patients with carcinoid heart disease when weaning from cardiopulmonary bypass (CPB) during tricuspid valve surgery. Case Presentation: The patient was a 14-year-old boy who had been diagnosed with a grade IV neuroendocrine tumor. The patient was premedicated with oral midazolam, hydroxyzine, somatostatin analogue (Octreotide®), and pheniramine maleate. Octreotide® and serotonin 5-hydroxytryptamine receptor antagonist were also added during the rewarming period. Dopamine was continued as an infusion (5 μg kg-1 min-1) for the first day. Bioprosthetic valve placement and transannular right ventricular outflow tract patch augmentation were performed. He was extubated within 20 hours and discharged from the hospital at postoperative 6 day. Discussion: Thanks to the premedication of this case and the addition of somatostatin analogue, pheniramine maleate and methylprednisolone to the pump reservoir and avoiding agents such as atracurium, morphine and meperidine, which may cause histamine release, the surgery was accomplished have been accomplished without development of carcinoid crisis.