Carcinoid

Octreotide

Median dose intraop was 350 mcg
30-4000 mcg have been given
Upto 1mg dose have been given during crisis.

Prophylactic dose of 50mcg/hour for 12 hours

H2 blockers can also be given to prevent histamine enhaneced hypotention

Avoid epinephrine and norepinephrine. Phenylephrine can be used carefully in small doses.

Avoid ondanstrone with maybe also cause QT prolongation like octreotide.

Betablocker, labetolol can be given for hypertension.

Avoid beta agonist for bronchospasm.

Anesthesia for Urological Surgery

Radical orchiectomy

Radical orchiectomy can be done with spinal anesthesia. Minimally L1 dermatome needs to be achieved for adequate anesthesia. 

Bupivicaine 0.75% with dextrose 1.5-2cc (10-15mg)


TURP

Spinal anesthesia is the preference.
T10 - T6-7 Dematome will be needed.

Before proceeding with spinal, clear patient of valvular heart disease or coagulopathy

Hyperbaric 

Bupivicaine 0.75% with dextrose 1.5cc (10-15mg)

Isobaric

Bupivicaine 0.5% - 15mg
Tetracaine 0.5% with saline or CSF - 15mg (3cc)

25mcg of fentanyl or morphine 0.2mg can be added

Atropine 0.5mg for bradycardia

Minimal amount of NS can be given due to circulatory overload.

20cc/minute of irrigation solution can be absorbed during TURP up to 200cc/min.

Prepare pressors

Treatment of TURP symdrome
- Lasix 20mg
- ABG, check for serum Na+
- Midazolam for seizures
- Hypertonic saline for hyponatremia

Radical Prostatectomy

Can be done with epidural

 1-2 cc of local anesthetic per segment of dermatome