Anaesthesia for the removal of carcinoid metastasis

ventilation with 100% oxygen was started. Pancuronium, peripheral cooling. steroids and dantrolene ( I mg:kg body wcight) were also given but the regime stopped short of rapid infusion of cold crystalloid in a patient with absent renal function and a compromised myocardium. The muscle spasm rapidly resolved. colour improved and the temperature rise was arrested. Cooling if anything was over enthusiastic and. partly as a result of a short ambulance journey back to the dialysis facilitics of the renal unit some 2 hours after surgery, when parameters appeared stable. core ternperaturc dropped to 34 C . Ventilation was continued for 48 hours. There was initial hypoxacmia requiring a high inspired oxygen tension, and later the arterirwenous fistula used for dialysis, clotted. possibly the result of peripheral vasoconstriction following cooling. The patient made an excellent recovery, although he will require further wrgery for closure of colostomy; on the debit side some E12O-worth o f dantrolene was used, possibly unnecessarily. We have revicwcd the case carefully but we have come to the conclusion that. if we werc faced with the same problem again, the same management would be adopted. The patient awaits investigation to confirm o r deny the diagnosis, until thcn he remains 'suspicious ~ possibly susceptible to malignant hyperpyrexia'.