A 42-year-old man with known carcinoid tumour of the ileum is undergoing right hemicolectomy. Preoperative 5-HIAA is elevated. The patient is on octreotide. During surgical manipulation of the tumour, he develops facial flushing and hypotension. Which drug given earlier would be MOST likely to have precipitated this crisis?
- A Fentanyl
- B Remifentanil
- C Morphine ✓
- D Sufentanil
Correct answer: C. Morphine
Explanation
Morphine and other opioids that cause histamine release can trigger mediator release from carcinoid tumours, leading to flushing, hypotension, and bronchospasm. Fentanyl, remifentanil, and sufentanil do not cause significant histamine release and are safer choices in carcinoid syndrome.
Reference: Miller's Anaesthesia, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.