Octreotide
Sandostatin
Somatostatin analogue
Long-acting somatostatin analogue → suppresses splanchnic blood flow, GI/pancreatic secretions, GH, glucagon, insulin, and serotonin/vasoactive-peptide release.
Indications
- •Variceal/GI bleeding (splanchnic vasoconstriction)
- •CARCINOID crisis (intraop — blocks vasoactive mediator release)
- •Acromegaly, VIPoma, chylothorax, refractory sulfonylurea hypoglycemia
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Variceal bleed | 50 mcg IV bolus, then 50 mcg/hr infusion | — |
| Carcinoid crisis | 25–100 mcg IV bolus, then infusion; pre-treat before tumor manipulation | — |
Pharmacokinetics
Onset minutes IV. Half-life ~1.5 h.
Side effects
- !Bradycardia, QT prolongation
- !Hyper/hypoglycemia
- !Nausea, biliary sludge/gallstones (chronic)
Contraindications
- ×None absolute
Clinical pearls
- ★ANESTHESIA KEY: the treatment for intraoperative CARCINOID CRISIS (flushing, bronchospasm, labile BP from mediator release) — have it drawn up before manipulating a carcinoid tumor; AVOID histamine-releasing drugs + catecholamines (can paradoxically worsen).
- ★First-line pharmacotherapy (with vasoactive support) for variceal hemorrhage.
Other drugs in Others
- Dantrolene
Blocks RYR1 (ryanodine receptor) → ↓ Ca²⁺ release from sarcoplasmic reticulum → muscle relaxation. The only drug for malignant hyperthermia.
- Lipid Emulsion 20%
Theory: 'Lipid sink' sequesters lipophilic drugs (especially LAs), shifts to better Ca²⁺ handling, fatty acid metabolic support.
- Hydroxocobalamin
Vitamin B12a precursor; cyanide binds to cobalt center of hydroxocobalamin → forms cyanocobalamin (B12) → renal excretion. Also scavenges nitric oxide → vasoconstriction.
- Alvimopan
Blocks GI mu-opioid receptors WITHOUT crossing the blood-brain barrier → reverses opioid-induced gut slowing while preserving central analgesia. Accelerates return of bowel function.
- Phentolamine
Competitive, reversible α1 + α2 blockade → vasodilation. Short-acting.
- Inhaled Nitric Oxide
Inhaled NO diffuses to pulmonary vascular smooth muscle → ↑ cGMP → SELECTIVE pulmonary vasodilation only in VENTILATED lung units (improves V/Q matching). Inactivated by hemoglobin before reaching systemic circulation → no systemic hypotension.
- Digoxin Immune Fab
Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert
