The recent discovery that both serotonin and bradykinin were involved in the clinical manifestations of the carcinoid syndrome, has important implications in the management of anaesthesia. In this report we reviewed the fundamental aspects underlying the biochemistry, the physiology, and the pharmacology of the secreting carcinoid tumor. Bradykinin and associated peptides were traced from their origin in the lysomal granules to their inactivation in the blood, the liver and the lungs. The pharmacological opportunity to block this proteolytic system with anti-peptidases (Trasylol, Iniprol, EACA), was stressed. Serotonin metabolism was also described. The pharmacodynamic pattern, involved in serotonin synthesis, uptake, storage, release, and degradation, was followed from the serotoninergic granule to the urinary excretion of 5 HIAA. The choice of drugs available to interfere with the steps of this sequence was emphasized. We also reported our clinical experience with the management of anaesthesia in 16 cases of carcinoid tumors, 7 of which were functional and secreting. The carcinoid attacks which occurred during anaesthesia were classified in two categories, namely the bradykininergic and the serotoninergic dysfunctions. Accordingly, preventive and corrective measures described were related to a more specific approach to these incidents with either bradykininolytic or serotoninolytic agents. This integration of new pharmacological knowledge with a clearer understanding of the clinical profile of the carcinoid attacks can result in a better management of the emergencies likely to arise during anaesthesia.