Diabetes mellitus (DM) is a common chronic disorder associated with cardiovascular disease and microvascular complications, often necessitating surgical intervention. These patients are at an increased risk of perioperative infection and postoperative morbidity and mortality. The complex interplay of stress from surgery, anesthesia, and fasting, along with additional postoperative factors such as infection, altered nutritional intake, hyperalimentation, and emesis, can lead to labile blood glucose levels. There is a clear association between perioperative hyperglycemia and adverse clinical outcomes, although the exact mechanism(s) underlying this remains unclear. Perioperative DM management focuses on glycemic control. Substantial evidence indicates that the correction of hyperglycemia with insulin administration reduces complication rates and decreases mortality in cardiac and general surgery patients.
Mechanical ventilation (MV) is a vital life support measure, but prolonged use is associated with morbidity. Indications include apnea, respiratory distress, hypoxemia, and hypercapnia. MV unloads the increased work of breathing and stops the development of acidosis with respiratory depression. There are no absolute contraindications, but tension pneumothorax, bronchopleural fistula, right ventricular failure, and hypovolemic shock are relative contraindications. A thorough understanding of the different modes of MV is essential for successful application. The common terms used with MV should be known, and efforts should be focused on MV liberation as soon as the patient meets criteria for safe extubation.
Pituitary adenomas are benign lesions commonly encountered in clinical practice. Functioning adenomas often result in symptoms related to hormone excess, whereas nonfunctioning adenomas often present later with symptoms secondary to mass effect of the tumor. Diagnosis is done by way of laboratory testing and magnetic resonance imaging (MRI). Transsphenoidal pituitary resection (TPR) is the mainstay of treatment for pituitary adenomas and poses unique challenges as it involves the principles and practices of both endocrine and neurosurgical management. Airway management may be difficult in patients with acromegaly or Cushing disease. The anesthetic management for pituitary surgery requires comprehensive preoperative assessment of hormonal function and airway anatomy. Intraoperative management revolves around facilitating surgical exposure while providing hemodynamic stability and allowing for rapid emergence. Postoperative disorders of sodium balance and pituitary hormone deficiency are common after pituitary surgery.
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