Airway Management and Perioperative Concerns in Acromegaly Patients Undergoing Endoscopic Transsphenoidal Surgery for Pituitary Tumors

Abstract

Acromegaly patients present a particular challenge to the endoscopic skull base surgeon. Despite preoperative anesthesia and otolaryngology evaluation, many of these patients will experience an unanticipated airway challenge during intubation. Preoperative preparation and perioperative awareness of anatomic and physiologic abnormalities of acromegalic patients is essential for successful endoscopic surgery in this unique population.

Craniofacial structure in patients with obstructive sleep apnoea

“…The factors reducing the cross-sectional area lead to the development of OSA. The above is confirmed by the reports on apnoea in patients with neoplastic tumours of the upper airways [11], hypertrophied tonsils [29], and macroglossia [8,20]. The size of the upper airways cross-sectional area is also related to the craniofacial structure, which was demonstrated in earlier reports concerning narrowed cross-sections of the pharynx in patients with extreme micrognathia [27].…”

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

“…It can be used for specific patients (invasive macroadenomas with low probability of surgical cure, severe complications) for a few months , Jacob & Bevan 2014, Katznelson et al 2014. SSA pretreatment can also be useful in individual patients with severe soft tissue overgrowth (associated with intubation difficulties and complications) as it reduces the anesthetic complications and facilitates intubation (Friedel et al 2013).…”

American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Management of Acromegaly Patients: What is the Role of Pre-Operative Medical Therapy?

“…Rates of Postsurgical Complications, Duration of Hospital Stay Patients with acromegaly are thought to have higher risk of anesthesia morbidity compared to patients with other types of pituitary adenomas, mainly related to hemodynamic changes and an increased incidence of difficult intubation (35)(36)(37)(38). However, Seidman et al (39) evaluated 29 acromegaly patients who underwent general anesthesia compared to age-matched controls and found no difference in the amount of vasoactive drugs required or in arterial oxygen or carbon dioxide tension.…”

“…Although acromegaly patients had altered intra-operative parameters compared to controls, there was no increased cardiovascular or pulmonary morbidity in this study. In a single-center study, Friedel et al (35) focused on airway management and noted that videoscopic direct laryngoscopy intubation was required in 7 of 32 patients and fiberoptic intubation in 4 of 32 patients with acromegaly. These data are similar to that of the study by Schmitt et al (38), in which 26% of patients with acromegaly were noted to have difficulty with laryngoscopy during planned surgical intervention.…”