Airway Obstruction in Acromegaly: A Method of Prevention

Abstract

Maintaining the airway of the acromegalic patient is a definite anaesthetic challenge during the perioperative period. Pulmonary oedema following acute upper airway obstruction is rare but is a likely complication in these patients. We describe the case of an acromegalic patient who developed such a problem after trans-sphenoidal resection of an hypophyseal adenoma. A simple method of prevention is suggested for patients at particular risk.CASE REPORT The patient, a 36-year-old man, had been diagnosed as acromegalic two years previously. On admission, clinical examination revealed the typical morphology of acromegaly. The patient was premedicated orally with lormetazepam 2 mg and intramuscularly with atropine 0.5 mg, hydrocortisone 100 mg and cimetidine 400 mg.Following administration of oxygen by mask, anaesthesia was induced intravenously with diazepam 6 mg, fentanyl 0.25 mg, thiopentone 400 mg and succinylcholine 100 mg. The trachea was intubated without difficulty with a 10 mm cuffed orotracheal tube and controlled ventilation commenced. After intubation pulmonary auscultation was normal. Monitoring consisted of a radial arterial catheter, a central venous line, a capnograph and a central core temperature probe. Anaesthesia was maintained with •M.D .. Senior Registrar. "M. D .. Staff Anaesthetist.