Radial artery cannulation Potential hazard in patients with acromegaly

Campkin, T.V.

doi:10.1111/j.1365-2044.1980.tb05004.x

Cited by 24 publications

(4 citation statements)

References 5 publications

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“…During insertion of radial arterial line one has to be cautious as there is a possibility of the ulnar circulation being compromised, especially in acromegaly patients due to the carpel tunnel syndrome. [38] As a result there is an increase in the chances of the development of ischemia of hand if proper evaluation of hand circulation is not carried out preoperatively. Cannulation of the dorsalis pedis artery or femoral artery is a better alternative to avoid this potentially hazardous complication.…”

Section: Peri-operative Monitoringmentioning

confidence: 99%

Anesthesia and Intensive care implications for pituitary surgery: Recent trends and advancements

Bajwa

2011

Indian J Endocr Metab

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The advancements in neuro-endocrine surgical interventions have been well supported by similar advancements in anesthesiology and intensive care. Surgery of the pituitary tumor poses unique challenges to the anesthesiologists and the intensivists as it involves the principles and practices of both endocrine and neurosurgical management. A multidisciplinary approach involving the endocrine surgeon, neurosurgeon, anesthesiologist, endocrinologist and intensivist is mandatory for a successful surgical outcome. The focus of pre-anesthetic checkup is mainly directed at the endocrinological manifestations of pituitary hypo or hyper-secretion as it secretes a variety of essential hormones, and also any pathological state that can cause imbalance of pituitary secretions. The pathophysiological aspects associated with pituitary tumors mandate a thorough airway, cardiovascular, neurologic and endocrinological assessment. A meticulous preoperative preparation and definite plans for the intra-operative period are the important clinical components of the anesthetic strategy. Various anesthetic modalities and drugs can be useful to provide a smooth intra-operative period by countering any complication and thus providing an uneventful recovery period.

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Section: Peri-operative Monitoringmentioning

confidence: 99%

Anesthesia and Intensive care implications for pituitary surgery: Recent trends and advancements

Bajwa

2011

Indian J Endocr Metab

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“…The authors reserve an arterial catheter for patients with poor exercise tolerance, patients with the signs and symptoms of congestive heart failure, or patients with documented cardiomyopathy. It should be noted that secondary to soft tissue overgrowth, blood flow through the ulnar artery may be compromised in up to 50% of acromegalic patients [42], especially in those with a history of carpal tunnel syndrome. In these patients, blood flow to the hand may be critically dependent upon the radial artery flow.…”

Section: Monitoringmentioning

confidence: 99%

Anesthetic and Critical Care Management of Patients Undergoing Pituitary Surgery

Burton

Nemergut²

2006

Frontiers of Hormone Research

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Patients with tumors of the pituitary gland represent a heterogeneous yet commonly encountered neurosurgical population. Optimal anesthetic care requires an understanding of the complex pathophysiology secondary to each patient's endocrinological disease. Although patients presenting with Cushing's disease and acromegaly have unique manifestations of endocrine dysfunction, all patients with tumors of the pituitary gland require meticulous preoperative evaluation and screening. There are many acceptable strategies for optimal intraoperative anesthetic management; however, the selection of anesthetic agents should be tailored to facilitate surgical exposure, preserve cerebral perfusion and oxygenation, and provide for rapid emergence and neurological assessment. A rapid emergence from anesthesia is particularly important, as an early neurological assessment is necessary to evaluate cranial nerve integrity. In the postoperative period, careful monitoring of fluid balance and serum sodium is essential to the early diagnosis of diabetes insipidus (DI) and the syndrome of inappropriate anti-diuretic hormone (SIADH) secretion. DI is most often transient, but can require medical therapy. SIADH has a number of treatment options and decisions should be based upon the patient's status. A thorough understanding of the preoperative assessment, intraoperative management, and potential complications is fundamental to successful perioperative patient care and avoidance of morbidity and mortality.

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“…Hypertrophy in the vocal cord can lead to changes in the upper airway, making airway management difficult during trachea intubation [ 3 , 4 ]. For 50% of acromegalic patients, collateral circulation of radial artery and ulnar artery is not clearly visible in one hand or both hands [ 5 ]. Therefore, catheter should be carefully inserted into the radial artery in the wrist to continuously measure the blood pressure.…”

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confidence: 99%

“…Because of this, they can develop impaired ulnar artery circulation. Approximately 50% of acromegalic patients have impaired ulnar artery circulation in one or both of their hands, with 30% of those who have impaired ulnar artery circulation can develop carpal tunnel syndrome [ 5 ]. However, our patient did not exhibit any signs of carpal tunnel syndrome.…”

mentioning

confidence: 99%