Perioperative management of patients with acromegaly-a retrospective analysis

Background: Acromegaly poses several challenges to the anesthetists, neurosurgeons, endocrinologists and intensivists, mandating a careful, coordinated multidisciplinary approach for a successful surgical outcome. An emphasis is required on a thorough preoperative evaluation of airway, neurological and endocrine and metabolic status so as to formulate a suitable perioperative management plan.Methods: The rates of various perioperative complications, both surgical and anesthesia related, during pituitary surgeries in acromegaly patients were studied. Data collected included demographics, patient’s medical history and any associated comorbid conditions, diagnosis, procedure performed, anesthetic management, intraoperative and postoperative complications.Results: This is a retrospective analysis of 22 patients of acromegaly who underwent excision of a growth hormone (GH) secreting pituitary adenoma from October 2012 to December 2017. Male: female, 14:8 with a mean age of 32±9.5 years. The common presenting symptoms were somatic dysmorphism, headache, visual field defects and menstrual irregularities. Preoperative associated co-morbidities were hypertension (4), diabetes mellitus (6), Ischemic Heart Disease (1), hypothyroidism (3), situs solitus (1), lumbar and cervical disc prolapse (1), nephropathy (1) and poliomyelitis (1). One patient had difficult tracheal intubation with repeated attempts at direct laryngoscopy and surgery was deferred to a later date where awake fibreoptic bronchoscopic intubation was done. Two more patients with anticipated difficult airway, trachea was intubated using a fibreoptic bronchoscope. Out of 22 Transsphenoidal surgical approach (transnasal or sublabial) and pterional craniotomy in 18 and 4. Inhalational anaesthetic was used in the majority of patients (isoflurane, 18 and sevoflurane, 03) propofol infusion was used in 1 patient. Intraoperative cardiac complications like hypertension, ventricular ectopics was seen. Postoperatively metabolic, water and electrolyte imbalance were common occurance. CSF rhinorrhoea in 4 patients and one developed meningitis.Conclusions: The present data shows that patients undergoing pituitary surgery for acromegaly have many airway issues, cardiac and metabolic risk factors