Endoskopik Transsfenoidal Cerrahi Uygulanan Akromegalik Hastalarda Anestezi Yönetiminin Retrospektif Analizi
Abstract
Amaç: Endoskopik transsfenoidal cerrahi ile tümör rezeksiyonu
uygulanan akromegalik hastaların anestezi yönetimi eşlik eden endokrinolojik ve
anatomik anamoliler sebebiyle özel dikkat ve yaklaşım gerektirmektedir. Bu
retrospektif çalışma ile akromegali tanısı alarak transsfenoidal hipofiz
cerrahisi geçiren hastalardaki anestezi yönetimine ve perioperatif bakıma değinilmek
istenmiştir.
Materyal ve Metot: Üniversitemiz Tıp Fakültesi Klinik Araştırmalar
Etik Kurulu’ndan etik kurul onayı alındıktan sonra Ocak 2017 ile Aralık 2018
tarihleri arasında endoskopik transsfenoidal cerrahi ile hipofizer tümör
eksizyonu uygulanan 25 akromegalik hastanın yazılı ve dijital dosyaları ile
anestezi kayıt formları incelenerek retrospektif analizi yapılmıştır.
Bulgular: Hastaların çoğunluğunun geliş şikayeti tümörün aşırı hormon
salgılamasının etkileriyle ilişkiliydi. Yaygın semptomlar somatik dismorfiklik,
baş ağrısı ve görme alanı defektleri idi. Hastalardan 3’ünde zor maske
ventilasyonu 2’sinde zor entübasyon gelişmişti. Zor entübasyon olgularının
birinde uyanık fiberoptik bronkoskop ile entübasyon sağlanırken diğer olguda
videolaringoskop kullanılmıştı.
Sonuç: Akromegalik hastaların
cerrahisi birçok hava yolu sorunu, kalp ve metabolik risk faktörleri
dolayısıyla pek çok anestezik zorluğu barındırabilir. Anestezistler, hipofiz
hastalığının çeşitli sunumlarını ve hastanın perioperatif durumu üzerine
etkilerini iyi bilmelidir.
Keywords
References
- 1. Amar AP, Weiss MH. Pituitary anatomy and physiology. Neurosurg Clin N Am 2003; 14: 11–23.
- 2. Larkin, S., & Ansorge, O. (2017). Pathology and pathogenesis of pituitary adenomas and other sellar lesions. In Endotext [Internet]. MDText. com, Inc.. Larkin S, Ansorge O. Pathology And Pathogenesis Of Pituitary Adenomas And Other Sellar Lesions. [Updated 2017 Feb 15]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK425704/
- 3. Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am 2008; 37:101-122
- 4. Carpenter, Griggs, Loscalzo. Endokrin Hastalıklar, Akromegali ve Gigantizm. Cecil Essentials of Medicine, Nobel Tıp Kitabevi 2002; 550-551.
- 5. Marulasiddappa V , Raghavendra. Anaesthetic management of a patient with extreme Gigantism for endoscopic transsphenoidal removal of pituitary adenoma. Int J Res Health Sci. 2015;3(1):62-5. 6. Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: A systematic review of the literature. J Clin Sleep Med. 2012;8:199-207.
- 7. Gadelha, M. R., Kasuki, L., Lim, D. S., & Fleseriu, M. (2018). Systemic complications of acromegaly and the impact of the current treatment landscape: an update. Endocrine reviews, 40(1), 268-332.
- 8. Melmed S. Acromegaly pathogenesis and treatment. J Clin Invest 2009; 119: 3189–202. 9. Katznelson L, Laws ER Jr, Melmed S, et al. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99:3933.10. Melmed S. Medical progress: Acromegaly. N Engl J Med 2006; 355:2558.
- 11. Abosch A, Tyrrell JB, Lamborn KR, et al. Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J Clin Endocrinol Metab 1998; 83:3411.
- 12. Freda PU, Wardlaw SL, Post KD. Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg 1998; 89:353.
- 13. Ross DA, Wilson CB. Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients. J Neurosurg 1988; 68:854.
- 14. Lim M, Williams D, Maartens N. Anaesthesia for pituitary surgery. J Clin Neurosci 2006; 13: 413–8.
- 15. Van Aken MO, de Marie S, van der Lely AJ, Singh R, de Marie S, van den Berge JH, et al. Risk factors for meningitis after transsphenoidal surgery. Clinical infectious diseases. 1997;25(4):852-6.
- 16. Gondim JA, Almeida JP, Albuquerque LA, Schops M, Gomes E, Ferraz T, et al. Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients. Pituitary. 2011;14:174‐83.
- 17. Menon, R., Murphy, P. G., & Lindley, A. M. (2011). Anaesthesia and pituitary disease. Continuing Education in Anaesthesia, Critical Care & Pain, 11(4), 133-137.
- 18. Smith M, Hirsch NP. Pituitary disease and anaesthesia. Br J Anaesth 2000; 85: 3–14.
- 19. Fabregas N, Lopez A, Valero R, Carrero E, Caral L, Ferrer E. Anesthetic management of surgical neuroendoscopies: Usefulness of monitoring the pressure inside the neuroendoscope. J Neurosurg Anesthesiol. 2000;12:21-8.
- 20. Chowdhury T, Prabhakar H, Bithal PK, Schaller B, Dash HH. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study. Saudi J Anaesth. 2014;8:335-41.
- 21. Ali Z, Bithal PK, Prabhakar H, Rath GP, Dash HH. An assessment of the predictors of difficult intubation in patients with acromegaly. J Clin Neurosci. 2009;16:1043-45.
- 22. Demirci, T., Uzun, Ş., Akça, B., & Aypar, Ü. Hipofiz Cerrahisi Yapılan Akromegalik Hastalarda Havayolu Yönetiminin Retrospektif Değerlendirilmesi. JARSS, 27(1), 38-43.23. Schmitt H, Buchfelder M, Radespiel-Tröger M, et al. Difficult intubation in acromegalic patients. Anesthesiology. 2000;93:110-4
A Retrospective Analysis of Anesthesia Management of Acromegalic Patients Undergoing Endoscopic Transsphenoidal Surgery
Abstract
Aim: Anesthesia management of acromegalic patients undergoing tumor
resection with endoscopic transsphenoidal surgery requires special attention
and approach due to the accompanying endocrinological and anatomical anamolies.
In this retrospective study, we aimed to address anesthesia management and
perioperative care in patients undergoing transsphenoidal pituitary surgery
with the diagnosis of acromegaly.
Material and Methods: After obtaining approval from the Institutional Investigation and Ethics
Committee of our university, between January 2017 and December 2018, 25
acromegalic patients with endoscopic transsphenoidal surgery underwent
pituitary tumor excision were retrospectively analyzed by using written and
online files and anesthesia records.
Results: The majority of patients presented with complaints of
excessive hormone secretion. Common symptoms were somatic dysmorphicity,
headache and visual field defects. Difficult mask ventilation was developed in
3 patients and difficult intubation in 2 patients. One of the difficult
intubation case was intubated with awake fiberoptic bronchoscope and the other
patient was with videolaryngoscope.
Conclusion: Surgery of acromegalic patients may involve several anesthetic
difficulties due to many airway problems, heart and metabolic risk factors.
Anesthesiologists should be familiar with the various presentations of
pituitary disease and its effects on the perioperative status of the patient.
Keywords
References
- 1. Amar AP, Weiss MH. Pituitary anatomy and physiology. Neurosurg Clin N Am 2003; 14: 11–23.
- 2. Larkin, S., & Ansorge, O. (2017). Pathology and pathogenesis of pituitary adenomas and other sellar lesions. In Endotext [Internet]. MDText. com, Inc.. Larkin S, Ansorge O. Pathology And Pathogenesis Of Pituitary Adenomas And Other Sellar Lesions. [Updated 2017 Feb 15]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK425704/
- 3. Ben-Shlomo A, Melmed S. Acromegaly. Endocrinol Metab Clin North Am 2008; 37:101-122
- 4. Carpenter, Griggs, Loscalzo. Endokrin Hastalıklar, Akromegali ve Gigantizm. Cecil Essentials of Medicine, Nobel Tıp Kitabevi 2002; 550-551.
- 5. Marulasiddappa V , Raghavendra. Anaesthetic management of a patient with extreme Gigantism for endoscopic transsphenoidal removal of pituitary adenoma. Int J Res Health Sci. 2015;3(1):62-5. 6. Vasu TS, Grewal R, Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: A systematic review of the literature. J Clin Sleep Med. 2012;8:199-207.
- 7. Gadelha, M. R., Kasuki, L., Lim, D. S., & Fleseriu, M. (2018). Systemic complications of acromegaly and the impact of the current treatment landscape: an update. Endocrine reviews, 40(1), 268-332.
- 8. Melmed S. Acromegaly pathogenesis and treatment. J Clin Invest 2009; 119: 3189–202. 9. Katznelson L, Laws ER Jr, Melmed S, et al. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99:3933.10. Melmed S. Medical progress: Acromegaly. N Engl J Med 2006; 355:2558.
- 11. Abosch A, Tyrrell JB, Lamborn KR, et al. Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J Clin Endocrinol Metab 1998; 83:3411.
- 12. Freda PU, Wardlaw SL, Post KD. Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg 1998; 89:353.
- 13. Ross DA, Wilson CB. Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients. J Neurosurg 1988; 68:854.
- 14. Lim M, Williams D, Maartens N. Anaesthesia for pituitary surgery. J Clin Neurosci 2006; 13: 413–8.
- 15. Van Aken MO, de Marie S, van der Lely AJ, Singh R, de Marie S, van den Berge JH, et al. Risk factors for meningitis after transsphenoidal surgery. Clinical infectious diseases. 1997;25(4):852-6.
- 16. Gondim JA, Almeida JP, Albuquerque LA, Schops M, Gomes E, Ferraz T, et al. Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients. Pituitary. 2011;14:174‐83.
- 17. Menon, R., Murphy, P. G., & Lindley, A. M. (2011). Anaesthesia and pituitary disease. Continuing Education in Anaesthesia, Critical Care & Pain, 11(4), 133-137.
- 18. Smith M, Hirsch NP. Pituitary disease and anaesthesia. Br J Anaesth 2000; 85: 3–14.
- 19. Fabregas N, Lopez A, Valero R, Carrero E, Caral L, Ferrer E. Anesthetic management of surgical neuroendoscopies: Usefulness of monitoring the pressure inside the neuroendoscope. J Neurosurg Anesthesiol. 2000;12:21-8.
- 20. Chowdhury T, Prabhakar H, Bithal PK, Schaller B, Dash HH. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study. Saudi J Anaesth. 2014;8:335-41.
- 21. Ali Z, Bithal PK, Prabhakar H, Rath GP, Dash HH. An assessment of the predictors of difficult intubation in patients with acromegaly. J Clin Neurosci. 2009;16:1043-45.
- 22. Demirci, T., Uzun, Ş., Akça, B., & Aypar, Ü. Hipofiz Cerrahisi Yapılan Akromegalik Hastalarda Havayolu Yönetiminin Retrospektif Değerlendirilmesi. JARSS, 27(1), 38-43.23. Schmitt H, Buchfelder M, Radespiel-Tröger M, et al. Difficult intubation in acromegalic patients. Anesthesiology. 2000;93:110-4
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Anaesthesiology |
| Journal Section | Articles |
| Authors | |
| Publication Date | August 31, 2019 |
| Acceptance Date | August 31, 2019 |
| Published in Issue | Year 2019 Volume: 2 Issue: 2 |
