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Anesth Analg 2005;101:1170-1181
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ane.0000166976.61650.ae

NEUROSURGICAL ANESTHESIA

Perioperative Management of Patients Undergoing Transsphenoidal Pituitary Surgery

Edward C. Nemergut, MD*{dagger}, Aaron S. Dumont, MD{dagger}, Usha T. Barry, MD*, and Edward R. Laws, MD{dagger}

Departments of *Anesthesiology and {dagger}Neurosurgery, University of Virginia Health System, Charlottesville, Virginia

Address correspondence and reprint requests to Edward C. Nemergut, MD, Department of Anesthesiology, University of Virginia Health System, P.O. Box 800710, Charlottesville, VA 22908-0710. Address e-mail to en3x{at}virginia.edu.

Pituitary adenomas often present with the symptoms of hormonal hypersecretion, and although medical therapy is available for most hyperfunctioning states, it is not curative. As a result, transsphenoidal pituitary surgery has become a commonly performed neurosurgical procedure with unique challenges for the anesthesiologist due to the distinct medical comorbidities associated with various adenomas. Any type of pituitary tumor may also produce hypopituitarism and local mass effects secondary to the expanding intrasellar mass. Here we review the perioperative concerns surrounding surgery to remove adenomas and decompress the sellar space. Special attention is given to Cushing’s disease (hypercortisolism secondary to an adrenocorticotropic hormone-secreting adenoma), acromegaly (secondary to a growth hormone-secreting adenoma), and hyperthyroidism in the setting of thyrotropic adenomas. Operative risks, including bleeding, diabetes insipidus, the syndrome of inappropriate antidiuretic hormone secretion, and hypopituitarism, are addressed in detail. Understanding preoperative assessment, intraoperative management, potential complications, their management, and strategies for avoidance are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.