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Principles and Pitfalls of Anesthesia for Transsphenoidal Surgery

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Transsphenoidal Surgery

Abstract

Pituitary tumors are common and may affect as many as one in six people. Microadenomas most frequently present with symptoms of hormone excess, whereas macroadenomas present due to symptoms of mass effect and elevated intracranial pressure. Patients with acromegaly and Cushing’s disease present unique challenges for the anesthesiologist. Medical therapy minimizes symptoms, but surgical resection offers a chance for definitive cure. Anesthetic management of patients for transsphenoidal surgery focuses on preoperative assessment of hormone function, airway, and cardiopulmonary risk factors. Intraoperative anesthetic goals include airway management, maintaining hemodynamic stability, and providing a rapid, smooth emergence. Postoperative considerations include pain control, monitoring for hypopituitarism and disorders of water and electrolytes, and management of surgical complications. Careful attention to these anesthetic principles improves patient care and minimizes morbidity for patients undergoing transsphenoidal pituitary surgery.

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Authors and Affiliations

  1. Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA

    Lauren K. Dunn MD, PhD

  2. Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA

    Edward C. Nemergut MD

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  1. Lauren K. Dunn MD, PhD
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  2. Edward C. Nemergut MD
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Correspondence to Edward C. Nemergut MD .

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Editors and Affiliations

  1. Department of Neurosurgery, Harvard Medical School Brigham and Women’s Hospital, Boston, MA, USA

    Edward R. Laws, Jr

  2. Department of Neurosurgery, Indianapolis Methodist Hospital, Indianapolis, IN, USA

    Aaron A. Cohen-Gadol

  3. Department of Neurosurgery, Weill Cornell Medical College New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

  4. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA

    Jason P. Sheehan

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Dunn, L.K., Nemergut, E.C. (2017). Principles and Pitfalls of Anesthesia for Transsphenoidal Surgery. In: Laws, Jr, E.R., Cohen-Gadol, A.A., Schwartz, T.H., Sheehan, J.P. (eds) Transsphenoidal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-56691-7_3

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