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Sevoflurane anesthesia rather than propofol anesthesia is associated with 3-month postoperative hypocortisolism in patients undergoing endoscopic transsphenoidal surgery for non-functional pituitary adenoma with preoperative normal hypothalamic–pituitary–adrenal axis

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Abstract

Purpose

The effects of anesthetic technique on intermediate-term postoperative adrenocorticotropic hormone (ACTH) functional outcomes have not been fully determined in non-functioning pituitary adenoma (NFPA) patients. Postoperative hypocortisolism is potentially life-threatening and requires steroid replacement after pituitary surgery. The present study determined whether sevoflurane anesthesia was predictive of 3-month postoperative hypocortisolism in NFPA patients with preoperative normal hypothalamic–pituitary–adrenal (HPA) axis.

Methods

Demographics, preoperative pituitary hormone status, intraoperative data, and tumor characteristics were retrospectively collected from 429 NFPA patients, who had preoperative normal HPA axis and underwent endoscopic transsphenoidal surgery. Patients were divided into two groups based on intraoperative anesthetic technique: sevoflurane-based inhalation anesthesia group (n = 74) and propofol-based intravenous anesthesia group (n = 355). After propensity score matching, 73 patients were selected in each group and the incidence of 3-month postoperative hypocortisolism (primary outcome measure) was compared between the two groups.

Results

The incidence of 3-month postoperative hypocortisolism was higher in the sevoflurane anesthesia group than the propofol anesthesia group before (n = 20[27.0%] vs. n = 49[13.8%], P = 0.008) and after (n = 20 [27.4%] vs. n = 5 [6.8%], P = 0.002) propensity score matching, respectively. Sevoflurane anesthetic use (odds ratio [95% CI] 5.37[1.80–15.98], P = 0.003) and postoperative steroid administration (2.89 [1.06–7.92], P = 0.039) were predictors of 3-month postoperative hypocortisolism.

Conclusion

In patients with preoperative normal HPA axis undergoing endoscopic transsphenoidal surgery for NFPA, sevoflurane anesthesia and postoperative steroid administration were associated with the development of 3-month postoperative hypocortisolism. A large-scale prospective study is needed to confirm the negative association between sevoflurane anesthesia and postoperative ACTH functional outcome.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Seungeun Choi, Yoon Jung Kim, Hyongmin Oh, Nayoung Kim & Hee-Pyoung Park

  2. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Yong Hwy Kim

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  1. Seungeun Choi
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Contributions

Conception and design: CS, OH, KYH, PHP. Acquisition of data: CS, KYJ, KN. Analysis and interpretation of data: CS, KYJ, OH. Drafting the article: CS. Critically revising the article: OH, KYH, PHP. Study supervision: PHP.

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Correspondence to Hee-Pyoung Park.

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This retrospective study was conducted after approval from the Institutional Review Board of Seoul National University Hospital (IRB no. H-2110–126-1264). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Because this was a retrospective study, for this type of study, formal consent is not required.

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This article does not contain any studies with human participants performed by any of the authors.

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Choi, S., Kim, Y.J., Oh, H. et al. Sevoflurane anesthesia rather than propofol anesthesia is associated with 3-month postoperative hypocortisolism in patients undergoing endoscopic transsphenoidal surgery for non-functional pituitary adenoma with preoperative normal hypothalamic–pituitary–adrenal axis. Acta Neurochir 164, 2083–2094 (2022). https://doi.org/10.1007/s00701-022-05260-4

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