A Retrospective Analysis Of Airway Management Of Acromegalyic Patients Undergoing Pituitary Surgery

Abstract

Objective: Acromegaly is an endocrinological disease that has morbidity and mortality characterised by high levels of growth hormone (GH) and insülin like growth factor-I (IGF-I). Typical big nose and lips, macroglossia, enlargement of mandible may be observed due to acral changes. Hypertrophy of pharynx, larynx, tonsils, vocal cords, mucosa and soft tissue may occur in acromegaly. Due to the characteristics of acromegaly, difficult mask ventilation and airway management might be anticipated in these patients. The purpose of this study was to document the challenges and methods used in airway management in acromegaly patients undergoing transsphenoidal pituitary surgery and to compare the success rates of these methods. Methods: The perioperative records of 120 patients that underwent transsphenoidal resection of pituitary adenoma at our university hospital between 2003-2013 were reviewed. Results: Among the patients studied, difficulty with intubation was encountered in %10 of patients which is consistent with literature. Patients whose laryngoscopy was challenging were intubated by changing blade, application of external laryngeal pressure or using a guide. One patient was intubated using LMA FastrachTM. Obstructive sleep apnea syndrome (OSAS) is a frequent comorbidity in acromegalic patients and this co-occurrence is also associated with difficult intubation. Conclusion: Significant correlation was observed between Mallampati gradings and incidence of difficult endotracheal intubation. Also obstructive sleep apnea syndrome (OSAS) which is very frequent in acromegalic patients is also associated with difficulty in airway management. We think that induction of anesthesia should be attempted after taking precautions to overcome difficult airway management in these patients. © Copyright Association of Anesthesiologists and Reanimation Specialists.