Anesthesia for transsphenoidal pituitary surgery

Abstract

Purpose of review: Pituitary tumors are commonly encountered in clinical practice. Patients with functioning adenomas frequently present with symptoms of hormone excess, whereas those with nonfunctioning adenomas often present later and have symptoms resulting from mass effect of the tumor. This article examines recent advancements in the preoperative assessment and anesthetic management of patients undergoing transsphenoidal pituitary surgery.

Recent findings: Endoscopic guidance has improved tumor visualization while minimizing the risk of nasal and dental complications and septal perforation. Computer-assisted navigation and intraoperative MRI has further improved surgical outcomes. Airway management may be particularly challenging in patients with acromegaly or Cushing's disease. Both intravenous and volatile agents can be used for anesthetic maintenance. Although pituitary surgery can be intensely stimulating and associated with intraoperative hypertension, most patients require little postoperative analgesia. Postoperative diabetes insipidus is common after pituitary surgery and is typically self-limited. Some patients will require treatment with desmopressin and it is important to avoid 'overshoot' iatrogenic syndrome of inappropriate antidiuretic hormone SIADH and hyponatremia in these patients.

Conclusion: Anesthetic management for pituitary surgery requires thorough preanesthetic assessment of hormonal function and intraoperative management to facilitate surgical exposure while providing hemodynamic stability and allowing for rapid emergence.