Airway Management and Perioperative Concerns in Acromegaly Patients Undergoing Endoscopic Surgery for Pituitary Tumors

Objectives: The purpose of this article is to review perioperative and airway concerns in acromegalic patients for the skull base surgeon in order to reduce preventable perioperative complications.

Study Design: Review of comprehensive cranial base surgery database and review of literature.

Setting: Tertiary care hospital.

Participants: Nineteen patients with acromegaly.

Main Outcome Measures: Literature review, airway management strategies, and cardiovascular and respiratory comorbidities.

Background: Patients with acromegaly present unique challenges to cranial base surgery and anesthesia teams in the perioperative period, especially with regard to airway management. Abnormal airway anatomy may result from soft tissue hypertrophy and bony alterations. Additional perioperative challenges relate to the management of medical comorbidities and specific surgical technical issues.

Results: Glide scope intubation (video-assisted direct laryngoscopy) was required in 7/19 patients (36.8%) and fiberoptic intubation in 3/19 patients (15.8%). Cardiovascular comorbidities (hypertension and conduction abnormalities predominated) were present in 12/19 patients (63.1%) and obstructive sleep apnea or other respiratory conditions existed in 11/19 patients (57.9%).

Conclusions: The views presented herein are based on the collective experience of otolaryngologists and neurosurgeons at a dedicated skull base center with several hundred endoscopic cranial base procedures/operations. Preoperative preparation and perioperative awareness of anatomic and physiologic abnormalities of acromegalic patients are essential for successful endoscopic surgery in this unique population.