Retrospective analysis of anesthesia management in patients undergoing pituitary tumor surgery

Introduction and Objective: The most important issue in neuroanesthesia is to provide adequate cerebral perfusion pressure (CPP) and appropriate surgical conditions without disturbing cerebral circulation autoregulation. Patients with pituitary tumors represent a heterogeneous but widely encountered neurosurgical population. Successful surgical management of patients with pituitary tumors requires a multidisciplinary approach and is critically dependent on the quality of perioperative care. All patients with pituitary gland tumors require rigorous preoperative evaluation and screening. Knowledge of potential complications, their management and prevention strategies are essential for successful perioperative patient care. This study aims to create a data source by retrospectively examining patients who underwent endoscopic endonasal transsphenoidal and/or craniotomy and pituitary surgery in our hospital in terms of anesthesia. Materials and Methods: The anesthesia registration forms of the patients who underwent neuroanesthesia due to pituitary adenoma in the Department of Neurosurgery at Dicle University Faculty of Medicine between January 2010 and December 2020 were reviewed retrospectively after the approval of the ethics committee. The registration forms of only 94 of the 102 patients who underwent pituitary surgery were obtained in a healthy way. One copy of the anesthesia registration forms, which are kept as copies, is stored in the patient file and one copy is stored in the department archive. Patient files have been transferred to the computer system since 2011. Computer records and anesthesia slips were examined by examining patients' demographic data (age, gender, height, weight), ASA (American Society of Anesthesiologist) class score and accompanying diseases, duration of anesthesia, duration of surgery, Mallampati score, intubation difficulty, monitoring methods, anesthesia methods, anesthetic drugs, bleeding conditions, perioperative complications and whether there was a need for postoperative intensive care, tumor characteristics were evaluated. Results: The mean age of the subjects included in the study was 44.76±15.25 years. Forty (42.6%) of the patients were female and 54 (57.4) were male. Most of the patients were in ASA II (60.6%) and ASA III (29.8%) classes. 9 (9.6%) of the patients were taken to emergency operation with the presence of clinical apoplexy. When the admission to surgery of the patients and the postoperative intensive care length of stay were compared, the intensive care unit admissions were found to be significantly higher in those who were admitted to emergency surgery. 7.4% of the surgeries were performed with open craniotomy and 92.6% with the transsphenoidal method. All cases taken by craniotomy before 2016; only 1 case was started transsphenoidally, but was terminated due to intraoperative bleeding and removed by craniotomy in the next session. As the anesthesia method, 18.1% TIVA and 81.9% inhalation anesthesia were applied. When the type of anesthesia and hypotension developed intraoperatively were compared, the rate was found to be higher in those who received inhalation anesthesia. When the postoperative lactate levels of the patients were examined, it was seen that it was higher in those who were administered inhalation anesthesia compared to those who received TIVA. There was no significant relationship between the preoperative IGF-1 value and the postoperative diabetes insipidus in the patients, but a positive correlation was found between IGF and the mallampati score. Conclusion: Successful treatment management of patients with pituitary tumors requires a multidisciplinary approach that combines anesthesia, neurosurgery, radiology and endocrinology units. It is stated that the applied neuroanesthesia is a specific type of anesthesia that starts from the preoperative period and covers the postoperative period; It should be kept in mind that endocrinological problems may be experienced in patients, the rate of encountering difficult intubation is high, invasive methods can be used if necessary in the follow-up of hemodynamics, and postoperative respiratory distress may develop especially in obese and OSAS patients.