Retrospective Analysis of Difficulties in Airway Management in Pituitary Tumor Surgery

Background: Changes in upper airway anatomy make patients with acromegaly a unique challenge for airway management. Previous publications indicated that intubation was difficult in 33/128 patients and that the predictive value of Mallampati score is low. [1]

Objectives: To assess retrospectively the incidence of difficult intubation in patients undergoing pituitary surgery in our institution.

Methods: Anesthesia and medical charts of patients undergoing pituitary surgery during the years 2015-2016 were explored for age, gender, hormonal diagnosis, Mallampati score, laryngoscopic view, difficulty of intubation, first end tidal carbon dioxide value immediately following intubation.

Results: Eighty-two patients, age 12-87 years old (mean age 51), 46 male and 36 females were included. From These patients 20 had the diagnosis of acromegaly and 62 had other pituitary tumors (11 Cushing syndrome, 13 prolactinoma, 21 none secreting, and 16 others). According to the pre-operative evaluation, 12/20 patients with acromegaly had Mallampati 1 or two, six had Mallampati of three, and one had Mallampati of four. During the induction of anesthesia awake fiberoptic intubation was performed in one patient, three patients had video-laryngoscopic intubation, and from the others 11 had laryngoscopic view of one or 2, 3 had laryngoscopic view of 3, and 1 had laryngoscopic view of 4. First end tidal carbon dioxide levels following orotracheal intubation was 38±6 mmHg (mean±SD).

Conclusion: According to our experience, most acromegaly patients are not difficult to intubate and that preoperative anesthetic evaluation can predict intubation difficulty.

References: 1. Clin Endocrinol (Oxf). 1994;41: 359–64. 2. Anesthesiology. 2000; 93;110-4.