Anesthesia for Pituitary Surgery

Anesthesia for pituitary surgery is challenging because of the diverse endocrinological abnormalities associated with the disease process. Close collaboration is required between anesthesiologists, neurosurgeons, and endocrinologists during the perioperative period. There is a strong association of pituitary tumors with disorders like acromegaly/gigantism and Cushing’s disease. Preoperative optimization and identification of systemic involvement in terms of hypertension, diabetes, and obstructive sleep apnea is required. Airway abnormalities are common. Intraoperative anesthetic management should be based upon tumor size and associated physiological disturbances. Trans-nasal excision of tumor has benefits in terms of mortality and recovery profiles. Newer anesthetic agents like dexmeditomidine and remifentanil are excellent for maintaining hemodynamic stability during the intraoperative period. Postoperative period requires strict monitoring and a high suspicion for complications such as cerebrospinal fluid leak and diabetes insipidus.