Acromegaly

 

 

Considerations

 

  • Difficult airway:

    • Macroglossia & enlarged epiglottis, resulting in difficult bag-mask ventilation & direct laryngoscopy

    • Recurrent laryngeal nerve palsy, narrow glottic opening, subglottic narrowing (stridor)

    • Nasal turbinate enlargement; caution with nasal intubation & consider smaller ETT

  • Multisystem disease:

    • Cardiovascular:

      • Hypertension, left ventricular hypertrophy, diastolic dysfunction 

      • Arrhythmias

      • Coronary artery disease, cardiomyopathy

    • Respiratory:

      • Obstructive sleep apnea

      • Pulmonary hypertension, right ventricular dysfunction  

    • CNS:

      • Pituitary dysfunction

      • Potential for raised ICP 

      • Peripheral neuropathies common 

    • Endocrine:

      • Diabetes mellitus/hyperglycemia

    • Difficult patient positioning, access, monitoring, regional anesthesia

      • Radial arterial line contraindicated due to poor collateral circulation 

 

 

Goals

 

  • Safely secure difficult airway: consider awake fiberoptic intubation with stridor & voice changes 

  • Thorough cardiopulmonary examination, including volume status assessment

 

 

Conflicts

 

  • Avoidance of CPAP following trans-sphenoidal surgery

  • Post-operative pain vs. enhanced sedation/respiratory depression 

 

 

Crises

 

  • Post-operative stridor (subglottic edema, vocal cord paralysis)

  • Endocrine emergencies 

    • Diabetes insipidus, SIADH

 

 

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