Pituitary Tumors account for 15% of Braun tumors. Trans sphenoidal endoscopic approach are more common. Post surgery fluid and electrolyte balance is important.
8. MOST TUMORS ARISE FROM ANTERIOR PART OF THE GLAND
RESEMBLE NORMAL GLAND AND ARE MOSTLY BENIGN ADENOMAS
INCIDENCE : 200/MILLION POPULATION BUT MOST ARE
ASYMPTOMATIC. PITUITARY ADENOMAS ARE FOUND IN 10 -27 %
OF POSTMORTEM FINDINGS.
32. FOR TRANSCRANIAL APPROACH HEAD SHAVING IS REQUIRED
FOR TRANS SPHENOIDAL APPROACH
EXPLAIN TO THE PATIENT THAT HE WILL NOT BE ABLE TO
BREATHE THROUGH THE NOSE DUE TO NASAL PACKS
AFTER SURGERY
PREPARATION OF NASAL MUCOSA
XYLOMETAZOLINE NASAL DROPS
10 – 15 MINUTES PRIOR TO SURGERY.
INJ. LIGNOCAINE 2 % WITH ADRENALINE (1:200000)
40. CAUTION:
Radial artery cannulation in
acromegaly patients.
Carpel tunnel syndrome
If ulnar circulation is
compromised: prone to
develop ischemia.
Cannulation of dorsalis pedis
artery is better option in such
patient.
44. The level of consciousness, eye movements, visual fields, and acuity
should be tested frequently and any deterioration discussed with the
surgeon, and radiological investigation and/or re-exploration considered.
Rashmi Menon, MD FRCA, Paul G. Murphy, FRCA, Andrew M. Lindley, FRCA, Anaesthesia and pituitary disease, Continuing Education in Anaesthesia Critical
Care & Pain, Volume 11, Issue 4, August 2011, Pages 133–137, https://doi.org/10.1093/bjaceaccp/mkr014
45.
46.
47.
48. Post operative
day
Dose of inj
hydrocortisone
Dosing
Schedule
1 50 mg 12 hrly
2 25mg 12 hrly
3 20 – 10 mg Day and night
Maintenance at the time of discharge:
a. 15 mg in morning
b. 5 mg in evening
49. P. Cortisol level
nmol/L
Maintenance dose of
hydrocortisone
< 100 15 – 30 mg /day
100 -200 10 – 20 mg /day
200 – 400 Only during stress
>400 No dosage required
This may increase BP specially in a patient with who have unopposed alpha adrenergic effect.
It can be treated with increasing depth of anesthesia, use of direct vasodilators, opioids, α₂ agonist dexmedetomidine.