Pituitary Tumors account for 15% of Braun tumors. Trans sphenoidal endoscopic approach are more common. Post surgery fluid and electrolyte balance is important.

1. DR. TUSHAR KUMAR
ASSISTANT PROFESSOR
ANAESTHESIOLOGY – TRAUMA
DEPT OF ANAESTHESIOLOGY, RIMS.

3. •
•
•

4. Large,
vascular, pink
Small, grey
white, posterior

5. Lies within pituitary fossa
(sella tursica)
• Floor & anterior wall
Roof of sphenoid sinus
• Posterior wall – clivus
• Lateral wall – cavernous sinus
• Roof – Diaphragmatic sella

6. 1.
2.
3.
4.
5.
Rest non functional
cells

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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.

11. WILSON-HARDY CLASSIFICATION: PITUITARY ADENOMA

12. Hormonal
hypersectretion
syndrome
Mass
effect
Non
specific
Incidental

13. STALK EFFECT

14. MASS EFFECT: NON FUNCTIONING MACROADENOMAS

15. PROLACTIN IS A STRESS HORMONE.
BLOOD FOR INVESTIGATION SHOULD BE TAKEN FROM AN
IV CANULA BUT SOME HOUR AFTER ITS PLACEMENT.

17. 1.
2.

19. 1.
2.

20. C/F ARE DUE TO MASS EFFECT

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23. 1. Recurrent LN palsy
and large thyroid
2. Obstructive sleep
apnea

24. INVESTIGATIONS
•
•
•

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•
•
•
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•

26. 1.
2.

27. 1.
2.
3.
4.
5.
6.

28. 1.
2.
3.

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)

33. •
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36. CHANNELING OF BLOOD
BLOOD MAY TRICKLE DOWN TO TRACHEA OR TO THE
OESOPHAGUS AND INTO THE STOMACH CAUSING BOWEL
IRRITATION

37. LUMBAR SPINAL DRAIN:
PERMISSIVE HYPERCAPNEA:

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MOST DANGEROUS INTRAOP COMPLICATION IS INJURY TO ICA

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.

42. POSTOP MASK VENTILATION IS DIFFICULT.

43. i.
ii.
iii.
iv.
v.
Postoperative dyspnea: trickling of blood or
CSF should be thought of

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

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

51. 1.
2.
3.
4.
5.
6.
Treatment : fluid restriction

52. Urine volume > 40 ml/ kg
U. osmolarity : < 300 mosmol/l