Prevalence and risk factors of hemodynamic instability during endoscopic transsphenoidal pituitary surgery: a retrospective analysis

Year 2020, Volume: 3 Issue: 2, 153 - 157, 19.03.2020

Fahri Acar , Oya Kılcı , Gülçin Hilal Öztürk Alay Canan Ün Hidayet Ünal Derya Gokcinar

https://doi.org/10.32322/jhsm.679406

Abstract

Objective: Intraoperative hemodynamic instability in patients undergoing endoscopic transsphenoidal pituitary surgery (ETSS) for pituitary adenoma may lead to significant complications. We aimed to investigate the prevalence of hemodynamic instability and its associated risk factors in these patients.
Methods: This retrospective study included patients who underwent ETSS at Ankara Numune Training and Research Hospital between 14 January 2010 and 20 March 2014. Intraoperatively occurring episodes of bradycardia, hypotension, and hypertension were recorded. Distribution of hemodynamic instability was determined based on age groups, ASA class, tumor type, and anesthesia method.
Results: A total of 323 patients met the study criteria. Mean age of the patients was 46.88 ± 13.91 years and 54.5% were female. Intraoperative bradycardia was detected in 137 patients (42.41%), hypotension in 57 patients (17.65%), and hypertension in five patients (1.55%). Hemodynamic instability occurred in all of the patients over the age of 51. Patients classified as ASA III were more likely to have hemodynamic instability than patients with ASA I and ASA II (p<0.05). All 18 patients who were transferred to intensive care unit were in the age group of 61 years and over. The rate of hemodynamic instability was higher in patients with non-functioning tumor compared to that in patients with functioning tumors.
Conclusion: The rate of intraoperative hemodynamic instability in patients undergoing ETSS is higher in older patients than that in young patients. The elderly has multiple comorbidities and are more sensitive to anesthetic agents. This group needs a carefully planned anesthetic management during perioperative period.

Keywords

Pituitary adenoma, Endoscopic transsphenoidal pituitary surgery (ETSS), Anesthesia Management

References

• 1.Lonjaret R, Lairez O, Minville V, Geeraerts T. Optimal perioperative management of arterial blood pressure. Integrated Blood Pressure Control 2014;7:49-59.
• 2.Kheterpal S, O’Reilly M, Englesbe MJ, et al. Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery. Anesthesiology. 2009;110(1):58–66.
• 3.Browner WS, Li J, Mangano DT; The Study of Perioperative Ischemia Research Group. In-hospital and long-term mortality in male veterans following non cardiac surgery. JAMA. 1992;268(2):228–232.
• 4.Aronson S, Boisvert D, Lapp W. Isolated systolic hypertension is associated with adverse outcomes from coronary artery bypass grafting surgery. AnesthAnalg. 2002;94(5):1079–1084.
• 5.Koerbel A, Charabaglui A, Samii A, et al. Trigemeniocardiac reflex during skull base surgery. Mechanism and management. ActaNeurochir (Wien) 2005; 147:727-733.
• 6.Schaller B. Trigemino-cardiacreflexduringtransphenoidalsurgeryforpituitaryadenomas. ClinNeurolNeurosurg 2005; 107:468-474.
• 7.Schaller BJ, Weigel D, Filis A, Buchfelder M. Trigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas: Methodological description of a prospective skull base study protocol. Brain Research 2007;1149:69-75.
• 8.Ezzat S1, Forster MJ, Berchtold P, Redelmeier DA, Boerlin V, Harris AG. Acromegaly. Clinical and biochemical features in 500 patients. Medicine (Baltimore). 1994 Sep;73(5):233-40.
• 9.Minniti G1, Moroni C, Jaffrain-Rea ML, Esposito V, Santoro A, Affricano C, Cantore G, Tamburrano G, Cassone R. Marked improvement in cardiovascular function after successful transsphenoidal surgery in acromegalic patients. ClinEndocrinol (Oxf). 2001 Sep;55(3):307-13.
• 10.Dyer MW1, Gnagey A, Jones BT, Pula RD, Lanier WL, Atkinson JLD, Pasternak JJ. Perianesthetic Management of Patients With Thyroid-Stimulating Hormone-Secreting Pituitary Adenomas. J NeurosurgAnesthesiol. 2017 Jul;29(3):341-346.
• 11.Gondim JA, Almeida JP, de Albuquerque LA, Gomes E, Schops M, Mota JI.Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas. J Neurosurg. 2015 Jul;123(1):31-8.
• 12.Prabhakar H, Singh GP, Mahajan C, Kapoor I, Kalaivani M, Anand V. Intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery. Cochrane Database SystRev. 2016 Sep 9;9:CD010467. doi: 10.1002/14651858.CD010467.pub2.
• 13.Reich DL, Bennett-Guerrero E, Bodian CA, Hossain S, Winfree W, Krol M. Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration. AnesthAnalg. 2002;95(2):273–277
• 14.Kheterpal S, O’Reilly M, Englesbe MJ, et al. Preoperative and intraoperative predictors of cardiac adverse events after general, vascular and urological surgery. Anesthesiology. 2009;110(1):58–66.
• 15.Pedersen T, Eliasen K, Henriksen E. A prospective study of mortality associated with anesthesia and surgery: risk indicators of mortality in hospital. ActaAnaesthesiolScand 1990;34:176.
• 16.Van Cleve WC, Nair BG, Rooke GA. Associations between age and dosing of volatile anesthetics in 2 academic hospitals. AnesthAnalg 2015;121:645-651.
• 17.Schnider TW, Minto CF, Shafer SL, et al. Theinfluence of age on propofol pharmacodynamics. Anesthesiology 1999;90:1502-1516.
• 18.Scott JC, Ponganis KV, Stanski DR. EEG quantitation of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil. Anesthesiology 1985; 62:234-241.
• 19.Akhtar S. Pharmacological considerations in the elderly. CurrOpinAnaesthesiol 2018; 31:11-18.
• 20.Murphy GS, Sokol JW, Avram MJ, et al. Residual neuromuscular block in the elderly: incidence and clinical implications. Anesthesiology 2015; 123:1322-1336.
• 21.Reich DL, Hossain S, Krol M, et al. Predictors of hypotension after induction of general anesthesia. AnesthAnalg 2005;101:622-628.
• 22.Smith M, Hirsch NP. Pituitary disease and anesthesia. Br J Anaesth 2000;85:3-14.
• 23.Nemergut EC, Dumont AS, Barry UT, Laws ER. Perioperative management of patients undergoing transsphenoidal pituitary surgery. AnesthAnalg 2005; 101:1170-1181.
• 24.McCutcheon IE. Pituitary adenomas: surgery and radiotherapy in the age of molecular diagnostics and pathology. CurrProblCancer 2013; 37:6-37.
• 25.Dunn LK, Nemergut EC. Anesthesia for transsphenoidal pituitary surgery. CurrOpinAnesthesiol 2013; 26:549-554.