Anaesthetic complications of acromegaly

The anaesthetic risks of acromegaly include difficulties in airway management, hypertension, and cardiac, gastrointestinal and renal problems. To estimate the incidence of major complications in this rare group of patients, we reviewed 28 patients with acromegaly who had pituitary tumour excision over a 10-yr period. Each patient was matched for age, weight and sex to a non-acromegalic patient undergoing transsphenoidal pituitary surgery. Acromegalic patients received significantly more fentanyl and midazolam and less thiopental and succinylcholine than controls (all P < 0.05). Mean arterial pressure (baseline, minimal and maximal values) was higher in acromegalic patients than in controls. There was no difference between groups in the use of vasoactive drugs. Pa(O₂) Fl(O₂), and Pa(CO₂) were similar in both groups. Arterial pH was significantly lower (P = 0.015), blood glucose was higher (P < 0.001) and fluid intake minus output was higher (P = 0.04) in acromegalic patients than in controls. Airway difficulty and tongue enlargement were encountered more often in acromegalic patients (P = 0.002 and P = 0.01, respectively). Our data confirm that in acromegalic patients: airway difficulties occurred more frequently; severe haemodynamic instability did not typically occur during surgery for acromegaly; pulmonary gas exchange was not altered during operation; glucose intolerance may be an intraoperative problem; and fluid regulation may be altered.