Anaesthetic complications of acromegaly

The anaesthetic risks of acromegaly include difficulties in airway manageme nt, hypertension, and cardiac, gastrointestinal and renal problems. To esti mate the incidence of major complications in this rare group of patients, w e reviewed 28 patients with acromegaly who had pituitary tumour excision ov er a IO-yr period. Each patient was matched for age, weight and sex to a no n-acromegalic patient undergoing transsphenoidal pituitary surgery. Acromeg alic patients received significantly more fentanyl and midazolam and less t hiopental and succinylcholine than controls tall P < 0.05). Mean arterial p ressure (baseline, minimal and maximal values) was higher in acromegalic pa tients 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 acromegal ic patients than in controls. Airway difficulty and tongue enlargement were encountered more often in acromegalic patients (P = 0.002 and P = 0.01, re spectively). Our data confirm that in acromegalic patients: airway difficul ties occurred more frequently; severe haemodynamic instability did not typi cally occur during surgery for acromegaly; pulmonary gas exchange was not a ltered during operation; glucose intolerance may be an intraoperative probl em; and fluid regulation may be altered.