Anesthetic Implications for Surgical Patients with Endocrine Tumors

Dougherty, Thomas B.; Cronau, L. H.

doi:10.1097/00004311-199803630-00006

Cited by 23 publications

(37 citation statements)

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“…Because anesthesia-related complica- tions are known to arise more commonly in patients with longstanding acromegaly, preoperative anesthesia, cardiac, and/or pulmonary evaluations are frequently warranted prior to any operation. 4,13,20 A cogent plan for intubation based on preoperative airway assessment should be discussed with the anesthesia team. 5,26 Plans for administration of antibiotics, hormone replacement, pretreatment with somatostatin analogs, 8 or any additional perioperative medications should also be addressed in advance.…”

Section: Operative Strategies For Endoscopic Transsphenoidal Surgery mentioning

confidence: 99%

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations

Zada

Cavallo

Esposito

et al. 2010

FOC

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Object In addition to difficulties with anesthetic and medical management, transsphenoidal operations in patients with longstanding acromegaly are associated with inherent intraoperative challenges because of anatomical variations that occur frequently in these patients. The object of this study was to review the overall safety profile and anatomical/technical challenges associated with transsphenoidal surgery in patients with acromegaly. Methods The authors performed a retrospective analysis of 169 patients who underwent endoscopic transsphenoidal operations for growth hormone–secreting adenomas to assess the incidence of surgical complications. A review of frequently occurring anatomical challenges and operative strategies employed during each phase of the operation to address these particular issues was performed. Results Of 169 cases reviewed, there was no perioperative mortality. Internal carotid artery injury occurred in 1 patient (0.6%) with complex sinus anatomy, who remained neurologically intact following endovascular unilateral carotid artery occlusion. Other complications included: significant postoperative epistaxis (5 patients [3%]), transient diabetes insipidus (5 patients [3%]), delayed symptomatic hyponatremia (4 patients [2%]), CSF leak (2 patients [1%]), and pancreatitis (1 patient [0.6%]). Preoperative considerations in patients with acromegaly should include a cardiopulmonary evaluation and planning regarding intubation and other aspects of the anesthetic technique. During the nasal phase of the transsphenoidal operation, primary challenges include maintaining adequate visualization and hemostasis, which is frequently compromised by redundant, edematous nasal mucosa and bony hypertrophy of the septum and the nasal turbinates. During the sphenoid phase, adequate bony removal, optimization of working space, and correlation of imaging studies to intraoperative anatomy are major priorities. The sellar phase is frequently challenged by increased sellar floor thickness, distinct patterns of tumor extension and bony invasion, and anatomical variations in the caliber and course of the internal carotid artery. Specific operative techniques for addressing each of these intraoperative challenges are discussed. Conclusions Transsphenoidal surgery in patients with longstanding acromegaly frequently poses greater challenges than operations for other types of sellar lesions, yet these challenges may be safely and effectively overcome with the anticipation of specific issues and implementation of various intraoperative techniques.

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Section: Operative Strategies For Endoscopic Transsphenoidal Surgery mentioning

confidence: 99%

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations

Zada

Cavallo

Esposito

et al. 2010

FOC

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“…158e163 It is also important to avoid drugs that release histamine or activate the sympathetic nervous system. 164 Despite octreotide therapy, patients may still develop life-threatening cardiorespiratory complications that can tax even the most experienced anaesthetist, who may have to use a-and b-adrenoreceptor blocking drugs to avoid severe complications. 165 In addition, short-acting octreotide should always be available, even when a non-syndromic patient with a small bowel NET undergoes an interventional procedure.…”

Section: General Approachmentioning

confidence: 99%

General Recommendations

2012

Rhinology

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“…An i.v. infusion of 50 µg/h octreotide, started prior to and continued for at least 48 h after any major intervention, is now standard prophylaxis (Kinney et al 2001); it is also important to avoid drugs that release histamine or activate the sympathetic nervous system (Dougherty & Cronau 1998); adrenoreceptor blockade may also be helpful (Holdcroft 2000). Despite these measures patients may still develop lifethreatening cardiorespiratory complications that can tax even the most experienced anaesthetist, who may have to use α-and β-blocking drugs to avoid severe complications (Holdcroft 2000).…”

Section: Wwwendocrinologyorg 473mentioning

confidence: 99%

Surgery for midgut carcinoid.

Doran¹,

Williams²,

Vora³

et al. 2003

Endocrine-Related Cancer

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Many clinicians prefer to avoid surgery in patients with carcinoid neoplasia, because of its slow growth and relatively favourable prognosis. Nevertheless, the commonest cause of death in patients with carcinoid is advanced metastatic disease, and both clinical and epidemiological data indicate that the more effectively the disease is ablated, the more long-lasting the benefit. Multidisciplinary management of patients with carcinoid must consider inherited risk, possible multiple carcinoids and/ or synchronous non-carcinoid cancer, and the use of a range of investigations that also evaluate the 10% of patients with carcinoid syndrome with or without valvular heart disease. Although primary size is correlated with the presence of nodal with or without liver metastases, carcinoid tumours < 1 cm in diameter may be metastatic at presentation, particularly those arising within the small intestine. In the jejunum and ileum, resection of all sizes of carcinoid with local and regional nodes is preferred, to prevent nodal dissemination causing mesenteric ischaemia with or without infarction. Resection of nodal metastases should be undertaken in those with persistent or recurrent nodal disease if possible. Appendiceal and right colonic carcinoids are most effectively treated by right hemicolectomy with local and regional nodal clearance, as for adenocarcinoma. However, for most appendiceal carcinoids which are < 1 cm in diameter and non-invasive, appendicectomy alone is sufficient. For appendiceal carcinoids 1-2 cm in diameter, histopathological assessment helps to determine the need for hemicolectomy. Liver resection has been followed by prolonged 5 year survival in several series and is recommended in appropriate patients to attempt cure or to debulk metastatic disease. Liver transplantation has had only qualified success in highly selected patients without extra-hepatic disease in whom other therapies have failed.

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Anesthetic Implications for Surgical Patients with Endocrine Tumors

Cited by 23 publications

References 0 publications

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations

General Recommendations

Surgery for midgut carcinoid.

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