ANAESTHESIA FOR ENDOSCOPIC ENDONASAL TRANSPHENOIDAL RESECTION OF PITUITARY ADENOMA: INITIAL EXPERIENCE OF A SINGLE NIGERIAN CENTER.

Abstract

Introduction: Endoscopic endonasal transsphenoidal surgery (EETSS) is an established technique for the resection of pituitary tumors and is well-domesticated in our center due to its numerous benefits. This study aimed to provide insights into the anaesthetic management of patients with pituitary tumors for EETSS, analyze the perioperative complications, and associations between demographic data, perioperative complications, intensive care unit (ICU) management, and outcomes.

Methods: This prospective descriptive study includes all patients who underwent EETSS for pituitary adenoma under general anaesthesia in a tertiary center. Data collected through a semi-structured proforma from patients and patient medical records included socio-demographic data, peri-operative complications, ICU management, and outcome.

Results: There was a total of 60 patients (Male: Female was 1:1), an age range between 18 to 76 years, and the mean age was 30.9 (± 12.8 years). Most patients (65%) presented with visual complaints. Hypertension (30%) was the most common intercurrent illness. The American Society of Anesthesiologists (ASA) physical status II and III were 56.7% and 43.3% respectively. Intraoperative complications were hypertension 30%, hypotension 5%, and bradycardia 15%. 30% (15) of the patients were admitted into the ICU and 13 (21.7%) of those admitted were ventilated. ICU length of stay was between 1-6 days. Overall mortality was 10%. Bivariate analysis revealed a significant association was observed between mortality and tumor size (p=0.046), ventilator use (p=0.05), and ICU admission (p=0.008).

Conclusion: The tumor size, postoperative complications that necessitated ICU admission, and ventilator use in the ICU significantly impact the overall perioperative outcome.