The Role of the Anesthesiologist

  • T. Cafiero


Even though their anesthetic management conforms to the general principles of neuroanesthesia, patients with pituitary tumors may present unique problems for the anesthesiologist. The perioperative care of any patient requires great cooperation among physicians to ensure the best possible outcome. The importance of integrating physicians’ expertise is even greater for pituitary surgery. In fact, preoperative evaluation of the patient’s endocrine status and appropriate therapeutic measures are important to decrease the morbidity of pituitary surgery, especially in patients with potential anesthetic problems. Therefore the collaboration among neurosurgeons, endocrinologists, ophthalmologists and anesthesiologists is essential to choose the optimal treatment before surgery is planned.


Transsphenoidal Surgery Endonasal Endoscopic Approach Transsphenoidal Pituitary Operation Endonasal Endoscopic Surgical Procedure Difficult Breathing 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Baxter MA (1994) Acromegaly and transsphenoidal hypophysectomy: a case report. AANA J 62: 182–185PubMedGoogle Scholar
  2. 2.
    Cafiero T, Mastronardi P, Gargiulo G, Cappabianca P, Cavallo LM (2002) Intraoperative analgesia with remifentanil for the endonasal endoscopic approach to pituitary lesions. Anesthesiology 96: 70Google Scholar
  3. 3.
    Cappabianca P, Alfieri A, de Oivitiis E (1998) Endoscopic endonasal transsphenoidal approach to the sella: towards Functional Endoscopic Pituitary Surgery (FEPS). Minin Invasive Neurosurg 41: 66–73CrossRefGoogle Scholar
  4. 4.
    Cappabianca P, Cavallo LM, Colao A, de Oivitiis E (2002) Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adeomas. J Neurosurg 97: 293–298PubMedCrossRefGoogle Scholar
  5. 5.
    Chan VW, Tindal S (1988) Anaesthesia for transsphenoidal surgery in a patient with extreme gigantism. Br J Anaesth 60: 464–468PubMedCrossRefGoogle Scholar
  6. 6.
    Chelliah YR, Manninen PH (2002) Hazards of epinephrine in transsphenoidal pituitary surgery. J Neurosurg Anesthesiol 14: 43–46PubMedCrossRefGoogle Scholar
  7. 7.
    de Oivitiis E, Cappabianca P (2002) Endoscopic endonasal transsphenoidal surgery. In: Pickard JD (ed) Advances and technical standards in neurosurgery. Springer, Wien New York, vol 27, pp 137–177CrossRefGoogle Scholar
  8. 8.
    Fleisher LA, Hogue S, Colopy M, Twersky RS, Warner DS, Jamerson BD, Tuman KJ, Glass PS, Roizen MF (2001) Does functional ability in the postoperative period differ between remifentanil-and fentanyl-based anesthesia? J Clin Anesth 13: 401–406PubMedCrossRefGoogle Scholar
  9. 9.
    Frey MA, Tomaselli CM, Hoffler WG (1994) Cardiovascular responses to postural changes: differences with age for women and men. J Clin Pharmacol 34: 394–402PubMedGoogle Scholar
  10. 10.
    Gemma M, Tommasino C, Cozzi S, Narcisi S, Mortini P, Losa M, Soldarini A (2002) Remifentanil provides hemodynamic stability and faster awakening time in transsphenoidal surgery. Anesth Analg 94: 163–168PubMedGoogle Scholar
  11. 11.
    Jho HO (1999) Endoscopic surgery of pituitary adenomas. In: Krisht AF, Tindall GT (eds) Comprehensive management of pituitary disorders. Lippincott Williams & Wilkins, Hagerstown, pp 389–403Google Scholar
  12. 12.
    Keegan MT, Atkinson JL, Kasperbauer JL, Lanier WL (2000) Exaggerated hemodynamic responses to nasal injection and awakening from anesthesia in a Cushingoid patient having transsphenoidal hypophysectomy. J Neurosurg Anesthesiol 12: 225–229PubMedCrossRefGoogle Scholar
  13. 13.
    Koren I, Hadar T, Rappaport ZH, Yaniv E (1999) Endoscopic transnasal transsphenoidal microsurgery versus the sublabial approach for the treatment of pituitary tumors: endonasal complications. Laryngoscope 109: 1838–1840PubMedCrossRefGoogle Scholar
  14. 14.
    Newfield P, Albin MS, Chestnut JS, Maroon J (1978) Air embolism during transsphenoidal pituitary operations. Neurosurgery 2: 39–42PubMedCrossRefGoogle Scholar
  15. 15.
    Seidman PA, Kofke WA, Policare R, Young M (2000) Anaesthetic complications of acromegaly. Br J Anaesth 84: 179–182PubMedCrossRefGoogle Scholar
  16. 16.
    Twersky RS, Jamerson B, Warner DS, Fleisher LA, Hogue S (2001) Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients. J Clin Anesth 13: 407–416PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2003

Authors and Affiliations

  • T. Cafiero

There are no affiliations available

Personalised recommendations