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What are the anesthetic considerations of acromegaly?
The constellation of physical manifestations, especially heart and lung disease, combined with upper airway involvement, make these patients a particular concern to the anesthesiologist. Cardiac complications in acromegalic patients have been described and cardiomegaly can occur with or without coexisting hypertension. Many typical acromegalic features are suggested to cause a difficult airway in these patients. An anesthetic technique that can be used in a majority of patients involves the use of opi-oids, volatile agent, nitrous oxide, and muscle relaxants. Many surgeons use intranasal epinephrine-containing local anesthetics and cocaine as part of their pre-surgical preparation. The use of these solutions reduces bleeding but also may lead to dysrhythmias in the presence or absence of volatile agents. Hypertension and bleeding dur-ing intrasellar exploration may be effectively controlled with appropriate anesthetic depth and intravenous administration of β-blockers or vasodilators. Practical con-siderations include difficulty in positioning of large extremities and the placement (if needed) of intra-arterial catheters.
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