What are the anesthetic considerations of acromegaly?

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.