Anesthesia for transsphenoidal surgery of the hypophyseal region

For pituitary surgery--by either the transcranial or the transsphenoidal approach--anesthetic management conforms to the general principles of neuroanesthesia as discussed in texts and review articles. In addition, the endocrine functions and the anatomic situation of the pituitary gland must be considered. Preoperative and perioperative evaluation of the patient's endocrine status and appropriate therapeutic measures are important. Preservation of neurohypophyseal function and, frequently, of adequate adenohypophyseal function is an advantage of the transsphenoidal approach to the sella. Potential problems with the transsphenoidal technic include damage to suprasellar and parasellar structures and harzards associated with intraoperative or postoperative bleeding. Anesthetic aspects peculiar to the transsphenoidal approach include positioning of the patient, surgical use of solutions containing epinephrine and topical cocaine, intraoperative air studies, and management of emergence. Anesthesia for the transsphenoidal approach to the sella is discussed on the basis of our experience with 148 surgical procedures in 142 patients.