Acromegaly
Considerations
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Difficult airway:
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Macroglossia & enlarged epiglottis, resulting in difficult bag-mask ventilation & direct laryngoscopy
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Recurrent laryngeal nerve palsy, narrow glottic opening, subglottic narrowing (stridor)
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Nasal turbinate enlargement; caution with nasal intubation & consider smaller ETT
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Multisystem disease:
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Cardiovascular:
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Hypertension, left ventricular hypertrophy, diastolic dysfunction
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Arrhythmias
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Coronary artery disease, cardiomyopathy
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Respiratory:
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Obstructive sleep apnea
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Pulmonary hypertension, right ventricular dysfunction
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CNS:
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Pituitary dysfunction
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Potential for raised ICP
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Peripheral neuropathies common
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Endocrine:
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Diabetes mellitus/hyperglycemia
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Difficult patient positioning, access, monitoring, regional anesthesia
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Radial arterial line contraindicated due to poor collateral circulation
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Goals
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Safely secure difficult airway: consider awake fiberoptic intubation with stridor & voice changes
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Thorough cardiopulmonary examination, including volume status assessment
Conflicts
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Avoidance of CPAP following trans-sphenoidal surgery
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Post-operative pain vs. enhanced sedation/respiratory depression
Crises
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Post-operative stridor (subglottic edema, vocal cord paralysis)
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Endocrine emergencies
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Diabetes insipidus, SIADH
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