Pituitary transsphenoidal anaesthesia

Model answer

Assessment (4). Written hormone map first: functioning versus non-functioning adenoma physiology, cortisol axis reliability, electrolytes and glucose, vision and visual fields, and OSA/cardiovascular burden — pituitary tumours present either with hormone excess or with mass effect, and each phenotype carries its own risk.^[1]

Airway (3). Acromegaly and Cushing disease both make airway management particularly challenging; examine mouth, tongue, neck, and OSA history, document Plan A/B/C before induction, and escalate early to video laryngoscopy and second-generation supraglottic rescue per DAS 2015 thinking when difficulty is predicted.^[1][3]

Intraop (4). Still bloodless endoscopic field with controlled pressure inside safe cerebral and optic perfusion limits, steroid cover per the endocrine protocol when the ACTH axis is unreliable, and smooth rapid emergence for the immediate vision check — pituitary surgery is intensely stimulating yet usually needs little postoperative analgesia.^[1]

DI (4). Postoperative diabetes insipidus is common and typically self-limited; suspect central DI on sustained high-volume dilute urine with rising sodium, confirm with paired osmolalities, replace free water, give protocol desmopressin, and avoid overshoot into SIADH-like hyponatraemia — then watch for the triphasic sequence.^[1]