Immediate postoperative complications in transsphenoidal pituitary surgery: a prospective study

Considering the important role of pituitary gland in regulating various endocrine axes and its unique anatomical location, various postoperative complications can be anticipated resulting from surgery on pituitary tumors. We examined and categorized the immediate postoperative complications according to various tumor pathologies. We carried out a prospective study in 152 consecutive patients and noted various postoperative complications during neurosurgical intensive care unit stay [within 48 hrs of hospital stay] in patients undergoing transsphenoidal removal of pituitary tumors. In our series, various groups showed different postoperative complications out of which, cerebrospinal fluid leak was the commonest followed by diabetes insipidus, postoperative nausea and vomiting, and hematoma at operation site. Various immediate postoperative complications can be anticipated in transsphenoidal pituitary surgery even though, it is considered to be relatively safe

Comparison of propofol versus sevoflurane on thermoregulation in patients undergoing transsphenoidal pituitary surgery: a preliminary study

General anesthesia causes inhibition of thermoregulatory mechanisms. Propofol has been reported to cause more temperature fall, but in case of deliberate mild hypothermia, both sevoflurane and propofol were comparable. Thermoregulation is found to be disturbed in cases of pituitary tumors. We aimed to investigate which of the two agents, sevoflurane or propofol, results in better preservation of thermoregulation in patients undergoing transsphenoidal excision of pituitary tumors. Twenty-six patients scheduled to undergo transsphenoidal removal of pituitary adenomas were randomly allocated to receive propofol or sevoflurane anesthesia. Baseline esophageal temperature was noted. Times for temperature to fall by 1[degree sign] C or 35[degree sign] C and to return to baseline were also comparable [P>0.05]. After that warmer was started at 43[degree sign] C and time to rise to baseline was noted. Duration of surgery, total blood loss, and total fluid intake were also noted. If any, side effects such as delayed arousal and recovery from muscle relaxant were noted. The demographics of the patients were comparable. Duration of surgery and total blood loss were comparable in the two groups. The time for temperature to fall by 1[degree sign] C or 35[degree sign] C and time to return to baseline was also comparable [P>0.05]. No side effects related to body temperature were noted. Both propofol and sevoflurane show similar effects in maintaining thermal homeostasis in patients undergoing transsphenoidal pituitary surgery

Persistent postoperative hypertension following posterior fossa surgery. A case report

We report a case of a 20 month old male child who underwent surgery for posterior fossa tumor. Post operatively the child developed persistent hypertension. No active intervention was done as it could have compromised cerebral perfusion pressure. The possible cause is discussed

Ventriculo-peritoneal shunt surgery in an infant with double aortic arch, patent ductus arteriosus and atrial septal defect

Double aortic arch with patent ductus arteriosus and atrial septal defect is an uncommon association. Such complex cardiac lesions may complicate an otherwise normal anesthetic course. We came across a case with aqueductal stenosis and hydrocephalus, scheduled for ventriculoperitoneal shunt surgery, on an emergent basis. The child was managed successfully. The anesthetic implications of resultant left-to-right shunt with increased intracranial pressure have been described

Effects of butorphanol and fentanyl on cerebral pressures and cardiovascular hemodynamics during tunneling phase for ventriculoperitoneal shunt insertion

Subcutaneous tunneling for ventriculoperitoneal shunt insertion is the most painful step of this surgery. It is associated with intense hemodynamic response, may influence the intracranial pressure, and thus may worsen the existing intracranial pathology. The purpose of this report is to evaluate the commonly used opioid fentanyl, along with butorphanol, an agonist-antagonist compound. Twenty adult patients undergoing ventriculoperitoneal shunt surgery were induced with fentanyl 2-mcg.kg[-1] and thiopentone 4-5 mg.kg[-1]. Intubation followed the administration of rocuronium 1 mg.kg[-1]. All patients were put on mechanical ventilation to maintain end-tidal carbon dioxide levels of 32 +/- 2 mmHg. Anesthesia was maintained with isoflurane in N[2]O and O[2] [MAC 1.0 +/- 0.2]. Routine monitoring, arterial blood pressure and intracranial pressures were measured. Three minutes prior to the tunneling phase, patients received either fentanyl 1 mcg.kg[-1] or butorphanol 1 mg in a randomized manner. Thereafter hemodynamic and intracranial pressure changes were noted during tunneling and each minute in the post-tunneling period for 5 minutes. The duration of the tunneling phase was also noted. Data were presented as number [proportion] or mean +/- SD/median [range] as appropriate. Statistical analysis was done using Wilkoxon ranksum test and the repeated measures of ANOVA. The value of p < 0.05 was considered significant. A significant rise in the intracranial pressure and cerebral perfusion pressure along with the hemodynamic parameters was noted during the tunneling phase in both groups. The changes were of longer clinical duration in the butorphanol group. Butorphanol must be used with caution in neurosurgical patients. The ventricular end of the shunt catheter should preferably be put before the tunneling phase to avoid rise in intracranial pressure

Cervical stabilization with halo fixation: Anesthetic implications-Case Reports

Halo fixation is often used to provide stability in patients with unstable cervical spine. These fixation devices pose unique challenges to the anesthesiologists encountered while securing an airway. Management of airway in patients with halo fixation is complicated by the fixed position, limited access to the face, and immobilization of neck. We managed two different patients, one in which halo fixation was done for atlanto-axial dislocation [AAD]; and the other, who came with halo fixation and underwent wound debridement under general anesthesia. In the former case, procedure was carried out with laryngeal mask anesthesia and patient breathing spontaneously whereas, in the later case, procedure was performed after securing the airway using awake fiberoptic intubation technique

Rupture of intracranial aneurysm after partial clipping due to aspiration drainage system - A Case Report

In neurosurgical practice, extradural or subgaleal drains are commonly placed and connected to a vacuum system. Several reports have described severe bradycardia or arterial hypotension, or both, after connection of negative suction pressure to the extradural or epicranial drains following craniotomy. We encountered an unusual complication with the use of the vacuum drain after an elective aneurysmal clipping surgery. Our case is an iatrogenic intracranial hypotension leading to a clinically significant and potentially fatal complication

Adriamycin induced pulseless electrical activity and cardiovascular collapse during general anesthesia for ventriculo-peritoneal shunt insertion-a case report

We report a case of a 45-year-old female undergoing an emergency ventriculoperitoneal shunt surgery. The patient had brain metastatic lesions of breast carcinoma with associated hydrocephalus. She had received Adriamycin as a part of chemotherapy regimen for breast cancer. Her preoperative cardiovascular status was normal. Under general anesthesia, the patient had a sudden cardiovascular collapse. The patient had a pulseless electrical activity and required inotropic support for cardiovascular stability. The possible cause is discussed

Ipsilateral re-expansion pulmonary edema in a neurosurgical patient - a case report

We report a case of a 42-year-old female with right parietal glioma, scheduled for elective craniotomy and tumor excision. The patient developed pneumothorax in the postoperative period. An incidence of unilateral pulmonary edema occurring as a result of rapid re-expansion of collapsed lungs is described. This type of pulmonary edema may delay postoperative recovery and have a catastrophic course especially in neurosurgical patients

Catheter malposition following supraclavicular approach for subclavian vein catheterization - case reports

The supraclavicular approach of subclavian vein catheterization is associated with the lowest incidence of malposition. We report two cases of unusual malpositions seen during central venous catheterization of subclavian vein via supraclavicular approach. Literature search did not reveal such malpositions. The possible cause for the malposition and method to prevent it is discussed

Intraoperative bronchospasm under spinal analgesia: a case report

The involvement of respiratory system occurs mainly as a result of a high spinal block. Our case describes the unusual effect of mid-spinal analgesia. We encountered bronchospasm in an otherwise healthy patient undergoing inguinal hernia repair under subarachnoid block. The highest level of block was T6. The anxiety of the patient further aggravated the symptoms. This is probably the first reported incident of bronchospasm as a result of spinal anesthesia. We speculate the role of unblocked parasympathetic system in the causation of this respiratory complication