Airway management in patients with pituitary disease: a review of 746 patients.

Difficulties in airway management are observed among patients with pituitary disease. The purpose of this study was to better characterize the relationship between disease factors such as tumor characteristics on difficult endotracheal intubation. The perioperative records of 746 patients that underwent transsphenoidal microsurgery at the University of Virginia between January 1995 and June 2001 were reviewed. Among the 746 patients studied, difficulty with endotracheal intubation was encountered in 28 patients (3.8%). Patient gender and tumor size were not associated with a difference in the incidence of unanticipated airway management difficulty. Unanticipated difficulty with airway management was more than three times more common in acromegalic patients (n = 121) than in patients with nonfunctioning pituitary tumors (9.1% [5.8-14%] vs 2.6% [1.5-4.5%], P = 0.007). Patients with Cushing disease (n = 182) and patients with a prolactinoma (n = 87) were no more difficult to intubate than patients with nonfunctioning tumors. Among patients with acromegaly, neither tumor size nor patient gender has any impact on the incidence of intubation difficulty. Among all patients, when difficulty was encountered, intubation assisted by the gum elastic bougie was successful 100% of the time. The incidence of difficulty in intubation is not higher among patients with pituitary disease than in the general surgical population; however, patients with acromegaly have difficult intubations three times more often.