ISSUES OF THE PITUITARY AND ANESTHESIA垂体的麻醉问题.pptVIP

ISSUES OF THE PITUITARY AND ANESTHESIA Martha Richter, MSN, CRNA OBJECTIVES At the conclusion of this lecture, the student will Distinguish important issues re: secreting vs nonsecreting tumors Describe the impact of tumor function on anesthesia decisions Begin to plan a course of anesthesia care for patients scheduled for pituitary surgery PITUITARY ISSUES Acromegaly SIADH DI Empty Sella Syndrome Pituitary Dwarfism Pituitary Infarction (apoplexy) PITUITARY ISSUES What hormones? =6 ACTH GH TSH FSH LH PROLACTIN PITUITARY ISSUES ACROMEGALY Excess GH (somatotropin) Promotes growth by Inc. rate of protein synthesis and dec. rate of protein breakdown (occurs rapidly) Inc mobilization of fatty acids for energy; enhances conversion fatty acids to acetyl co-enzymeA (requires several hrs to occur) PITUITARY ISSUES Acromegaly May be insulin resistant b/o diabetogenic effect of GH Affects bone growth and density by Inc. deposit of pro by chondrocytesosteogenic cells Inc rate of cell reprod result-=deposit new bone PITUITARY ISSUES Acromegaly Bone growth (lengthening) occurs b/o effects of somatomedins (=insulin-like growth factors) Formed by the liver insufficiency=some forms of dwarfism PITUITARY ISSUES GH t1/2 = 20 min Somatocedin t1/2 = 20 hrs GH normally diminishes by age after adolescence (to 25% in elderly) Inc first 2 hrs deep sleep PITUITARY ISSUES ACROMEGALY SS Enlargement hands and feet (Bone enlarge.) Enlarge soft tissue Lips, tongue, epiglottis, vocal cords Enl membraneous bones Cranium, nose, supraorb ridges, lower jaw, kyphosis engorge liver and kidneys PITUITARY ISSUES ACROMEGALY cont’d Subglottic tracheal narrowing Peripheral nerve/artery entrapment Connective tissue overgrowth=recurrent laryng. N. paralysis Increased incide: HTN, IHD, osteoporosis and osteoarthritis PITUITARY ISSUES ACROMEGALY Coarse facial hair DOE R laryngeal n paralysis Stridor Cricoarytenoid involvement Inc lung volumes with V/Q mismatch PITUITARY ISSUES ACROMEGALY Special airway