ABSTRACT
This chapter describes the investigations, premedication, intravenous access and monitors of the pituitary surgery. It also describes the induction, intravenous fluids, extubation or elective mechanical ventilation and postoperative analgesia of the pituitary surgery. The chapter discusses the goals of anesthesia to understand possible presentation/comorbidities of pituitary disease, to optimize endocrine function/review by endocrinology preoperatively, to avoid any hemodynamic instability and to protect airway from soiling intraoperatively and postoperatively. It explains the electrocardiography (ECG)/noninvasive blood pressure (NIBP)/invasive blood pressure (IBP)/pulse oximetry (SpO2)/end-tidal carbon dioxide (EtCO2)/core temperature/neuromuscular transmission (NMT). The chapter focuses on the drugs like nasal decongestants, hydrocortisone, antiemetics, antibiotics and vasopressor. Surgical infiltration using local anesthetic containing adrenaline at the start can result in profound hypotension, which should not be treated as it is due to transient vasodilatation from beta 2 adrenoceptor activation. A throat pack is recommended and should be included in the swab count to ensure removal prior to extubation.
