Perioperative consideration of general anesthesia for acromegalic patients

provided the original work is properly cited. CC Acromegaly is a condition caused by an excessive secretion of growth hormones [1]. Hypertrophy in the face and extremities can cause enlarged lower jaws, macroglossia, and thickened pharyngeal and laryngeal soft tissues [2]. Hypertrophy in the vocal cord can lead to changes in the upper airway, making airway management difficult during trachea intubation [3,4]. For 50% of acromegalic patients, collateral circulation of radial artery and ulnar artery is not clearly visible in one hand or both hands [5]. Therefore, catheter should be carefully inserted into the radial artery in the wrist to continuously measure the blood pressure. We report a case of successful general anesthesia for an acromegalic patient. A 63 year-old male patient diagnosed with ossification of yellow ligament T11-12 and spinal stenosis L1-5 was hospitalized for an operation of posterolateral fusion T11-12 and decompression L1-5. Two years ago, a macroadenoma of 17 × 27 mm was observed in the patient by sella magnetic resonance imaging at another hospital. The height of the patient was 200 cm. His weight was 94 kg. Based on results of laboratory examination and chest x-ray performed before surgery, nospecific abnormal finding was observed. Electrocardiogram (ECG) revealed signs of AV block type I. Physical examination found clinical signs of Mallampati class III, jaw malocclusion, and macroglossia. After performing Allen’s test, flushing did not occur in the left handeven in 15 seconds. Flushing in the right hand was delayed for 9 seconds. In the following upper extremity computed tomography angiography (CTA), collateral blood flow of radial and ulnar artery was not clearly visible (Fig. 1A). No premedication was carried out. After the patient arrived in the operation room, routine monitoring tests such as non invasive blood pressure, ECG, and pulse oximetry were performed. His vital signs were stable, with blood pressure (BP)