Intubacja dotchawicza u chorych z akromegalią

Izabela Duda¹, Konstancja Grzybowska¹, Adam Rudnik², Anna Skorupa¹, Ewa Karpel¹

Summary
Background. Airway management may be difficult in acromegalic patients due to the protrusion of the jaw, and thickening and coarsening of the soft tissues of the face and throat. Myocardial involvement includes cardiac hypertrophy/myopathy and hypertension. The purpose of the study was to assess conditions for intubation, success rate and circulatory response to rocuronium-facilitated intubation. Methods. 30 patients, scheduled for hypophyseal tumour resection, were equally divided into 2 groups. Group A consisted of 15 acromegalic patients; group B (15 non-affected patients) served as controls. Rocuronium (0.8 mg kg^-1) was used for neuromuscular relaxation. We assessed the possibility of manual ventilation via a face mask, and conditions for intubation using the Cormack scale. Heart rate and arterial blood pressure were noted before anaesthesia (T₁), after induction (T₂), during direct laryngoscopy (T₃), and 1 and 3 minutes after intubation (T₄ and T5). Results. In 10 acromegalic patients, ventilation via a face mask was difficult, requiring the assistance of a second anaesthetist. Patients in both groups were intubated without major difficulty. Blood pressure increased significantly after intubation in both groups, and there was no difference between the groups. Discussion and conclusion. manual ventilation via a face mask was the main problem in the acromegalic patients. Contrary to other reports we did not experience any problems during intubation. Rocuronium, because of its rapid onset of action, can be recommended for intubation in acromegalic patients.

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