Assessment of Airway in Patients With Acromegaly for Predicting Successful Tracheal Intubation
Assessment of Airway in Patients With Acromegaly for Predicting Successful Tracheal Intubation
Acromegaly is associated with increased risk of difficult intubation and its management. The
 overall incidence of difficult intubation in patients suffering from acromegaly is four to
 five times more than those without acromegaly.The difficult intubation scenario in these
 patients can be managed by various methods ranging from awake fiberoptic intubation to
 tracheostomy. Difficult tracheal intubation accounts for 17% of respiratory-related injuries
 and results in significant morbidity and mortality in general population. In patients with
 acromegaly, inability to mask ventilate or intubate can lead to 28% of all anesthesia related
 deaths. Therefore, the need and importance of airway assessment in patients with acromegaly
 cannot be overemphasized. Various tests of airway assessment have to be used to assess
 difficult airway and tracheal intubation in acromegalics.

 The investigators aim to assess the various tests of airway assessment affecting the outcome
 of patients with acromegaly undergoing pituitary surgery and identify which was best suited.
All the patients of either gender, diagnosed as a case of acromegaly scheduled for pituitary
 surgery will be enrolled. This observational study will be conducted over a period of 3
 years. A written informed consent will be taken from all the patients. The clinical diagnosis
 will be made on the basis of growth hormone (GH) levels and magnetic resonance imaging (MRI)
 findings. All patients will be evaluated preoperatively, a day before surgery by an
 independent observer. Airway assessment for difficult intubation will be performed using
 Modified Mallampati classification in sitting and supine position followed by mouth opening,
 upper lip bite test, measurement of thyromental, thyrohyoid, sternomental and hyomental
 distance. Next the length of upper incisors, presence of receding mandible and neck movement
 will be checked. An associated history of OSA will also be taken in to account for assessing
 the difficult intubation followed by OSA grading in acromegalic patients posted for pituitary
 surgery. In situation of difficult tracheal intubation the fiberoptic intubation would be the
 preferred choice, which is a gold standard.

 General anesthesia will be induced with fentanyl 2µg/kg, propofol 2 mg/kg and rocuronium
 1mg/kg. After 90 seconds of mask ventilation, laryngoscopy will be performed with an
 appropriate sized Macintosh laryngoscope and thereafter Cormac lehane grading will be noted.
 External laryngeal manipulation (ELM) if carried out will be noted. A standard anesthesia
 protocol will be followed. After completion of the surgery, neuromuscular blockade will be
 reversed with neostigmine 0.05mg/kg and glycopyrrolate 0.01mg/kg intravenously. Once the
 patient follows the verbal command and respiratory parameters are satisfactory, endotracheal
 tube will be removed. All patients will be shifted to neurosurgical ICU for observation and
 supportive management.
Inclusion Criteria:

 -  Acromegalic patients undergoing surgery

 Exclusion Criteria:

 -  None