چكيده فارسي :
آكرومگالي يك بيماري مزمن، موذي و ناتوان كننده هست كه غالبا بدليل ترشح بيش از حد هورمون رشد ناشي از ادنوم هيپوفيز قدامي است. اين بيماران اغلب درگيري چند سيستمي شامل تنفسي، قلبي عروقي، عصبي عضلاني، نورولوژيك و اسكلتي دارند. مديريت راه هوايي بعلت رشد بيش از حد بافت نرم راه هوايي (بزرگي زبان و اپيگلوت)، تغييرات اسكلتي و همچنين فلج عصب راجعه حنجرهاي و درگيري مفصل كريكوآريتنوييد و ضخيم شدن تارهاي صوتي بيمار را مستعد انسداد راه هوايي و ايجاد چالش بزرگ براي متخصص بيهوشي مي كند. ما موردي را معرفي مي كنيم كه اداره راه هوايي بيمار برخلاف انتظار بود.
چكيده لاتين :
Introduction: Acromegaly is a chronic, insidious and debilitating disease that often occurs due to
excessive secretion of growth hormone by the anterior pituitary adenoma. Patients with this disorder
often have multisystem involvement, including respiratory, cardiovascular, neuromuscular,
neurological, and skeletal.
Airway management in these patients faces anesthesiologist to a great challenge due to overgrowth
of airway soft tissue (enlargement of tongue and epiglottis), skeletal changes, recurrent laryngeal
nerve palsy, cricoarytenoid joint involvement and thickening of vocal cords and predispose the
patient to airway obstruction. We present a case in which the patient airway administration was
unexpected.
Case Report: A 25-year-old man with a history of acromegaly was referred to our anesthesiology
clinic for severe decrease visual acuity in right eye for vitrectomy. After taking the history and
performing the necessary examinations, tests and consultations for the operation, it was decided to
undergo general anesthesia and insert a laryngeal Mask Airway.
Despite using different mask sizes, changing head position and standard techniques, thumb, 90-
degree rotation, 180-degree, partial inflation, and laryngoscopic guide, we were unable to insert the
LMA and the patient completed surgery and recovery without complications.
Conclusion: Complete preoperative evaluation of acromegaly patients is very important in the
anesthesia and airway management. This preoperative evaluation helps the anesthesiologist to make
the necessary arrangements in the patient's airway management to prevent the risks.
Supraglottic devices such as laryngeal masks are useful in cases where mask ventilation and tracheal
intubation are difficult. But the opposite can also happen. Therefore, our scientific evaluation and
decision-making may not take place before the procedure during the procedure and we may have to
use other methods. Therefore, the anesthesiologist must be prepared to implement the difficult airway
management algorithm.
