Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
Acta Neurochir (Wien). 2022 Aug;164(8):2083-2094. doi: 10.1007/s00701-022-05260-4. Epub 2022 May 31.
The effects of anesthetic technique on intermediate-term postoperative adrenocorticotropic hormone (ACTH) functional outcomes have not been fully determined in non-functioning pituitary adenoma (NFPA) patients. Postoperative hypocortisolism is potentially life-threatening and requires steroid replacement after pituitary surgery. The present study determined whether sevoflurane anesthesia was predictive of 3-month postoperative hypocortisolism in NFPA patients with preoperative normal hypothalamic-pituitary-adrenal (HPA) axis.
Demographics, preoperative pituitary hormone status, intraoperative data, and tumor characteristics were retrospectively collected from 429 NFPA patients, who had preoperative normal HPA axis and underwent endoscopic transsphenoidal surgery. Patients were divided into two groups based on intraoperative anesthetic technique: sevoflurane-based inhalation anesthesia group (n = 74) and propofol-based intravenous anesthesia group (n = 355). After propensity score matching, 73 patients were selected in each group and the incidence of 3-month postoperative hypocortisolism (primary outcome measure) was compared between the two groups.
The incidence of 3-month postoperative hypocortisolism was higher in the sevoflurane anesthesia group than the propofol anesthesia group before (n = 20[27.0%] vs. n = 49[13.8%], P = 0.008) and after (n = 20 [27.4%] vs. n = 5 [6.8%], P = 0.002) propensity score matching, respectively. Sevoflurane anesthetic use (odds ratio [95% CI] 5.37[1.80-15.98], P = 0.003) and postoperative steroid administration (2.89 [1.06-7.92], P = 0.039) were predictors of 3-month postoperative hypocortisolism.
In patients with preoperative normal HPA axis undergoing endoscopic transsphenoidal surgery for NFPA, sevoflurane anesthesia and postoperative steroid administration were associated with the development of 3-month postoperative hypocortisolism. A large-scale prospective study is needed to confirm the negative association between sevoflurane anesthesia and postoperative ACTH functional outcome.
在无功能性垂体腺瘤（NFPA）患者中，麻醉技术对中期术后促肾上腺皮质激素（ACTH）功能结果的影响尚未完全确定。术后皮质醇功能减退症有潜在的生命威胁，需要在垂体手术后进行类固醇替代治疗。本研究旨在确定在术前下丘脑-垂体-肾上腺（HPA）轴正常的 NFPA 患者中，七氟醚麻醉是否可预测术后 3 个月时的皮质醇功能减退症。
回顾性收集了 429 例 NFPA 患者的人口统计学、术前垂体激素状态、术中数据和肿瘤特征，这些患者术前 HPA 轴正常，并接受了内镜经蝶窦手术。根据术中麻醉技术将患者分为两组：七氟醚吸入麻醉组（n=74）和依托咪酯静脉麻醉组（n=355）。在进行倾向评分匹配后，每组各选择 73 例患者，比较两组患者术后 3 个月时发生的皮质醇功能减退症（主要结局指标）的发生率。
七氟醚麻醉组术后 3 个月时皮质醇功能减退症的发生率高于依托咪酯麻醉组，分别为术前（n=20[27.0%] vs. n=49[13.8%]，P=0.008）和术后（n=20[27.4%] vs. n=5[6.8%]，P=0.002）。七氟醚麻醉的使用（比值比[95%CI]5.37[1.80-15.98]，P=0.003）和术后类固醇的使用（2.89[1.06-7.92]，P=0.039）是术后 3 个月发生皮质醇功能减退症的预测因素。
在接受内镜经蝶窦手术治疗 NFPA 的术前 HPA 轴正常的患者中，七氟醚麻醉和术后类固醇的使用与术后 3 个月时发生的皮质醇功能减退症有关。需要进行大规模的前瞻性研究来证实七氟醚麻醉与术后 ACTH 功能结果之间的负相关关系。
