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Abstract  Objective: Pituitary Adenoma with overt hypothyroidism coming for non neurological emergency surgery is a challenge to the anesthetist due to the risks of pituitary apoplexy during spinal and general anesthesia and the risk of myxoedema coma. Our objective is to present one such rare case which was successfully managed with combined sciatic and femoral block. Case Report: An 18 year old male patient with residual pituitary adenoma came to our hospital for tibia fracture fixation. Preoperative thyroid function tests revealed overt hypothyroidism (T.S.H. 11.3 mIu/ml, T3 40 ng/dl T4 1.59ug/dl). Combined femoral and sciatic nerve block was planned. Epidural anesthesia was kept as a backup plan. Sciatic block was given with the classic approach of Labat. Inj lignocaine 2% 10 ml with injlevobupivacaine 0.5% 20ml with inj. dexamethasone 8mg as additive was injected. 15 ml of 0.5% bupivacaine plus 5 ml of 2% lignocaine adrenaline was injected for femoral block. Inj hydrocortisone 100mg was administered intravenously in view of surgical stress. Preventive measures were taken to avoid hypothermia. Surgery was successfully performed in supine position and lasted for two and half hours. Conclusions: We conclude that peripheral nerve blockade can successfully overcome all the challenges associated with general and regional anesthesia in a rare case of Pituitary adenoma with overt hypothyroidism coming for emergency surgery.

Keywords: Pituitary adenoma, Sciatico-femoral block, Hypothyroidism, Apoplexy.


STATPERSON PUBLISHING GROUP | Aurangabad | Maharashtra |2016 | INDIA
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