Introduction:
Changes in air way anatomy induced by growth hormone secretion in acromegaly make these patients a unique challenge. Past publications indicate that intubation was difficult in 33 out of 128 (25.7%) patients and that the predictive value of Mallampati score in predicting airway difficulty is low.
Aims: 
The aim of the study was to assess the incidence of difficult intubation in patients with acromegaly undergoing pituitary surgery.

Methods:
Medical records of patients undergoing pituitary surgery during the years 2014-2017 were explored for age, gender, hormonal diagnosis, Mallampati score, difficulty of intubation, and first end tidal carbon dioxide (EtCO2) value immediately following intubation. 

Results:
From 148 patients who had undergone pituitary surgery, 31 (20.9%) suffered from acromegaly. During the preoperative evaluation, 7 out of 31 (22.6%) were suspected as difficult to intubate (SDI).  From these in 1 awake fiber optic was performed, in 2 intubation was performed using a video-laryngoscope and in 4 direct laryngoscopy was performed. 2 were reported to be difficult to intubate, the 1 who had undergone awake fiber optic and 1 of those who had undergone video laryngoscopy. 
From 24 non-SDI patients in 20 intubation was performed after direct laryngoscopy and in 4 using a video-laryngoscopy. Only 1 out of 24 (4.2%) was reported to have difficulty in intubation. 
The Mallampati score in the SDI group patients was 4 in 1 patient, 3 in 3, and 1 in 3. In the non-SDI group patients Mallampati score was 4 in 1 patients, 3 in 5, and 2 in 9, with reminder having a score of 1. The Mallampati scores of the difficult to intubate patients where 3 in the patients from the SDI group and 3 in the non SDI. 
The first EtCO2 measurement following intubation was <40 mmHg in 3 patients from the SDI group (42.8%) and 15 from the non-SDI group (48.4%), 40-45 mmHg in 1 from the SDI group (14.3%) and 5 from the non-SDI group (16.1%), and ≥46 in 3 from the SDI group (42.8%) and 4 from the non-SDI group (12.9%).

Conclusion:
According to this sample the incidence of suspected difficult intubation was 22.6% and incidence of reported difficult intubation was 9.7%. If EtCO2 values ≥46 are considered as indicatior for difficulties in airway management the incidence is 22.6%.  Clinical evaluation or Mallampati score were not good predictors for airway difficulties.  


07 / Retrospective Analysis of Difficulties in Airway Management in Patient with Acromegaly Undergoing Pituitary Tumor Surgery