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Education  |   May 2019
Fatal Iatrogenic Pituitary Apoplexy after Surgery for Neuroophthalmological Disorder
Author Notes
  • From Department of Clinical Sciences and Public Health, Forensic Medicine Unit (M.N.), and Department of Surgical Science, Eye Clinic (P.E.N.), University of Cagliari, Cagliari, Italy; and Department of Otolaryngology, Head and Neck Surgery, Humanitas Clinical and Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas University, Milan, Italy (F.F.).
  • M.N. and P.E.N. contributed equally to this article.
    M.N. and P.E.N. contributed equally to this article.×
  • Address correspondence to Dr. Nioi: nioimatteo@gmail.com
Article Information
Education / Images in Anesthesiology / Central and Peripheral Nervous Systems / Endocrine and Metabolic Systems
Education   |   May 2019
Fatal Iatrogenic Pituitary Apoplexy after Surgery for Neuroophthalmological Disorder
Anesthesiology 5 2019, Vol.130, 822. doi:https://doi.org/10.1097/ALN.0000000000002584
Anesthesiology 5 2019, Vol.130, 822. doi:https://doi.org/10.1097/ALN.0000000000002584
Perioperative medical management of patients undergoing transsphenoidal pituitary surgery may represent a challenge and can require expert overall knowledge.1–3  The autonomous feeding and the oral assumption of drugs is not possible in the immediate postoperative period. Accordingly, an adequate correction of water imbalance and food deficit could be achieved by feeding via gastric probe.
Here, we present an image, from reconstructed tridimensional computed tomography scans, which shows a disastrous misadventure during postoperative management in a patient with neuroophthalmologic disorder. A 50-yr-old Caucasian woman was admitted to the hospital for visual impairment, headache, and vertigo. Examination disclosed a pituitary adenoma, and the transsphenoidal adenectomy was performed. Postoperatively, based on a gradual worsening of general status, the patient was transferred to the intensive care unit. During the night, at the shift change, a nasogastric tube was placed by a clinician who was not aware of the surgery performed.
The patient developed hemodynamic collapse and imaging demonstrated intracranial positioning of the nasogastric tube. The cause of death was considered to be pituitary apoplexy secondary to incorrect placement of the nasogastric tube.
In general, although nasal placement of gastric or tracheal tubes is considered a safe medical procedure, clinicians should consider the (very rare) risk associated with its practice.
Consequently, it is of crucial importance to evaluate the use of guidance systems (imaging or endoscopy) to verify the correct position of the tube during its insertion in these circumstances.
Acknowledgments
The authors would like to thank Ernesto d’Aloja, M.D., Ph.D., Maurizio Fossarello, M.D., and Gabriele Finco, M.D., of the University of Cagliari, Cagliari, Italy, for their help in critical manuscript revision.
Competing Interests
The authors declare no competing interests.
References
Nemergut, EC, Dumont, AS, Barry, UT, Laws, ER Perioperative management of patients undergoing transsphenoidal pituitary surgery.. Anesth Analg. (2005). 101 1170–81 [Article] [PubMed]
Ausiello, JC, Bruce, JN, Freda, PU Postoperative assessment of the patient after transsphenoidal pituitary surgery.. Pituitary. (2008). 11 391–401 [Article] [PubMed]
Johnstone, JC, Leung, JS, Friedman, JN Nasogastric tube misadventures.. Clin Pediatr (Phila). (2011). 50 983–6 [Article] [PubMed]