piperidines and Pituitary-Diseases

Endoscopic endonasal transphenoidal surgery has been recently proposed as a minimally invasive procedure for the treatment of pituitary adenomas. The main objective of the anaesthesiologist is to induce sufficient haemodynamic control together with rapid recovery at the end of surgery. The aim of this study was to examine recovery profile, surgical operative conditions and haemodynamic differences using remifentanil infusion with either propofol target controlled infusion system or sevoflurane.. Forty-four adult patients were enrolled in a prospective, randomized, single-blind, two-group study: Group P received propofol target controlled infusion system and remifentanil; Group S received sevoflurane and remifentanil for maintenance of anaesthesia.. No statistically significant differences between the two groups with regards to the haemodynamic changes, operative conditions as assessed by a four-step bleeding score (0-3), were obtained. Recovery times were considerably shorter after remifentanil-sevoflurane in comparison with remifentanil-propofol target controlled infusion system group (7.4 vs. 12.8 min, P < 0.01).. This study demonstrates that sevoflurane-remifentanil gives a faster recovery and equivalent intraoperative status compared with propofol target controlled infusion system with remifentanil for the endoscopic endonasal transphenoidal approach.

Topics: Adult; Aged; Anesthesia Recovery Period; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Blood Pressure; Endoscopy; Female; Heart Rate; Humans; Male; Methyl Ethers; Middle Aged; Minimally Invasive Surgical Procedures; Nasal Cavity; Piperidines; Pituitary Diseases; Pituitary Neoplasms; Propofol; Prospective Studies; Remifentanil; Sevoflurane; Single-Blind Method; Sphenoid Bone; Treatment Outcome

Domperidone is a peripheral antagonist of dopamine which does not cross the blood-brain barrier. It is administered orally in doses of 40 mg and consistently induces a rise in prolactin (delta + 2500 % at 90 minutes; surface under the curve 306,000) on condition that the mammotropic cells are in sufficient numbers and under central dopamine control. Adenomatous mammotrophs do not respond to domperidone (p less than 0.001 difference with controls). Three months after transphenoidal adenomectomy and correction of hyperprolactinaemia, there was no significantly change in the kinetics of prolactin response to the product. Some gonadotrophic hormone-producing adenomas exhibit paradoxical response of GH to L-dopa and domperidone, which disappears after surgical excision.

Topics: Benzimidazoles; Domperidone; Female; Growth Hormone; Humans; Male; Piperidines; Pituitary Diseases; Pituitary Gland; Pregnancy; Prolactin