Abstract
Pituitary macroadenomas are most common suprasellar tumours in adult. Trans sphenoidal approach is commonly used for tumour resection. We report a case of forty four year old female who had undergone fontan palliation procedure at age of 19 years with pulmonary stenosis, thoracic khyphoscoliosis and pulmonary artery hypertension at present who presented for excision of tumor. Along with general concerns of pituitary patient was nebulised with bronchodilators, milrinone, encouraged spirometry, lung protection strategies were used for ventilation and hemodynamic stability maintained. Multi system involvement poses challenge to anaesthetists as it demands management and care of all the involved systems.
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