Transnasal transsphenoidal (TNTS) pituitary surgery is associated with short-lived but intense nociceptive stimuli which cause substantial hemodynamic perturbations that may increase blood loss and impair visualization of the surgical field. This systematic review aimed to critically appraise the clinical evidence for the efficacy and safety of various anesthetic techniques, other pharmacological modalities, and supplementary interventions by assessing intraoperative systemic hemodynamics, use of adjunct medications, quality of the surgical field, intraoperative blood loss, and recovery profiles in patients undergoing TNTS pituitary surgery. Relevant randomized clinical trials and observational studies were identified in a systematic literature search; 16 studies (13 randomized clinical trials, 3 observational studies) enrolling a total of 907 patients were identified for inclusion in this review. Propofol provided more potent hemodynamic control compared with volatile anesthetics with a sparing effect on the need for additional drugs to blunt hemodynamic responses. Recovery profiles between propofol and sevoflurane were either equivalent or favored sevoflurane, but both agents were superior to isoflurane. Regarding intraoperative analgesia, remifentanil was associated with superior hemodynamic control and recovery profiles than fentanyl. Dexmedetomidine had beneficial effects on hemodynamics, surgical field quality, recovery characteristics, and nociceptive properties compared with placebo. Although there was no clear-cut superiority of other adjunct pharmacological modalities on hemodynamic responses during surgery, regional blocks were associated with beneficial impacts on both primary and secondary outcomes. In summary, short-acting anesthetics, analgesics and dexmedetomidine seem to improve intraoperative hemodynamics, blood loss, and recovery qualities during TNTS pituitary surgery. However, definitive conclusions cannot be drawn because of methodological heterogeneity in the identified studies.

经鼻经蝶 (TNTS) 垂体手术与短暂但强烈的伤害性刺激有关，这会导致大量血流动力学扰动，从而可能增加失血并损害手术区域的可视化。本系统评价旨在通过评估术中全身血流动力学、辅助药物的使用、手术区域的质量、术中失血量和恢复情况，严格评估各种麻醉技术、其他药理学方式和补充干预措施的有效性和安全性的临床证据接受 TNTS 垂体手术的患者的概况。在系统文献检索中确定了相关的随机临床试验和观察性研究；16 项研究（13 项随机临床试验，3 项观察性研究）共纳入 907 名患者，被确定纳入本次审查。与挥发性麻醉剂相比，异丙酚提供了更有效的血流动力学控制，并且减少了对额外药物减弱血流动力学反应的需求。异丙酚和七氟醚之间的回收率曲线要么相当，要么优于七氟醚，但两种药物都优于异氟醚。关于术中镇痛，瑞芬太尼与芬太尼相比具有更好的血流动力学控制和恢复特征。与安慰剂相比，右美托咪定对血流动力学、手术区域质量、恢复特征和伤害感受特性具有有益作用。尽管其他辅助药理学方式对手术期间的血流动力学反应没有明显的优势，区域块与对主要和次要结果的有益影响有关。总之，短效麻醉剂、镇痛剂和右美托咪定似乎可以改善 TNTS 垂体手术期间的术中血流动力学、失血量和恢复质量。然而，由于已确定研究的方法学异质性，无法得出明确的结论。