How do I install the Endo Preop Srl Severe Pharyngeal Sleepapnea Hf skill?

Run npx skillmds@latest add dromlakhani/endo-preop-srl-severe-pharyngeal-sleepapnea-hf in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Endo Preop Srl Severe Pharyngeal Sleepapnea Hf by dromlakhani

Name: Endo Preop Srl Severe Pharyngeal Sleepapnea Hf
Rating: 4.2 (5 reviews)
Author: dromlakhani

Endo Preop Srl Severe Pharyngeal Sleepapnea Hf

This skill suggests preoperative somatostatin receptor ligand (SRL) therapy to reduce anesthetic risk in acromegaly patients with severe pharyngeal thickness, obstructive sleep apnea, or high-output heart failure. It is triggered when assessing preoperative risk before transsphenoidal surgery and phrases like "severe pharyngeal thickening", "sleep apnea syndrome", or "high-output heart failure" are identified.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Preoperative SRL for severe pharyngeal thickness, sleep apnea, or high-output heart failure

STEP 1 — Gather Information

Collect data on pharyngeal thickness (Mallampati grade ≥3, neck circumference >40 cm, or imaging showing narrowing), sleep apnea (STOP‑BANG ≥5 or polysomnography AHI >15), high‑output heart failure (cardiac index >4 L/min/m², dyspnea at rest, edema, echocardiogram showing elevated output), and confirm acromegaly (elevated IGF‑1 with lack of GH suppression). Document planned transsphenoidal surgery date.

STEP 2 — Rule In / Rule Out

If any of severe pharyngeal thickness, sleep apnea, or high‑output heart failure is present → proceed to Step 3; if none are present → follow routine preoperative optimization (no SRL indicated).

STEP 3 — Classify or Stratify

Classify as candidate for preoperative SRL therapy. Obtain baseline liver function tests, fasting glucose, and consider gallbladder ultrasound only if symptomatic. Choose SRL agent: octreotide LAR or lanreotide autogel.

STEP 4 — Decide

Initiate SRL at standard starting dose (octreotide LAR 20 mg IM monthly or lanreotide autogel 90 mg SC monthly) for 4–6 weeks preoperatively. Reassess pharyngeal symptoms, sleep apnea scores, and cardiac status; continue postoperatively if biochemical control is needed per guideline 5.1.

Clinical Guardrails / Mimics / Pitfalls

Do not use SRL solely to improve IGF‑1 levels without the comorbid indication (see 4.3). Avoid in patients with known SRL allergy, uncontrolled GI obstruction, or active infection. Monitor for hyperglycemia, gallstones, and injection‑site reactions. Do not delay urgent surgery for prolonged SRL course; a minimum of 2–4 weeks may still confer benefit.

Concrete Clinical Example

A 50‑year‑old with acromegaly, macroadenoma abutting the cavernous sinus, Mallampati grade 4, diagnosed OSA (AHI 28), and high‑output heart failure (cardiac index 4.8 L/min/m²) scheduled for transsphenoidal decompression; started lanreotide autogel 90 mg monthly for 6 weeks preoperatively, resulting in reduced snoring, improved dyspnea, and uneventful intubation.

Source: Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI:10.1210/jc.2014-2700

---name: endo-preop-srl-severe-pharyngeal-sleepapnea-hfdescription: This skill suggests preoperative somatostatin receptor ligand (SRL) therapy to reduce anesthetic risk in acromegaly patients with severe pharyngeal thickness, obstructive sleep apnea, or high-output heart failure. It is triggered when assessing preoperative risk before transsphenoidal surgery and phrases like "severe pharyngeal thickening", "sleep apnea syndrome", or "high-output heart failure" are identified.---# Preoperative SRL for severe pharyngeal thickness, sleep apnea, or high-output heart failure## STEP 1 — Gather InformationCollect data on pharyngeal thickness (Mallampati grade ≥3, neck circumference >40 cm, or imaging showing narrowing), sleep apnea (STOP‑BANG ≥5 or polysomnography AHI >15), high‑output heart failure (cardiac index >4 L/min/m², dyspnea at rest, edema, echocardiogram showing elevated output), and confirm acromegaly (elevated IGF‑1 with lack of GH suppression). Document planned transsphenoidal surgery date.## STEP 2 — Rule In / Rule OutIf any of severe pharyngeal thickness, sleep apnea, or high‑output heart failure is present → proceed to Step 3; if none are present → follow routine preoperative optimization (no SRL indicated).## STEP 3 — Classify or StratifyClassify as candidate for preoperative SRL therapy. Obtain baseline liver function tests, fasting glucose, and consider gallbladder ultrasound only if symptomatic. Choose SRL agent: octreotide LAR or lanreotide autogel.## STEP 4 — DecideInitiate SRL at standard starting dose (octreotide LAR 20 mg IM monthly or lanreotide autogel 90 mg SC monthly) for 4–6 weeks preoperatively. Reassess pharyngeal symptoms, sleep apnea scores, and cardiac status; continue postoperatively if biochemical control is needed per guideline 5.1.## Clinical Guardrails / Mimics / PitfallsDo not use SRL solely to improve IGF‑1 levels without the comorbid indication (see 4.3). Avoid in patients with known SRL allergy, uncontrolled GI obstruction, or active infection. Monitor for hyperglycemia, gallstones, and injection‑site reactions. Do not delay urgent surgery for prolonged SRL course; a minimum of 2–4 weeks may still confer benefit.## Concrete Clinical ExampleA 50‑year‑old with acromegaly, macroadenoma abutting the cavernous sinus, Mallampati grade 4, diagnosed OSA (AHI 28), and high‑output heart failure (cardiac index 4.8 L/min/m²) scheduled for transsphenoidal decompression; started lanreotide autogel 90 mg monthly for 6 weeks preoperatively, resulting in reduced snoring, improved dyspnea, and uneventful intubation.**Source:** Acromegaly: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2014, DOI:10.1210/jc.2014-2700

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