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Transsphenoidal pituitary resection is a common surgical procedure that offers unique challenges to the anesthesiologist. Generally, the transsphenoidal approach to the sella region can be divided into two techniques: (1) the sublabial approach which involves an incision made beneath the upper lip into the gum and subsequently through the septum and (2) the transnasal approach which involves dissection through the nasal cavity wall using microsurgical or endoscopic instruments inserted through the nostrils. The heterogeneity of the patient population and their medical condition requires a fundamental knowledge of the nature of pituitary disease and management. Understanding the specific demands of the surgical technique allows the anesthesia provider to facilitate the procedure and increase the efficacy of the intervention. Additionally, predicting and managing the peri- and postoperative complications allows the anesthesiologist to maximize the safety of the patient.