Anaesthetic Management for Hand Assisted Laparoscopic Enucleation of Pancreatic Insulinoma

Akhtaruzzaman, Akm; Dhar, Satyajit; Asaduzzaman, Akm; Samad, Abdus; Laskar, Manzoorul Haq; Kamal, Mustafa; Hye, Abdul

doi:10.3329/jbsa.v21i1.3552

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…So, it is essential to start an infusion of 10% dextrose with blood sugar monitoring every 15-30 minutes. 8 Normalisation of blood insulin level within 20 minutes of tumour resection is a better indicator of surgical outcome than measuring blood glucose level. 9 When enucleation is performed laparoscopically, rise in intra-abdominal pressure (IAP) may result in cortisol release causing disturbances of glucose metabolism along with hemodynamic and respiratory fluctuations.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic challenges in surgical enucleation of pancreatic insulinoma

Deb,

Ahmed,

Bhattacharyya

2023

IJCA

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Insulinoma is a very rare tumour occurring in 1-4 persons per million per year. It is a functional endocrine tumour of the pancreas characterized by repeated attacks of hypoglycaemia presenting as adrenergic or neuroglycopenic symptoms. Surgical management of insulinoma is the mainstay of treatment which can be done by either laparoscopic or open approach. There is occurrence of rapid and wide fluctuations of blood glucose levels in the intraoperative as well as perioperative period. Intraoperative hypoglycaemia is critical due to masking of symptoms by the effect of anaesthesia and if not detected and treated promptly may lead to permanent neurological insult. We here-in describe the challenges of anaesthetic management in a case of functional pancreatic insulinoma undergoing open surgical enucleation with the help of intraoperative ultrasonography.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic challenges in surgical enucleation of pancreatic insulinoma

Deb,

Ahmed,

Bhattacharyya

2023

IJCA

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“…We chose to check blood glucose sampling every 30 min as suggested by Akhtaruzzaman et al . [ 3 ] Patients can have hypoglycaemic attacks if they are kept fasting for long hours during the preoperative period. There are studies supporting the effect of fasting on deprivation of blood glucose level in insulinoma.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of excision of a functioning pancreatic beta cell tumour

et al. 2014

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“…[ 33 ] But, this therapy with cortisol may lead to post-operative hyperglycaemia, and there is an increased chance of infection. [ 34 35 ] Other drugs like calcium channel blocker (verapamil), β-blockers (propranolol) and glucagon have also been used. [ 5 8 ]…”

Section: Managementmentioning

confidence: 99%

“…Other groups recommended this frequency of sampling every 30 min. [ 35 ] Some surgical groups prefer to maintain moderate hypoglycaemia so that post-resection increase in plasma glucose concentration can be used as an indication of successful tumour removal. But, this technique can lead to severe hypoglycaemia intraoperatively and also hyperglycaemic rebound is not adequately reliable as there are reports of both false-positive and -negative responses.…”

Section: Managementmentioning

confidence: 99%

Insulinoma and anaesthetic implications

2012

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Insulinoma is a rare neuroendocrine tumour of the pancreas , which is usually small, solitary and benign. It may be part of the multiple endocrine neoplasia type 1 syndrome. It is diagnosed by clinical, biochemical and imaging modalities. Hypoglycaemic symptoms can be medically controlled by diazoxide or somatostatin analogues. Localisation of the tumour is a challenge to clinicians. Surgical resection is the curative treatment with a high success rate. Intraoperatively, ultrasound and surgical palpation help to confirm the site of tumour. Intraoperatively, maintenance of optimum glucose levels is of main concern because there may be severe hypoglycemia while handling the tumour, symptoms of which remain masked under general anaesthesia. Glucose infusion and frequent plasma glucose monitoring to maintain plasma glucose level more than 60 mg/dL is found to be helpful. We performed a systematic search in PubMed, Cochrane Library and also in Google. We used the following text words for our search: Insulinoma, neuro-endocrine tumors, multiple endocrine neoplasia, hypoglycemia, anaesthetic management of insulinoma, glucose management. In this article, we review the incidence and epidemiology of insulinoma, its clinical features, diagnosis, localisation and treatment, with special emphasis on anaesthetic management.

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Anaesthetic Management for Hand Assisted Laparoscopic Enucleation of Pancreatic Insulinoma

Abstract: Journal of BSA, Vol. 21, No. 1, January 2008 50-52

Cited by 5 publications

References 4 publications

Anaesthetic challenges in surgical enucleation of pancreatic insulinoma

Anaesthetic challenges in surgical enucleation of pancreatic insulinoma

Anaesthetic management of excision of a functioning pancreatic beta cell tumour

Insulinoma and anaesthetic implications

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