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Teikyo Medical Journal

Journal ID : TMJ-05-12-2023-11588
Total View : 459

Title : Anesthesia Management of Laparoscopic Pancreatectomy for Pediatric Insulinoma

Abstract :

Insulinoma, a rare neuroendocrine tumor in pediatrics, presents with hyperinsulinism and recurrent hypoglycemia. Surgical excision, particularly through laparoscopy, is the preferred treatment. Anesthesia management during laparoscopic insulinoma resection demands meticulous blood glucose control due to the risk of fluctuations during tumor manipulation. A 2-month-old infant with recurrent seizures and hypoglycemia was diagnosed with insulinoma. The patient also had congenital hypothyroidism, heart disease, and growth failure. Laparoscopic pancreatectomy was performed under general anesthesia. Anesthesia induction involved sevoflurane, fentanyl, and atracurium, with caudal analgesia using Bupivacaine. Maintenance included sevoflurane, fentanyl, and close glucose monitoring. The 5-hour surgery maintained stable hemodynamics. Postoperatively, meticulous blood glucose management continued in the Pediatric Intensive Care Unit, along with pain control and treatment for comorbidities. Pediatric insulinoma is a rare neuroendocrine tumor causing hypoglycemia with various manifestations. Surgical excision is the primary treatment, and laparoscopy is favored. Anesthesia management is crucial, and the choice of anesthetic agents and hemodynamic stability are essential considerations. This case adds to the limited literature on pediatric insulinoma anesthesia. Anesthetic management of pediatric insulinoma cases, particularly during laparoscopic resection, requires a tailored approach to ensure perioperative blood glucose control. The combination of general anesthesia with caudal analgesia presents advantages, including stable hemodynamics and expedited postoperative recovery. This report contributes valuable insights into the successful management of a rare pediatric condition, emphasizing the importance of collaboration between anesthesia and surgical teams for optimal outcomes.

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