Manabe Motoko, Morimatsu Hiroshi, Egi Moritoki, Suzuki Satoshi, Kaku Ryuji, Matsumi Masaki, Morita Kiyoshi
Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama.
Masui. 2009 Jun;58(6):757-9.
Insulinomas are rare tumors, the incidence of which is 1-2 per million. Patients with insulinomas present with symptoms of hypoglycemia secondary to insulin hypersecretion. Surgical resection is a treatment of choice and offers the only chance of cure. The important points in anesthesia are the precaution against hypoglycemia until tumor resection and the control of rebound hyperglycemia soon after tumor resection. We report the anesthetic management of a 5-year-old patient with insulinoma. Soon after the induction of anesthesia, the continuous glucose monitoring was commenced. Until the tumor resection, 10% glucose infusion was required to avoid hypoglycemia. Then, insulin infusion was continued to maintain blood glucose level around 150 mg x dl(-1). All glucose management was guided with continuous glucose monitoring. This is a first case report to show the feasibility and usefulness of continuous glucose monitoring in management of pediatric insulinoma patients. As the blood glucose was dramatically altered during perioperative period, frequent blood glucose measurements or continuous glucose monitoring is mandatory during perioperative period of insulinoma resection.
胰岛素瘤是罕见肿瘤，其发病率为百万分之一至二。胰岛素瘤患者表现为因胰岛素分泌过多继发的低血糖症状。手术切除是首选治疗方法，也是唯一的治愈机会。麻醉中的要点是在肿瘤切除前预防低血糖，以及在肿瘤切除后不久控制反弹性高血糖。我们报告一例5岁胰岛素瘤患者的麻醉管理。麻醉诱导后不久，开始持续血糖监测。在肿瘤切除前，需要输注10%葡萄糖以避免低血糖。然后，继续输注胰岛素以维持血糖水平在150 mg×dl⁻¹左右。所有血糖管理均在持续血糖监测的指导下进行。这是首例展示持续血糖监测在小儿胰岛素瘤患者管理中的可行性和实用性的病例报告。由于围手术期血糖会发生显著变化，因此在胰岛素瘤切除的围手术期，必须频繁测量血糖或进行持续血糖监测。
