Insulinoma e gestação: anestesia e manejo perioperatório

A 33‐year primiparous woman, 86 kg, 1.62m, BMI 32.7 kg.m−2, at 15 weeks of gestation, physical status ASA III, investigated for a reduced level of consciousness. Laboratory tests showed: hypoglycemia (45 mg.dL−1) associated with hyperinsulinemia (24 nUI.mL−1), glycosylated hemoglobin (4.1%); other laboratory findings and physical examination were normal. Magnetic resonance imaging showed a 1.1 cm nodule in the pancreatic tail with suspected insulinoma. Due to the difficult glycemic control with bolus and continuous infusion of glucose, laparotomy was performed for tumor enucleation under total intravenous anesthesia combined with epidural block. Monitoring, central and peripheral venous access, radial artery catheterization, diuresis, and glucosimetry were recorded every 15 minutes. Intraoperatively, there was severe hypoglycemia while handling the tumor and shortly before its enucleation, which was controlled through continuous infusion of 10% glucose balanced crystalloid solution (100‐230 ml.h−1). The patient's postoperative evolution was uneventful, with resolution of hypoglycemia and total withdrawal of glucose intravenous infusion.