“Keeping it steady”: Anaesthetic challenges in insulinoma surgery

Abstract

Insulinoma is a tumor of the pancreas that secretes excessive insulin, causing recurrent hypoglycemia. The median presentation age of 47 years and a mild female preponderance. Most cases are benign, with only 10% showing malignant potential. A typical presentation involves Whipple's triad, which includes symptomatic hypoglycemia, fasting blood glucose below 50 mg/dL, and immediate relief of symptoms after glucose administration. This case report discusses the perioperative anaesthetic management of a 54-year-old patient with insulinoma who underwent laparoscopic enucleation. A comprehensive approach involving preoperative blood glucose optimization through medications and dietary adjustments, vigilant intraoperative monitoring with timely dextrose infusion during tumor manipulation, and careful postoperative control of rebound hyperglycemia using insulin infusion is essential for improved outcomes in these patients. The primary treatment is surgical enucleation, but managing perioperative glycemic fluctuations presents significant challenges for anesthesiologists.