Sevoflurane anesthesia for a patient with insulinoma]

A 56-y-o female had recurrent bouts of unconsciousness and convulsions. Her blood glucose level was often below 40 mg.dl-1. Blood chemistry, echography and angiography revealed an insulinoma of 14 x 12 mm in size. Under sevoflurane anesthesia, excision of the tumor was scheduled. The preanesthetic glucose level was 38 mg.dl-1. Under fluid therapy, with 5% glucose in acetate Ringer solution, no hypoglycemic episode occurred during and after the operation. The arterial IRI level was elevated as the blood glucose level increased before the extirpation of the tumor, but it decreased to the normal level 30 minutes after the tumor removal. The IRI level of the portal vein also decreased from 81.7 microU.ml-1 to 19.0 microU.ml-1 after the removal. The perioperative course was uneventful under sevoflurane anesthesia and the result substantiates the report by Murakawa et al, who contend that sevoflurane suppresses the spontaneous release of insulin. We believe that sevoflurane is an appropriate anesthetic agent for a patient with an insulinoma.