A patient with glucagonoma may require careful anesthetic management during surgery.
Patient selection: glucagonoma
Usually surgery is performed to resect the primary tumor and any metastases. Manipulation of the primary glucagonoma or its metastases can result in a sudden fluctuations in serum glucagon concentrations. Glucagon levels usually fall to normal concentrations within 24 hours of surgery if all tumor has been resected (persistent elevation suggests unresected tumor).
The preoperative evaluation of the patient should try to identify all abnormal products being secreted by the tumor. The presence of polypeptides in addition to glucagon may require modification of the anesthetic management.
Special needs:
(1) glucose control (see below)
(2) monitoring of cardiac function, especially if there is evidence of cardiomyopathy (unexplained tachycardia, heart failure)
Blood glucose levels can fluctuate in the perioperative period and requires constant monitoring during and after surgery.
(1) Sudden increases in glucose may require infusion of insulin.
(2) Episodes of hypoglycemia may require infusion of dextrose solutions (constant or bolus).
To read more or access our algorithms and calculators, please log in or register.
