Surgical management of
congenital hyperinsulinism is improved by accurate localization of small, focal dysregulated pancreatic lesions using the arterial stimulation and venous sampling (ASVS) test, which can demonstrate increased hepatic venous
insulin concentrations after selective arterial
injections of
calcium. However,
anesthesia-related increases in
blood glucose can induce insulin secretion, making it difficult to interpret ASVS test data. In this retrospective study, we examined the effect of
anesthetic interventions on
blood glucose concentrations in 68 children undergoing ASVS testing. We considered only the
glucose concentrations observed before
calcium stimulation in the final analysis. The choice of drugs for induction (
sevoflurane,
propofol, or
thiopentone), maintenance inhaled
anesthetics (
sevoflurane,
desflurane, or
isoflurane), and the use of caudal epidural
bupivacaine were not associated with significant differences in the mean
blood glucose concentration before ASVS. However, patients receiving
remifentanil infusions had smaller mean
glucose concentrations (80 +/- 18 versus 100 +/- 44 mg x dl(-1), P = 0.01). These concentrations were also significantly smaller if tracheal intubation was delayed for at least 10 min after induction while patients received inhaled
anesthetics via a face mask along with
remifentanil infusions (79 +/- 14 for delayed intubation versus 95 +/- 39 mg x dl(-1) for early intubation, respectively, P = 0.03). The percentage increase in
glucose concentrations from preintubation values was significantly smaller in these subjects (3.7% +/- 21.9% for delayed intubation versus 31.7% +/- 60.4% for early intubation, P = 0.02). We conclude that the
anesthetic management protocol for these patients should include the use of
remifentanil infusions and the administration of inhaled
anesthetics and
remifentanil infusions for a minimum of 10 min to establish a deep plane of
anesthesia before tracheal intubation.