Prakash Deb

Abstract

Cerebrovascular accident in pregnancy may occur as a complication of hypertensive disorders of pregnancy & urgent non-contrast computed tomography brain is required to rule out intracerebral haemorrhage along with other investigations to find the underlying aetiology. Management of cerebrovascular accident during pregnancy may be conservative, neurosurgical or thrombolysis. However, if associated with raised intracranial pressure, priority should be given to airway protection, ventilation, reduction of intracranial pressure & neuroprotection along with the definitive treatment. We report herein a case of cerebrovascular accident who presented at term pregnancy with hemiplegia with impending eclampsia & foetal distress with deteriorating Glasgow Coma Scale requiring urgent stabilisation & emergency caesarean section prior to any brain imaging to establish the cause rendering the anaesthetic management challenging. Keywords: Anaesthesia, Cerebrovascular accident, Emergency caesarean section, Hemiplegia, Severe preeclampsia.

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Abstract

Insulinoma is a very rare tumour occurring in 1-4 persons per million per year. It is a functional endocrine tumour of the pancreas characterized by repeated attacks of hypoglycaemia presenting as adrenergic or neuroglycopenic symptoms. Surgical management of insulinoma is the mainstay of treatment which can be done by either laparoscopic or open approach. There is occurrence of rapid and wide fluctuations of blood glucose levels in the intraoperative as well as perioperative period. Intraoperative hypoglycaemia is critical due to masking of symptoms by the effect of anaesthesia and if not detected and treated promptly may lead to permanent neurological insult. We here-in describe the challenges of anaesthetic management in a case of functional pancreatic insulinoma undergoing open surgical enucleation with the help of intraoperative ultrasonography.   Keywords: Hypoglycaemia, Enucleation, Pancreatic, Intraoperative ultrasonography, Blood sugar monitoring.

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