[Craniotomy in a pediatric patient complicated with insufficiently controlled diabetes mellitus: intraoperative management with remifentanil and an electrolyte-containing glucose solution].

An 8-year-old girl of Type 1 diabetes mellitus on insulin therapy, was surgically treated for brain cavernous hemangioma. Since the hemangioma gradually became larger, the medical team including anesthesiologists, neurosurgeons, and pediatricians discussed and decided to perform craniotomy. Preoperative blood sugar level was around 40 to 300 mg x dl(-1) and appeared poorly controlled. During the surgery, opioid-based anesthesia and 1.3% glucose infusion were given to the patient to avoid surgical stress-induced hyperglycemia and to avoid starvation. Intraoperative blood sugar levels were maintained exactly at 100 to 120 mg x dl(-1) without insulin medication, and cortisol levels were below the limit of detection. Postoperative sugar level was difficult to control at the preoperative level Tumor was completely removed and the patient was discharged without any neurological sequelae. This report suggests that sufficient analgesia with remifen tanil and appropriate glucose infusion may be useful for the metabolic management not only in patients without diabetes but also in those with diabetes.