{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:40:13Z","timestamp":1787071213863,"version":"build-2736575974"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Congenital hyperinsulinemic hypoglycemia (CHI) is a rare but serious condition resulting from genetic abnormalities that cause excessive insulin secretion and recurrent hypoglycemia. It poses significant neurological risks in infancy. When medical therapy fails, pancreatectomy becomes necessary; however, the procedure presents major anesthetic challenges due to unstable glucose levels during surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology:<\/jats:title>\n                    <jats:p>We performed a retrospective study of electronic records of 34 patients &lt;5 years who underwent laparoscopic pancreatectomy at King Faisal Specialist Hospital and Research Center (KFSHRC Riyadh, Saudi Arabia) between 2015 and 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of the 34 patients, 64.7% (n = 22) were male; most (67.6%, n = 23) were aged 4\u20138 weeks. Nesidioblastosis was the most common pathology (55.9%, n = 19). The mean surgery duration was 177.2 \u00b1 51.7 minutes. Nearly all patients (94.1%, n = 32) were referred to the intensive care unit (ICU), and 85.3% (n = 29) remained intubated postoperatively. All patients received dextrose-containing fluids (5\u201350% concentration). Intraoperative blood glucose levels ranged from 2.5\u201333.4 mmol\/L, with significant variation between preoperative, intraoperative, and postoperative values (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.005). Blood transfusion was required in 35.3% (n = 12) of patients, with no critically low glucose levels recorded perioperatively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Pediatric pancreatectomy for CHI is associated with significant intraoperative glucose fluctuations, necessitating meticulous glucose and fluid management. Nesidioblastosis remains the leading pathology. Most patients require postoperative ICU care with elective ventilation. Early diagnosis, vigilant anesthetic management, and structured postoperative protocols are essential to minimize morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sja.sja_869_25","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T07:00:30Z","timestamp":1775199630000},"page":"339-343","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Anesthesia considerations in pediatric pancreatectomy for congenital hyperinsulinemic hypoglycemia: A retrospective case series"],"prefix":"10.4103","volume":"20","author":[{"given":"Osama","family":"Arafah","sequence":"first","affiliation":[{"name":"Department of Anesthesia, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Nassef","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Bilal","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"},{"name":"Department of Anesthesia, Fellow \u2013 Surgical Oncology and Hepatobiliary Anesthesia, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hammad","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Fellow Anesthesia, McGil University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Norris","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"R1-20260421","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/S0031-3955(05)70481-8","article-title":"Hyperinsulinism in infants and children","volume":"44","author":"Stanley","year":"1997","journal-title":"Pediatr Clin North Am"},{"key":"R2-20260421","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1056\/NEJM199805073381904","article-title":"Hyperinsulinism and hyperammonemia in infants with regulatory mutations of the glutamate dehydrogenase gene","volume":"338","author":"Stanley","year":"1998","journal-title":"N Engl J Med"},{"key":"R3-20260421","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1177\/000992288802700307","article-title":"Persistent neonatal hyperinsulinism","volume":"27","author":"Mathew","year":"1988","journal-title":"Clin Pediatr (Phila)"},{"key":"R4-20260421","doi-asserted-by":"crossref","first-page":"111","DOI":"10.3389\/fendo.2019.00111","article-title":"The genetic and molecular mechanisms of congenital hyperinsulinism","volume":"10","author":"Galcheva","year":"2019","journal-title":"Front Endocrinol (Lausanne)"},{"key":"R5-20260421","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s11154-020-09548-7","article-title":"Hyperinsulinemic hypoglycemia in children and adolescents: Recent advances in understanding of pathophysiology and management","volume":"21","author":"G\u03cbemes","year":"2020","journal-title":"Rev Endocr Metab Disord"},{"key":"R6-20260421","doi-asserted-by":"crossref","first-page":"38","DOI":"10.21037\/tgh-20-220","article-title":"Minimally invasive surgery of the pancreas: A narrative review of current practice","volume":"6","author":"Richards","year":"2021","journal-title":"Transl Gastroenterol Hepatol"},{"key":"R7-20260421","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jpedsurg.2003.11.004","article-title":"The surgical management of congenital hyperinsulinemic hypoglycemia in infancy","volume":"39","author":"F\u00e9k\u00e9t\u00e9","year":"2004","journal-title":"J Pediatr Surg"},{"key":"R8-20260421","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1111\/j.1460-9592.2007.02192.x","article-title":"Congenital hyperinsulinism - 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