Perioperative management of mastocytosis.

Autor: Lau S; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA., Sprung J; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA., Volcheck GW; Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA., Butterfield JH; Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA., Divekar RD; Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA., Weingarten TN; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. weingarten.toby@mayo.edu.; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. weingarten.toby@mayo.edu.
Jazyk: angličtina
Zdroj: Journal of anesthesia [J Anesth] 2023 Oct; Vol. 37 (5), pp. 741-748. Date of Electronic Publication: 2023 Jul 19.
DOI: 10.1007/s00540-023-03228-x
Abstrakt: Purpose: Patients with mastocytosis have an increased risk of anaphylaxis during surgical procedures with general anesthesia. Therefore, we reviewed the anesthesia course of a large cohort of patients with mastocytosis.
Methods: We retrospectively reviewed adult and pediatric patients with mastocytosis who underwent surgical procedures with general anesthesia at Mayo Clinic from January 1, 2000, through June 30, 2021. We also included any procedures with general anesthesia that occurred during the 3-year period preceding mastocytosis diagnosis and designated the patients who underwent these procedures as having an unknown diagnosis at the time of their surgical procedure. We analyzed whether patients received chronic antimediator treatment for mastocytosis and/or prophylactic medications before the procedures. We also determined whether medications indicative of mastocytosis-related adverse events were intraoperatively administered.
Results: We identified 113 patients who underwent 219 procedures during the study period; 25 procedures were performed before mastocytosis diagnosis. Of 194 procedures in patients with known mastocytosis, patients received chronic antimediator therapy and/or perioperative prophylactic medications for 178 (91.8%) procedures. Among these procedures, 10 were potentially complicated by mast cell activation, which was inferred from administration of inhaled albuterol (n = 3) or intravenous diphenhydramine (n = 8). In addition, there was only one case of intraoperative anaphylaxis which occurred in a patient who underwent anesthesia before mastocytosis diagnosis and therefore did not receive prophylaxis.
Conclusion: Intraoperative anaphylaxis can be the first presenting sign of mastocytosis. Patients with mastocytosis who received chronic antimediator therapy and/or preoperative prophylactic medications had an uneventful surgical course.
(© 2023. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)
Databáze: MEDLINE
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