Patients with systemic mastocytosis (SM) who face surgical procedures that require anesthesia need to be aware of the potential risks associated with anesthetics and how to manage them.
Surgery with general anesthesia has an increased risk of anaphylaxis for people living with SM. There are some safer anesthetic alternatives and some practical steps you can take to reduce the stress of prepping for surgery.
What is SM?
Systemic mastocytosis (SM) is a rare hematological disease characterized by mast cells that are overactive and accumulate in different parts of the body such as the bone marrow, liver, spleen, gastrointestinal tract and lymph nodes.
Reducing the risk of anesthesia
The greatest risks for people with SM undergoing surgery are related to general anesthesia and morphine derivatives, as they can activate mast cells. This can lead initially to skin flushing, hives or itching before developing into anaphylaxis.
Read more about SM signs and symptoms
Surgery shouldn’t be avoided because you have SM. It is possible to adjust the anesthesia options and tailor the approach to the SM patient, based on previous experiences and symptom history.
Here’s what experts advise.
- Avoid MRGPRX2 agonists and morphine derivatives.
- Take fentanyl for post-operative pain relief instead of aspirin.
- Consider regional anesthesia rather than general anesthesia as a safer option.
Beyond the potential risks associated with anesthesia, other potential symptom triggers may include pain and extreme changes in temperature. It’s important to manage these triggers with mast cell stabilizing medication before and after surgery.
How to prepare for surgery
Consult your health care provider for advice on how best to prepare for surgery. Discuss different options for anesthesia and ways to mitigate the risks of anesthesia. Below are some ways you can contribute to reducing the risks associated with anesthesia.
- Plan ahead: Communicate clearly about your SM with your surgeon and share your medical history. Put your health care team in touch with your surgeon to ensure you receive the best care before, during and after your surgery. Make sure the surgery team is equipped to recognize the signs of the onset of anaphylaxis and treat it urgently if it occurs.
- Premedicate: Your doctor is likely to advise you to take antihistamines and corticosteroids before surgery to stabilize your mast cells.
- Mentally prepare yourself: The anticipation of surgery can cause emotional stress, which can activate mast cells. Use visualization, meditation and deep breathing techniques to alleviate your anxiety before your surgery.
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