An specially tailored anesthetic protocol for a cesarean section (C-section) in a woman with systemic mastocytosis (SM) and other diseases that elevate anesthetic risk was recently published in Cureus.
“Triggers are varied and can include changes in temperature, emotional and physical stress, as well as a multitude of drugs. For these reasons, both labor and the peri-operative period can be high risk with potential for multifactorial acute, life-threatening reactions,” the authors wrote.
The case involved a woman in her 20s with suspected SM. The patient had a complex medical history including Ehlers-Danlos syndrome and multiple drug-related allergic reactions, including anaphylaxis. She also reported symptoms such as hot flushes and gastrointestinal discomfort. Despite inconclusive genetic testing, clinicians opted to treat her as having confirmed SM until a bone marrow biopsy could provide definitive diagnosis.
The patient was referred to maternal medicine and allergy multidisciplinary teams (MDTs). The plan included initiating high-dose antihistamines two weeks before surgery and creating a trigger-free operating room, with considerations like skin preparation solutions less likely to trigger symptoms.
An elective cesarean was scheduled at 38 weeks, but preterm labor at 35 weeks required precautionary hospitalization. The procedure was performed under spinal anesthesia with a regimen of bupivacaine and fentanyl.
“Morphine should be avoided due to the comparatively high amounts of histamine released on administration in comparison to fentanyl or oxycodone,” the authors noted.
During surgery, the only adverse event was transient skin flushing during bowel manipulation, with no cardiovascular or respiratory instability. Postoperatively, the patient was monitored for 48 hours, including 24 hours in a high-dependency unit. No complications were observed, and she was discharged with plans for definitive diagnostic testing.
The authors noted that while many aspects of their approach in this case can be used with other patients, treatment needs differ between patients with SM. “There is no single anesthetic that is optimum for pregnant patients with SM, and each patient should have an individualized plan for anesthetic management following consultation with the multidisciplinary team,” they said.
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