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Guidelines for safe surgery in patients with systemic mastocytosis
Cassius I Ochoa Chaar1, Robert L Bell, Thomas P Duffy
1Department of Surgery, Section of Hematology, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
The American Surgeon
|February 14, 2009
Summary
Systemic mastocytosis (SM) requires careful perioperative management. Patients with SM can safely undergo surgical procedures, including hernia repair, with appropriate precautions to minimize exacerbations.
Area of Science:
- Anesthesiology
- Hematology
Background:
- Systemic mastocytosis (SM) is a rare disorder with significant perioperative risks.
- Anesthetic and analgesic agents can trigger acute SM exacerbations.
Observation:
- Two cases of systemic mastocytosis undergoing hernia repair (open and laparoscopic) are presented.
- Preoperative antihistamines and steroids were administered to both patients.
- One patient experienced a rash post-neostigmine/glycopyrrolate administration but remained hemodynamically stable.
Findings:
- Both patients underwent successful surgical procedures (inguinal, umbilical, and ventral hernia repairs) under spinal and general anesthesia.
- The patient who developed a rash was managed with intravenous corticosteroids and antihistamines.
- Postoperative courses for both patients were unremarkable.
Implications:
- Careful perioperative management is crucial for patients with systemic mastocytosis.
- Surgical procedures, including hernia repairs, can be performed safely in SM patients.
- Adherence to specific anesthetic and medication guidelines can prevent severe perioperative complications.
