Perioperative management of patients with indolent systemic mastocytosis (adapted from published reviews52,56 )
| Principle . | Timing . | Specific measure . |
|---|---|---|
| Multidisciplinary (anesthesia/hematology/allergy) preoperative evaluation | 2 wk prior to surgery | Review strategies for avoidance of potential/known provocative factors (eg, extremes of temperature, pressure, friction) during surgery |
| Decide on anesthetic/analgesic medications: | ||
| 1. Review prior drug exposure history and anesthesia records for information on drug tolerability | ||
| 2. Lower-risk agents (preferred): inhalant anesthetic agents (fluranes), fentanyl, propofol, etomidate, ketamine, midazolam, cis-atracurium, pancuronium, vecuronium | ||
| 3. Higher-risk agents (avoid): morphine, codeine, thiopental, succinylcholine, mivacurium, rocuronium, atracurium, NSAIDS | ||
| Consider usefulness of skin/other allergy testing for selecting anesthetic and analgesic agents | ||
| Maintaining baseline symptom control | Morning of surgery and postoperatively | Continue daily antimediator treatment regimen if feasible |
| Premedications | 8 to 12 h and 1 h prior to surgery | Diphenhydramine, 25-50 mg PO/IV Ranitidine, 150 mg PO or 50 mg IV Montelukast, 10 mg PO (optional) Prednisone, 60 mg (for higher-risk cases) |
| Anaphylaxis treatment | Intra- and postoperatively | Ensure preparedness to treat anaphylaxis at any time (eg, epinephrine, IV corticosteroids) |
| Monitoring for breakthrough mast cell degranulation symptoms (including hypotension, bleeding) | 24-72 h postoperatively | Administer additional antihistamine agents and/or corticosteroids as needed |
| Principle . | Timing . | Specific measure . |
|---|---|---|
| Multidisciplinary (anesthesia/hematology/allergy) preoperative evaluation | 2 wk prior to surgery | Review strategies for avoidance of potential/known provocative factors (eg, extremes of temperature, pressure, friction) during surgery |
| Decide on anesthetic/analgesic medications: | ||
| 1. Review prior drug exposure history and anesthesia records for information on drug tolerability | ||
| 2. Lower-risk agents (preferred): inhalant anesthetic agents (fluranes), fentanyl, propofol, etomidate, ketamine, midazolam, cis-atracurium, pancuronium, vecuronium | ||
| 3. Higher-risk agents (avoid): morphine, codeine, thiopental, succinylcholine, mivacurium, rocuronium, atracurium, NSAIDS | ||
| Consider usefulness of skin/other allergy testing for selecting anesthetic and analgesic agents | ||
| Maintaining baseline symptom control | Morning of surgery and postoperatively | Continue daily antimediator treatment regimen if feasible |
| Premedications | 8 to 12 h and 1 h prior to surgery | Diphenhydramine, 25-50 mg PO/IV Ranitidine, 150 mg PO or 50 mg IV Montelukast, 10 mg PO (optional) Prednisone, 60 mg (for higher-risk cases) |
| Anaphylaxis treatment | Intra- and postoperatively | Ensure preparedness to treat anaphylaxis at any time (eg, epinephrine, IV corticosteroids) |
| Monitoring for breakthrough mast cell degranulation symptoms (including hypotension, bleeding) | 24-72 h postoperatively | Administer additional antihistamine agents and/or corticosteroids as needed |
NSAIDS, nonsteroidal anti-inflammatory drug; PO, by mouth; and IV intravenously.