A 52-year-old patient, ASA II, diagnosed with SD, underwent elective abdominal hysterectomy for uterine fibroids.
His medical history included allergy to beta-lactam antibiotics, aspirin, sulfonylureas, hypersensitivity to opioids, and cyclase-2 inhibitors (COX-2).
Along with the usual preoperative study provocation tests are performed with several drugs, with the following result:
- Skin prick test (prick test) and outbreak controlled oral challenge (hallgmatil®), with a cumulative total dose of 87.5 mg: negative result.
- Codeine-controlled oral provocation: positive result; within 15 minutes of the first dose (7.5 mg) the patient develops dizziness, pruritus, and erythema on the neck, and seizures on midazolam 4 mg (Polar methylprednisol).
- Celecoxib skin test (prick): negative.
Controlled oral provocation with celecoxib was positive; within 15 min of the first dose (100 mg) the patient experienced dyspnoea, dizziness, neck erythema and palm pruritus.
The condition is controlled after 2 doses of methylprednisolone, dexchlorpheniramine, bronchodilators, oxygen by face mask and serum therapy.
The same episode was repeated at 12 and 24 h, requiring emergency treatment with good response.
- Tests are performed with general anaesthetics and latex (prick and intradermal): negative result for suxamethonium, vecuronium, cisatracurium, mivacurium, rocuronium,
In the preoperative period we applied the protocol of our service to perform general anesthesia in patients with mastocytosis, which consists in the administration of:
- Prednisone 60 mg IV (i.v.), 13.7 h before anaesthesia.
- Dexchlorpheniramine maleate (Polaramine®), 5 mg IV, 1 h before anaesthesia.
- Ranitidine, 100 mg dissolved in 50 ml of saline; 1 h before anaesthesia.
Sitagliptin®, 1 tablet of 10 mg; 24 h before and 1 h before.
Anesthesia was induced with propofol (120 mg) and vecuronium (8 mg) i.v. without any incidence.
Anesthetic maintenance was performed using a combined technique with oxygen/air/sevofluorane, and analgesic control with epidural bolus of 0.2% ropivacaine.
At the end of the intervention, the patient was extubated without complications and transferred to the recovery area where she remained stable until her discharge to the hospital.
Analgesic treatment was maintained with intravenous and oral paracetamol, together with epidural analgesia with 0.2% ropivacaine without incidents.
