Pediatric Mastocytosis: Routine Anesthetic Management for a Complex Disease
Year: 2008
Type: article
Study design: Observational Study
Abstract: In Brief BACKGROUND: Pediatric mastocytosis consists of a spectrum of clinical variants characterized by increased numbers of resident mast cells in various organ systems. Mast cells are instrumental in mediating anaphylaxis and patients with mastocytosis are at risk to develop provoked and unprovoked episodes of anaphylaxis. METHODS: We examined perianesthetic records of patients with pediatric mastocytosis who were anesthetized for diagnostic and surgical procedures from 1993 to 2006. In addition, we conducted a literature review of the anesthetic experience in pediatric mastocytosis. RESULTS: Twenty-two patients with pediatric mastocytosis, with a median age of 3.2 yr (range, 6 mo–20 yr) at the time of the procedure, were anesthetized for 29 diagnostic and surgical procedures. All variants of the disease are represented in this series. Most patients had a history of flushing, pruritus, gastro-esophageal reflux diseases, and abdominal pain; one patient had a history of spontaneous anaphylaxis. Routine anesthetic techniques were used and, despite the complexity of the disease, the perioperative courses were uncomplicated and without serious adverse events. CONCLUSIONS: We reviewed the main features of pediatric mastocytosis, its anesthetic and perioperative implications, and describe a practical approach to the anesthetic management of pediatric patients with the disease. Although many drugs used routinely in anesthesia reportedly caused mast cell degranulation, deviations from routine anesthesia techniques are not necessarily warranted. However, an understanding of the anesthetic implications of the disease and meticulous preparation to treat possible adverse events are advised. IMPLICATIONS: Pediatric mastocytosis is characterized by a spectrum of clinical variants which have in common an increase in mast cells in various organ systems and that can be associated with unprovoked anaphylaxis. Given the complex nature of the disease, understanding the pathophysiology is important for the management of patients with pediatric mastocytosis. This article suggests that commonly administered anesthetics may be used for patients with pediatric mastocytosis.
Source: Anesthesia & Analgesia
Authors: Melody C. Carter, Ashraf Uzzaman, Linda M. Scott, Dean D. Metcalfe, Zenaide Quezado
Language: English
Topic: Mast cells and histamine
Subfield: Immunology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W1985898421