Work

Perioperative Management of Coexisting Mast Cell Activation Syndrome and Malignant Hyperthermia Susceptibility: A Case Report and Novel Approach to Local Analgesia

Year: 2026

Type: article

Abstract: The coexistence of mast cell activation syndrome (MCAS) and malignant hyperthermia (MH) presents a significant perioperative challenge due to combined risks of anaphylaxis and anaesthesia-related hypermetabolic crisis. We describe the successful anaesthetic management of a man in his 60 s with confirmed MCAS and a strong family history of MH who underwent excision of multiple malignant cutaneous lesions. A structured perioperative strategy incorporating immunological optimisation with omalizumab, strict trigger avoidance, dexmedetomidine and remifentanil procedural sedation, prophylactic corticosteroids and a controlled low-dose adrenaline infusion enabled safe completion of surgery without complication. In the absence of tolerated local anaesthetic agents, dilute adrenaline infiltration was used as an adjunct to improve procedural tolerability. This case highlights the importance of multidisciplinary planning and individualised perioperative strategy in patients with high-risk perioperative profiles.

Source: Case Reports in Anesthesiology

DOI: 10.1155/cria/2750619

Authors: Peter Francis Gearing, Thomas Nack, Dinuk Liyanage, Walston Reginald Martis, Michael Findlay

Institutions: The University of Melbourne, Peter MacCallum Cancer Centre, Monash Medical Centre, Monash Health, Monash University

Language: English

Topic: Anesthesia and Sedative Agents

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $790