| ROSA MARIA |
| MERCADO BUSTAMANTE |
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| Authorized Medication |
| Anesthesia |
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| General Anesthesia |
| Anesthesia Information for Patients and Doctors: Proposal (The European Competence Network on Mastocytosis, ) to assist physicians and anesthesiologists when performing surgery in patients with mastocytosis. Both regional and general anesthesia can produce life-threatening complications in patients with mastocytosis. The following is a list of recommended maneouvers and perioperative considerations: - Administration of beta-blockers is contraindicated in patients with SMCD who are undergoing surgery because these agents may interfere with endogenous epinephrine and may precipitate anaphylaxis. - Avoid alpha-blockers and cholinergic antagonists. - Perform an intra-dermal skin test of drugs used during anaesthesia before surgery - Give preoperative H1 and H2 antihistamines - Consider preoperative sedation with oral diazepam - Give a pre-operative corticosteroid i.v. - Administer pre-induction with diphenhydramine i.v. - Check continuos perioperative availability of epinephrine infusion and epinephrin bolus (The dose used to manage acute exacerbation of systemic mastocytosis was 1 - )3 mg/kg IV. - Consider isoflurane for induction (including the intubation of the trachea) - Keep temperature in the OP room and at the patient (metals) not too cold - Avoid skin irritation (rubbing etc.). - Avoid upsetting the patient, be calm and quiet. - Be careful with nasal tubes (easy bruising and nose bleeds) - Minimize the number of pharmacological agents - Try to avoid atropine - If muscle relaxing agents are used, don't give them as a bolus - Use a relaxing agent with low potential of histamine liberation (e.g. cis-atracurium or vecuronium) - Do not use pancuronium. - If local anesthesia is needed, use amide-type and not ester-linked, local anesthetics - Avoid the preserving additives methylparaben and para-amino-benzoic acid LITERATURE FOR PERIOPERATIVE CONSIDERATIONS |