General Anesthesia in a Patient With Urticaria Pigmentosa Referred for Electroconvulsive Therapy

Abstract

Urticaria pigmentosa is a rare disorder characterized by an abnormal systemic proliferation of mast cells. In this condition, various triggers can induce either cutaneous histamine release, resulting in rash, or generalized histamine release, resulting in symptomatic hypotension, syncope, or in its severest form, an anaphylactoid reaction resistant to most resuscitative measures. Many anesthetic agents and adjuncts are known potential triggers, and patients who require surgery or procedures under anesthesia must be managed carefully. In this review, we describe the safe use of general anesthesia for electroconvulsive therapy in a patient with urticaria pigmentosa and discuss the association between psychiatric disorders and mastocytoses.

Sugammadex in systemic mastocytosis

“…In 4 case reports of patients with systemic mastocytosis the use of sugammadex is reported [ 8 – 11 ]. Two articles justify not using of sugammadex due to its unavailability [ 12 , 13 ]. In another article, sugammadex is proposed as an acceptable option in pregnant women with mastocytosis, although in the reported case neuraxial anesthesia was used [ 14 ].…”

“…(2017) [ 12 ] Used Not available No Case report: electroconvulsive therapy Aloysi et al. (2016) [ 13 ] Acceptable alternative (not used) Not available No Case report: electroconvulsive therapy Kumaraswami et al. (2018) [ 14 ] Acceptable (not used) Acceptable (not used) No Case report: vaginal delivery with neuraxial analgesia in mast cell activation syndrome …”