C 3, 4 and 5, keep the diaphragm alive

Case Report: Perioperative immediate hypersensitivity involves not only allergy but also mastocytosis

“…The figure shows the lateral aspect of the patient's right thigh usually contraindicated, although this drug has been used uneventfully in patients with mastocytosis. 12,17,20 In our patient, morphine was administered without adverse effects. Additionally, we find no reason to contraindicate steroid-based NMBDs as well as succinylcholine or cisatracurium, hypnotics, morphinomimetics, and/or local anesthetics, since these drugs have been administered uneventfully in patients with mastocytosis.…”

“…11 Perioperative immediate reactions have been reported to occur in patients either with cutaneous 12,13 or with systemic mastocytosis. [14][15][16][17][18] Mast cells are localized predominantly around blood vessels, and they preferentially populate tissues in contact with the external environment, including the skin and the gastrointestinal and respiratory tracts. 19 The severity of clinical expression, however, is related to the cardiovascular homeostasis disturbances, as profound vasodilatation following mast cell degranulation with subsequent histamine release may, at the extreme, result in life-threatening conditions.…”

“…8 Among the different perioperative cases reported, [12][13][14]16,17 only two authors performed skin tests, the results of which remained negative to the suspected agents, i.e., anesthetic 17 or antibiotic. 18 Russell et al 17 reported a patient with systemic mastocytosis experiencing cardiac arrest after combined spinal and general anesthesia, and in whom cardiac arrest was attributed to the hemodynamic effects of spinal anesthesia. Lastly, the diagnosis of systemic mastocytosis remains doubtful in the case reported by Goldfinger et al, 18 as both the bone marrow aspirate and the bone biopsy revealed normal cellularity.…”