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Peer-reviewedCC BYCase reports in anesthesiology

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

  • Peter Francis Gearing1,2
  • Thomas Nack3
  • Dinuk Liyanage3
  • Walston Reginald Martis3,4,5,6
  • Michael Findlay2
6 affiliations
  1. 1Peter MacCallum Department of Oncology The University of Melbourne Melbourne 3010 Victoria Australia unimelb.edu.au.
  2. 2Department of Plastic & Reconstructive Surgery Peter MacCallum Cancer Centre Melbourne 3000 Victoria Australia petermac.org.
  3. 3Department of Anaesthesia Perioperative and Pain Medicine Peter MacCallum Cancer Centre Melbourne 3000 Victoria Australia petermac.org.
  4. 4Department of Anaesthesia Perioperative and Pain Medicine Monash Health Clayton 3168 Victoria Australia monashhealth.org.
  5. 5Department of Critical Care The University of Melbourne Melbourne 3010 Victoria Australia unimelb.edu.au.
  6. 6Department of Surgery Monash University, Clayton Melbourne 3800 Australia.
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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.

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Cite

BibTeXRIS
BibTeX
@article{gearing2026perioperative,
  title = {{Perioperative Management of Coexisting Mast Cell Activation Syndrome and Malignant Hyperthermia Susceptibility: A Case Report and Novel Approach to Local Analgesia.}},
  author = {Peter Francis Gearing and Thomas Nack and Dinuk Liyanage and Walston Reginald Martis and Michael Findlay},
  journal = {Case reports in anesthesiology},
  year = {2026},
  month = oct,
  doi = {10.1155/cria/2750619},
  url = {https://europepmc.org/article/MED/42953382},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Perioperative Management of Coexisting Mast Cell Activation Syndrome and Malignant Hyperthermia Susceptibility: A Case Report and Novel Approach to Local Analgesia.
AU  - Peter Francis Gearing
AU  - Thomas Nack
AU  - Dinuk Liyanage
AU  - Walston Reginald Martis
AU  - Michael Findlay
PY  - 2026
DA  - 2026/10/27
JO  - Case reports in anesthesiology
DO  - 10.1155/cria/2750619
UR  - https://europepmc.org/article/MED/42953382
AB  - 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.
SN  - 2090-6382
SN  - 2090-6390
ER  -