Researchers described the case study of a patient with systemic mastocytosis (SM) who was administered anesthesia for a cesarean section birth delivery and published their results in the International Journal of Obstetric Anesthesia. 

The case study as presented by Alex and colleagues from the George Eliot Hospital NHS Trust in Nuneaton, England was about a 37-year-old female patient who was diagnosed with SM upon immunology and bone marrow examination. The G2P1 patient was about to give birth and was admitted to the obstetric department for an elective cesarean section.

Anesthesiologists previously determined that she was a suitable candidate for central neuraxial anesthesia. In the operation theatre, she received a combined spinal-epidural with intrathecal injection of fentanyl 20 μg and hyperbaric bupivacaine 11 mg. The woman was well throughout the administration of anesthesia and the surgical procedure. 

Read more about the SM care team

Postoperatively, her pain relief was managed by bilateral transversus abdominis block with ropivacaine, as well as regular antipain medications such as oral ibuprofen and paracetamol. She was monitored in the labor ward for a day and discharged the day after. 

SM can cause severe allergy-like symptoms that can be triggered by factors such as stress, exercise, drugs, or environmental temperature. Hence, anesthesiologists need to be careful to avoid these triggers if anesthesia needs to be administered, the researchers said.

In addition, the use of nonhistamine-releasing drugs is advisable, meaning that drugs such as morphine and codeine should be avoided. Postoperatively, the researchers recommend physicians watch out for signs of delayed reactions.


Alex J, Abraham N, Ravindran M, Dasgupta K. Anaesthesia for caesarean section in a parturient with systemic mastocytosis. Int J Obstet Anesth. Published online May 3, 2022. doi:10.1016/j.ijoa.2022.103471