Anesthetic management of a labouring parturient with urticaria pigmentosa.
OBJECTIVE
To report the anesthetic management of labour pain and Cesarean section in a patient with urticaria pigmentosa at risk for systemic mastocytosis. CLINICAL: A 37-yr-old patient with a history of urticaria pigmentosa and an allergic reaction to a local anesthetic agent was seen in consultation at 36 weeks gestation. She previously tested negative for an allergy test to lidocaine. Recommendations to avoid systemic mastocytosis included: avoidance of histamine-releasing drugs, using lidocaine for labour epidural, and regional anesthesia in case of a Cesarean section. The patient presented at term in labour. Intravenous fentanyl was used for early labour, followed by a combined spinal-epidural. The spinal contained lidocaine and fentanyl, but because of pruritus, the epidural infusion contained lidocaine only. Most likely because of tachyphylaxis to lidocaine, an epidural bolus of lidocaine with epinephrine failed to provide adequate anesthesia for a Cesarean section. The block was supplemented with nitrous oxide by mask, with fentanyl postdelivery. Postoperative pain control was managed with an epidural infusion of lidocaine and fentanyl for three days. The patient was discharged without complications four days postsurgery.


CONCLUSIONS
Proper allergy testing prior to pregnancy is important to help the management of labour pain and anesthesia for Cesarean section in a patient at risk for systemic mastocytosis.
Centre Universitaire de Santé de l'Estrie, Sherbrooke University.
Valérie
V
Villeneuve
Ian
I
Kaufman
Sally
S
Weeks
Alain
A
Deschamps
D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000009:adverse effects / Q000627:therapeutic use; D002585:Cesarean Section; D004342:Drug Hypersensitivity / Q000150:complications; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007743:Labor, Obstetric; D008012:Lidocaine / Q000627:therapeutic use; D010146:Pain / Q000517:prevention & control; D036801:Parturition; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D014582:Urticaria Pigmentosa / Q000150:complications*
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008012:Lidocaine; D005283:Fentanyl