Anesthetic Management of a Patient With Mast Cell Activation Syndrome: A Case Study.

Mast cell activation syndrome (MCAS) is a relatively new diagnosis for a constellation of symptoms with sometimes devastating results for patients. A 40-year old woman with MCAS underwent arthroscopic repair of her right shoulder, with successful anesthetic management. This case report discusses the basic immunologic physiology surrounding this syndrome, myriad medications often used by this patient population, and the anesthetic management of this patient.

Impact of goal-directed perioperative fluid management in high-risk surgical procedures: a literature review.

Guidelines for the perioperative administration of fluid are often based on static hemodynamic targets such as central venous pressure, and delayed volume status indexes such as blood pressure, heart rate, capillary refill, and urine output. Traditional fluid management protocols also rely heavily on algorithmic estimates of fluid deficit, intravascular fluid volume status, fluid loss, and basal fluid requirements to guide perioperative fluid administration. Such formulaic approaches lack definitive physiologic endpoints for determining fluid optimization and fail to address the roles of tissue oxygenation and end-organ perfusion in achieving positive long-term patient outcomes.