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International Journal of Anesthesia and Critical Care

ISSN: 2834-2887

Case Report Open Access

Anesthesia in a Patient with Ehlers-Danlos Syndrome and Mast Cell Activation Syndrome—Case Report

Carlos Henrique Viana de Castro1, Fábio Fantazzini Vieira1,*, Felipe Cruz Jorge1, Marcelo Figueiredo1, Marco Túlio Froes2
  • 1Department of Anesthesiology, Hospital Lifecenter de Belo Horizonte, Belo Horizonte, MG, Brazil
  • 2Department of Plastic Surgery, Hospital Lifecenter de Belo Horizonte, Belo Horizonte, MG, Brazil
+ Affiliations - Affiliations

Corresponding Author

Fábio Fantazzini Vieira, fabiofantazzinivieira@gmail.com

Received Date: November 16, 2025

Accepted Date: January 23, 2026

Citation:

Viana de Castro CH, Vieira FF, Jorge FC, Froes MT, Figueiredo M. Anesthesia in a Patient with Ehlers-Danlos Syndrome and Mast Cell Activation Syndrome—Case Report. Int J Anaesth Crit Care. 2026;5(1):1–4.


Copyright: © 2026 Viana de Castro CH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

The concurrent presentation of Hypermobile Ehlers-Danlos Syndrome (hEDS) and Mast Cell Activation Syndrome (MCAS) poses significant anesthetic challenges, balancing the risks of tissue fragility and autonomic dysfunction with potential anaphylaxis. We report the anesthetic management of a female patient with confirmed hEDS and MCAS undergoing mastopexy. Preoperative planning focused on immune stabilization and mechanical protection. Balanced general anesthesia was maintained with Sevofluorane and Propofol to avoid histamine-releasing agents. To minimize neuraxial risks associated with connective tissue laxity, multimodal analgesia was achieved via an ultrasound-guided intercostal nerve block. The procedure was completed successfully without anaphylactic, hemorrhagic, or positioning-related complications. This case highlights the importance of a trigger-free anesthetic technique, the utility of peripheral nerve blocks as an alternative to neuraxial anesthesia in hEDS, and the adaptability required in prophylactic protocols.

Keywords

Ehlers-Danlos syndrome, Mast cell activation syndrome, Anesthesia, Perioperative management

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