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

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.