Patient 1
A 34-year-old female (height, 164 cm; weight, 45 kg) was scheduled for a right-side thyroidectomy. She had a history of allergic rhinitis. At 27 years old, anaphylaxis (dyspnea, hives on the body trunk, and loss of consciousness) after exercise in a bathroom had occurred. She was then diagnosed as having cholinergic urticaria based on her history of repeated hives following exercise, sunbathing, mental stresses, and the consumption of spicy foods. Her daily medications were loratadine 20 mg and bilastine 20 mg, and she sometimes used prednisolone 5 mg or d-chlorpheniramine maleate 4 mg as a rescue. Her preoperative white blood cell count was 4900/mm3, and the portion of eosinophils was 10%.
The patient’s daily medications were taken on the operative day, and her preoperative axillary body temperature was 36.7 ℃. General anesthesia was induced with 90 mg propofol, 0.25 μg/kg/min remifentanil, 200 μg fentanyl, and 40 mg rocuronium. General anesthesia was maintained with 5.0 mg/kg/h propofol and 0.2–0.3 μg/kg/min remifentanil. For antiemesis, 6.6 mg dexamethasone and 4 mg ondansetron were given, and 350 μg fentanyl, 800 mg acetaminophen, and 50 mg flurbiprofen were administered for multimodal analgesia.
The patient’s intraoperative body temperature was continuously measured by a rectal thermometer, and it ranged from 37.2° to 37.4 ℃. The surgical data were as follows: surgical duration, 95 min; anesthesia time, 131 min; blood loss, 21 g; urine output, a small amount, total infusion volume, 900 mL. The postoperative axillary body temperature measured periodically during the patient’s hospitalization ranged from 36.5° to 36.9 ℃, and perioperative cholinergic urticaria was not observed.
Patient 2
A 35-year-old female (height, 153 cm; weight, 50 kg) was scheduled for a laparoscopic ovarian cystectomy. She had a history of atopic dermatitis and cold-induced urticaria. At 19 years old, anaphylaxis (vomiting, coughing, hives on the body trunk, and edema of lips and eye lids) after long-time bathing had occurred. She was then diagnosed with cholinergic urticaria based on her history of repeated hives following hot showers, bicycle riding, and long walks. Her daily medications were levocetirizine 5 mg, cimetidine 400 mg, d-chlorpheniramine maleate 6 mg, and suplatast tosilate 200 mg. Her preoperative white blood cell count was 5000/mm3, and the portion of eosinophils was 4.8%.
The patient’s daily medications were taken on the operative day, and her preoperative axillary body temperature was 36.5 ℃. General anesthesia was induced with 7.0 μg/mL propofol (target controlled infusion; TCI), 0.25 μg/kg/min remifentanil, 100 μg fentanyl, and 35 mg rocuronium. General anesthesia was maintained with 2.7–4.0 μg/mL propofol (TCI) and 0.15–0.25 μg/kg/min remifentanil. For antiemesis, 4 mg ondansetron was given. The administration of 300 μg fentanyl and 1000 mg acetaminophen and rectus sheath block were done for multimodal analgesia.
The patient’s intraoperative body temperature was continuously measured by a nasopharyngeal thermometer, and it ranged from 36.1° to 36.5 ℃. The surgical data were as follows: surgical duration, 164 min; anesthesia time, 234 min; blood loss, a slight amount; urine output, 500 mL, total infusion volume, 1000 mL. The postoperative axillary body temperature measured periodically during the patient’s hospitalization ranged from 36.2° to 37.3 ℃, and perioperative cholinergic urticaria was not observed.