Anesthesia in patients with multiple chemical sensitivity: current understanding
1Department of MeSVA, University of L’Aquila-San Salvatore Teaching Hospital of L’Aquila, 67100 L’Aquila, Italy
2Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, 67100 L’Aquila, Italy
DOI: 10.22514/sv.2023.096 Vol.19,Issue 6,November 2023 pp.24-29
Submitted: 11 April 2023 Accepted: 19 May 2023
Published: 08 November 2023
Multiple Chemical Sensitivity (MCS) is a pathological condition that we do not yet have a clear understanding of from an etiological and clinical point of view. The underlying mechanisms of the disorder are still being investigated and the most frequently reported symptoms by patients are malaise, fatigue, headache, arthralgia, insomnia and dermatitis. Although this condition may entail a real risk of the occurrence of adverse reactions following exposure to many substances, often inhaled, or the taking of drugs, medical/scientific literature provides only a little information regarding the safest course of action to be taken when patients affected by MCS need to undergo anesthesia. It is for this reason that an electronic search of existing literature has been made, using PubMed and Scopus as a primary source, in order to find articles about patients affected by MCS and who have undergone anesthesia. The time frame considered was January 2000–December 2022. The research showed only 13 articles that dealt with anesthesia in patients with multiple chemical sensitivity in the years in question. Only 6 works, all case reports, describe the drugs used to perform anesthesia. Five cases were for general anesthesia and one was a case of subarachnoid block. No major complications related to anesthesiological practice were reported in any of the cases. The limited data does not enable the identification of anesthesiological practice and anesthetic drugs that can be used more safely in MCS patients, but the absence of serious adverse reactions in the case reports described, and in the literature in general, is reasonably reassuring about the possibility of anesthesia in MCS patients without causing serious complications by implementing easily achievable measures.
Anesthesia; Idiopathic environmental intolerance; Multiple chemical sensitivities
Alba Piroli,Alessandra Ciccozzi,Antonella Paladini,Ida Marsili,Emiliano Petrucci,Franco Marinangeli. Anesthesia in patients with multiple chemical sensitivity: current understanding. Signa Vitae. 2023. 19(6);24-29.
 Cullen MR. The worker with multiple chemical sensitivities: an overview. Occupational Medicine. 1987; 2: 655–661.
 Damiani G, Alessandrini M, Caccamo D, Cormano A, Guzzi G, Mazzatenta A, et al. Italian expert consensus on clinical and therapeutic management of multiple chemical sensitivity (MCS). International Journal of Environmental Research and Public Health. 2021; 18: 11294.
 Hausteiner C, Bornschein S, Hansen J, Zilker T, Förstl H. Self-reported chemical sensitivity in Germany: a population-based survey. International Journal of Hygiene and Environmental Health. 2005; 208: 271–278.
 Pigatto PD, Guzzi G. Prevalence and risk factors for multiple chemical sensitivity in Australia. Preventive Medicine Reports. 2019; 14: 100856.
 Caress SM, Steinemann AC. A review of a two-phase population study of multiple chemical sensitivities. Environmental Health Perspectives. 2003; 111: 1490–1497.
 Gibson PR, Kovach S, Lupfer A. Unmet health care needs for persons with environmental sensitivity. Journal of Multidisciplinary Healthcare. 2015; 8: 59–66.
 Davidoff AL, Fogarty L. Psychogenic origins of multiple chemical sensitivities syndrome: a critical review of the research literature. Archives of Environmental Health. 1994; 49: 316–325.
 Davidoff AL, Keyl PM. Symptoms and health status in individuals with multiple chemical sensitivities syndrome from four reported sensitizing exposures and a general population comparison group. Archives of Environmental Health. 1996; 51: 201–213.
 Orriols R, Costa R, Cuberas G, Jacas C, Castell J, Sunyer J. Brain dysfunction in multiple chemical sensitivity. Journal of the Neurological Sciences. 2009; 287: 72–78.
 Kipen HM, Fiedler N. Environmental factors in medically unexplained symptoms and related syndromes: the evidence and the challenge. Environmental Health Perspectives. 2002; 110: 597–599.
 Pall ML. Elevated nitric oxide/peroxynitrite theory of multiple chemical sensitivity: central role of N-methyl-D-aspartate receptors in the sensitivity mechanism. Environmental Health Perspectives. 2003; 111: 1461–1464.
 Rea WJ. A large case-series of successful treatment of patients exposed to mold and mycotoxin. Clinical Therapeutics. 2018; 40: 889–893.
 Belpomme D, Irigaray P. Electrohypersensitivity as a newly identified and characterized neurologic pathological disorder: how to diagnose, treat, and prevent. International Journal of Molecular Sciences. 2020; 21: 1915.
 Molot J, Sears M, Marshall LM, Bray RI. Neurological susceptibility to environmental exposures: pathophysiological mechanisms in neurodegeneration and multiple chemical sensitivity. Reviews on Environmental Health. 2022; 37: 509–530.
 Baldwin CM, Bell IR. Increased cardiopulmonary disease risk in a community-based sample with chemical odor intolerance: implications for women’s health and health-care utilization. Archives of Environmental Health. 1998; 53: 347–353.
 Elberling J, Lerbaek A, Kyvik KO, Hjelmborg J. A twin study of perfume-related respiratory symptoms. International Journal of Hygiene and Environmental Health. 2009; 212: 670–678.
 Driesen L, Patton R, John M. The impact of multiple chemical sensitivity on people’s social and occupational functioning; a systematic review of qualitative research studies. Journal of Psychosomatic Research. 2020; 132: 109964.
 Fares-Medina S, Díaz-Caro I, García-Montes R, Corral-Liria I, García-Gómez-Heras S. Multiple chemical sensitivity syndrome: first symptoms and evolution of the clinical picture: case-control study/epidemiological case-control study. International Journal of Environmental Research and Public Health. 2022; 19: 15891.
 Caress SM, Steinemann AC. National prevalence of asthma and chemical hypersensitivity: an examination of potential overlap. Journal of Occupational and Environmental Medicine. 2005; 47: 518–522.
 Piroli A, Ciccozzi A, Petrucci E, Paladini A, Marsili I, Panella L, et al. Anaesthesia management in patients with multiple chemical sensitivity syndrome. International Journal of Immunopathology and Pharmacology. 2013; 26: 961–964.
 Sato Boku A, Furuno S, Kamimura Y, Sento Y, Kako E, Okuda M, et al. General anesthetic management of a patient with multiple chemical sensitivity for oral surgery: a case report. JA Clinical Reports. 2019; 5: 10.
 Maberly J, Anthony H. Multiple chemical sensitivity: phased initiation by anaesthetics and a new building. Journal of Nutritional & Environmental Medicine. 2000; 10: 297–304.
 Stoppe C, Cremer J, Rex S, Schälte G, Fahlenkamp AV, Rossaint R, et al. Xenon anaesthesia for laparoscopic cholecystectomy in a patient with multiple chemical sensitivity. British Journal of Anaesthesia. 2011; 107: 645–647.
 Facco E, Pasquali S, Zanette G, Casiglia E. Hypnosis as sole anaesthesia for skin tumour removal in a patient with multiple chemical sensitivity. Anaesthesia. 2013; 68: 961–965.
 Lorenzo López M, Hernández Martín D, Ortega Ladrón de Cegama E, Aldecoa Álvarez-Santullano C. Elective cesarean section in a patient with multiple chemical sensitivity syndrome. Revista Española de Anestesiología y Reanimación. 2014; 61: 118. (In Spanish)
 Fernández Martín MT, Álvarez López JC. Sevoflurane anaesthesia for nasal surgery in a patient with multiple chemical sensitivity. Spanish Journal of Anethesiology and Resuscitation. 2018; 65: 49–52.
 Esnaola Iriarte B, Irigoyen Miró S, Torre Mollinedo F. Anesthetic management of hysterectomy and double annexectomy for borderline left ovarian tumor in a patient with MCS syndrome. Revista de la Sociedad Española de Dolor. 2019; 26: 243–246. (In Spanish)
 Cozzolino M, Celia G, Rossi KL, Rossi EL. Hypnosis as sole anesthesia for dental removal in a patient with multiple chemical sensitivity. The International Journal of Clinical and Experimental Hypnosis. 2020; 68: 371–383.
 Pullman M, Andrzejowski J. Comfortably numb. Anaesthesia. 2013; 68: 896–898.
 Castelnuovo G. Good communication and outcome after anaesthesia. Anaesthesia. 2013; 68: 1203–1204.
 Fisher MM, Rose M. Anaesthesia for patients with idiopathic environmental intolerance and chronic fatigue syndrome. British Journal of Anaesthesia. 2008; 101: 486–491.
 Del Casale A, Ferracuti S, Mosca A, Pomes LM, Fiaschè F, Bonanni L, et al. Multiple chemical sensitivity syndrome: a principal component analysis of symptoms. International Journal of Environmental Research and Public Health. 2020; 17: 6551.
 Zucco GM, Doty RL. Multiple chemical sensitivity. Brain Sciences. 2022; 12: 46.
 Cooper C. Multiple chemical sensitivity in the clinical setting. The American Journal of Nursing. 2007; 107: 40–47.
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