{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:11:19Z","timestamp":1777867879558,"version":"3.51.4"},"reference-count":56,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Eosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg\u2013Strauss syndrome, is a rare necrotizing vasculitis characterized by asthma, eosinophilia, and systemic granulomatosis vasculitis. Perioperative risk is primarily driven by airway hyperreactivity, potential cardiac disease, chronic immunosuppressive therapy, and reported alterations in plasma cholinesterase activity. Evidence specifically addressing anesthetic management remains scarce and largely limited to case-based reports. Methods: A focused narrative review was conducted by searching MEDLINE (via PubMed), Scopus, and Embase from inception to January 2026 for publications reporting perioperative anesthetic management in patients with EGPA\/Churg\u2013Strauss syndrome. Case reports and case-based descriptions providing explicit anesthetic details were qualitatively synthesized. Results: Available evidence consists predominantly of isolated case reports across heterogeneous surgical settings, including ENT, abdominal, orthopedic, ambulatory, pediatric, and rare cardiac procedures. Recurring perioperative principles include optimization of bronchial disease and continuation of inhaled therapy; minimization of airway stimulation and avoidance of histamine-releasing drugs; selection of induction agents preserving hemodynamic stability in the presence of myocardial involvement; preference for non-depolarizing neuromuscular blockade with quantitative monitoring (and consideration for sugammadex when appropriate); individualized corticosteroid management and multimodal, opioid-sparing analgesia, often supported by regional techniques. Conclusions: In the absence of dedicated perioperative guidelines, anesthetic care for EGPA should be individualized based on clinical phenotype and organ involvement. A structured approach targeting airway protection, cardiovascular stability, safe neuromuscular management, and opioid-sparing analgesia may represent a pragmatic risk-mitigation framework. These considerations are illustrated by an institutional experience in mitral valve surgery.<\/jats:p>","DOI":"10.3390\/jpm16050241","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T10:47:28Z","timestamp":1777546048000},"page":"241","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anesthetic Management of Eosinophilic Granulomatosis with Polyangiitis: A Narrative Review with an Illustrative Case in Cardiac Surgery"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5046-4275","authenticated-orcid":false,"given":"Debora Emanuela","family":"Torre","sequence":"first","affiliation":[{"name":"Department of Cardiac Anesthesia and Intensive Care Unit, Cardiac Surgery, Ospedale dell\u2019Angelo, Mestre, 30174 Venice, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-6549","authenticated-orcid":false,"given":"Carmelo","family":"Pirri","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"iii84","DOI":"10.1093\/rheumatology\/kez570","article-title":"Eosinophilic granulomatosis with polyangiitis: Understanding the disease and its management","volume":"59","author":"Trivioli","year":"2020","journal-title":"Rheumatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"103219","DOI":"10.1016\/j.autrev.2022.103219","article-title":"Eosinophilic granulomatosis with polyangiitis: A review","volume":"22","author":"White","year":"2023","journal-title":"Autoimmun. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1038\/s41584-023-00958-w","article-title":"Evidence-Based Guideline for the diagnosis and management of eosinophilic granulomatosis with polyangiitis","volume":"19","author":"Emmi","year":"2023","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.rdc.2023.03.006","article-title":"Therapeutic Advances in Eosinophilic Granulomatosis with Polyangiitis","volume":"49","author":"Bloom","year":"2023","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"49","DOI":"10.4097\/kjae.2010.59.1.49","article-title":"A patient with Churg-Strauss syndrome who underwent endoscopic sinus surgery under general anesthesia\u2014A case report","volume":"59","author":"Im","year":"2010","journal-title":"Korean J. Anesthesiol."},{"key":"ref_6","first-page":"364","article-title":"Update on Asthma Management Guidelines","volume":"121","author":"Dubin","year":"2024","journal-title":"Mo. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1007\/s12630-013-9968-9","article-title":"Unrecognized tamponade diagnosed pre-induction by focused echocardiography","volume":"60","author":"Gerlach","year":"2013","journal-title":"Can. J. Anaesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1111\/j.1365-2044.1990.tb14390.x","article-title":"Cholinesterase deficiency and the Churg-Strauss syndrome","volume":"45","author":"Taylor","year":"1990","journal-title":"Anaesthesia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1017\/S0265021506241395","article-title":"A case of Churg-Strauss syndrome undergoing radical mastectomy under general anaesthesia and thoracic epidural analgesia","volume":"23","author":"Gurjar","year":"2006","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"749","DOI":"10.4097\/kjae.2009.57.6.749","article-title":"Cholecystectomy of a patient with Churg-Strauss syndrome: A case report","volume":"57","author":"Chung","year":"2009","journal-title":"Korean J. Anesthesiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"400","DOI":"10.4103\/ija.IJA_19_18","article-title":"Anaesthetic management and the role of sugammadex in a patient with Churg-Strauss syndrome","volume":"62","author":"Chia","year":"2018","journal-title":"Indian J. Anaesth."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e239052","DOI":"10.1136\/bcr-2020-239052","article-title":"Anaesthetic management of a patient with eosinophilic granulomatosis with polyangiitis for internal fixation of a fractured femur","volume":"14","author":"Mohamed","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2058738420980260","DOI":"10.1177\/2058738420980260","article-title":"Severe anaphylactic shock after anesthesia induction: An unusual initial manifestation of Churg-Strauss syndrome","volume":"34","author":"Melemeni","year":"2020","journal-title":"Int. J. Immunopathol. Pharmacol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.redar.2022.03.006","article-title":"Anesthesia management in a patient with Churg-Strauss syndrome in the ambulatory setting: A case report","volume":"70","author":"Barbosa","year":"2023","journal-title":"Rev. Esp. Anestesiol. Reanim. (Engl. Ed.)"},{"key":"ref_15","first-page":"e93411","article-title":"Navigating Anesthesia for Thoracoscopic Biopsy in a Six-Year-Old Child with Eosinophilic Granulomatosis with Polyangiitis, Stroke Sequelae, and Pulmonary Collapse","volume":"17","author":"Atlapure","year":"2025","journal-title":"Cureus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1136\/annrheumdis-2021-221794","article-title":"2022 American College of Rheumatology\/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis","volume":"81","author":"Grayson","year":"2022","journal-title":"Ann. Rheum. Dis."},{"key":"ref_17","first-page":"e21521","article-title":"Multiple Episodes of Severe Bronchospasm During General Anesthesia: A Case Report","volume":"14","author":"Garcia","year":"2022","journal-title":"Cureus"},{"key":"ref_18","first-page":"1","article-title":"Guidelines for the management of asthma in adults: Evidence and recommendations","volume":"40","author":"Kawamatawong","year":"2022","journal-title":"Asian Pac. J. Allergy Immunol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.bjae.2022.07.001","article-title":"Perioperative management of the child with asthma","volume":"22","author":"Bali","year":"2022","journal-title":"BJA Educ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2020-12-8","DOI":"10.7573\/dic.2020-12-8","article-title":"The multiple faces of ketamine in anaesthesia and analgesia","volume":"10","author":"Natoli","year":"2021","journal-title":"Drugs Context"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1213\/01.ane.0000247884.94119.d5","article-title":"Intravenous lidocaine after tracheal intubation mitigates bronchoconstriction in patients with asthma","volume":"104","author":"Adamzik","year":"2007","journal-title":"Anesth. Analg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5989","DOI":"10.1021\/acs.molpharmaceut.4c00325","article-title":"The Application and Pharmaceutical Development of Etomidate: Challenges and Strategies","volume":"21","author":"Zhang","year":"2024","journal-title":"Mol. Pharm."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"321","DOI":"10.4103\/ija.IJA_417_20","article-title":"Haemodynamic responses following orotracheal intubation in patients with hypertension---Macintosh direct laryngoscope versus Glidescope\u00aevideolaryngoscope","volume":"65","author":"Meshram","year":"2021","journal-title":"Indian. J. Anaesth."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s00204-022-03402-2","article-title":"Opioid toxicity: Histamine, hypersensitivity, and MRGPRX2","volume":"97","author":"Baldo","year":"2023","journal-title":"Arch. Toxicol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1007\/s00204-021-03068-2","article-title":"Toxicities of opioid analgesics: Respiratory depression, histamine release, hemodynamic changes, hypersensitivity, serotonin toxicity","volume":"95","author":"Baldo","year":"2021","journal-title":"Arch. Toxicol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1016\/j.bja.2019.01.031","article-title":"Molecular mechanisms and pathophysiology of perioperative hypersensitivity and anaphylaxis: A narrative review","volume":"123","author":"Ebo","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e27275","DOI":"10.1097\/MD.0000000000027275","article-title":"Comparison between remifentanil and other opioids in adult critically ill patients: A systematic review and meta-analysis","volume":"100","author":"Yang","year":"2021","journal-title":"Medicine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ddmod.2014.02.004","article-title":"Volatile Anesthetics and the Treatment of Severe Bronchospasm: A Concept of Targeted Delivery","volume":"15","author":"McNeil","year":"2015","journal-title":"Drug. Discov. Today Dis. Models"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1186\/s13054-024-05122-8","article-title":"A systematic review on the use of sevoflurane in the management of status asthmaticus in adults","volume":"28","author":"Ho","year":"2024","journal-title":"Crit. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/ALN.0000000000004379","article-title":"2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade","volume":"138","author":"Thilen","year":"2023","journal-title":"Anesthesiology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1136\/ard-2022-223764","article-title":"EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update","volume":"83","author":"Hellmich","year":"2024","journal-title":"Ann. Rheum. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/EJA.0000000000001769","article-title":"Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care","volume":"40","author":"Romero","year":"2023","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1111\/anae.14545","article-title":"Butyrylcholinesterase deficiency and its clinical importance in anaesthesia: A systematic review","volume":"74","author":"Andersson","year":"2019","journal-title":"Anaesthesia"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Chen, Y., Guo, X., Zhou, J., Li, J., Wu, Q., Yang, H., Zhang, S., Fei, Y., Zhang, W., and Zhao, Y. (2020). Cardiac Involvement in Eosinophilic Granulomatosis With Polyangiitis: A Retrospective Study in the Chinese Population. Front. Med., 7.","DOI":"10.3389\/fmed.2020.583944"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e005816","DOI":"10.1136\/rmdopen-2025-005816","article-title":"Coronary vasospasms and other cardiac manifestations in Eosinophilic Granulomatosis with Polyangiitis: Clinical impact and frequency in a monocentre study of 103 patients","volume":"11","author":"Schramm","year":"2025","journal-title":"RMD Open."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"106045","DOI":"10.1016\/j.jaccas.2025.106045","article-title":"Coronary Vasospasm in Eosinophilic Granulomatosis With Polyangiitis Presenting as Acute Coronary Syndrome Treated With Anti-IL-5","volume":"31","author":"Thota","year":"2026","journal-title":"JACC Case Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ejim.2020.12.008","article-title":"Cardiac involvement in eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome): Prospective evaluation at a tertiary referral centre","volume":"85","author":"Zampieri","year":"2021","journal-title":"Eur. J. Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s11886-025-02258-z","article-title":"Cardiac Involvement in Eosinophilic Granulomatosis with Polyangiitis","volume":"27","author":"Srikantharajah","year":"2025","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"G25","DOI":"10.1093\/ejendo\/lvae029","article-title":"European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency","volume":"190","author":"Beuschlein","year":"2024","journal-title":"Eur. J. Endocrinol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/ALN.0000000000001659","article-title":"Perioperative Steroid Management: Approaches Based on Current Evidence","volume":"127","author":"Liu","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"147","DOI":"10.4103\/joacp.JOACP_242_17","article-title":"Perioperative \u201cstress dose\u201d of corticosteroid: Pharmacological and clinical perspective","volume":"35","author":"Chilkoti","year":"2019","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1111\/anae.14963","article-title":"Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: Guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK","volume":"75","author":"Woodcock","year":"2020","journal-title":"Anaesthesia"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"bvac185","DOI":"10.1210\/jendso\/bvac185","article-title":"Perioperative Evaluation and Management of Patients on Glucocorticoids","volume":"7","author":"Santhanam","year":"2022","journal-title":"J. Endocr. Soc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1111\/anae.16556","article-title":"Peri-operative corticosteroid supplementation guideline adherence","volume":"80","author":"Miggelbrink","year":"2025","journal-title":"Anaesthesia"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/ACO.0000000000000541","article-title":"Risk factors for opioid-induced respiratory depression and failure to rescue: A review","volume":"31","author":"Gupta","year":"2018","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Pascarella, G., Costa, F., Nonnis, G., Strumia, A., Sarubbi, D., Schiavoni, L., Di Pumpo, A., Mortini, L., Grande, S., and Attanasio, A. (2023). Ultrasound Guided Parasternal Block for Perioperative Analgesia in Cardiac Surgery: A Prospective Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12052060"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"102874","DOI":"10.1016\/j.amsu.2021.102874","article-title":"Perioperative management of patients with asthma during elective surgery: A systematic review","volume":"70","author":"Bayable","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1093\/rheumatology\/keae085","article-title":"Cardiac involvement in eosinophilic granulomatosis with polyangiitis: Acute eosinophilic myocarditis and chronic inflammatory cardiomyopathy","volume":"64","author":"Liu","year":"2025","journal-title":"Rheumatology"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Gioffredi, A., Maritati, F., Oliva, E., and Buzio, C. (2014). Eosinophilic granulomatosis with polyangiitis: An overview. Front. Immunol., 5.","DOI":"10.3389\/fimmu.2014.00549"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/MD.0b013e3182a72299","article-title":"Glucocorticoid Therapy and the Risk of Infection in Patients With Newly Diagnosed Autoimmune Disease","volume":"92","author":"Migita","year":"2013","journal-title":"Medicine"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1002\/art.37721","article-title":"Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): Clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort","volume":"65","author":"Comarmond","year":"2013","journal-title":"Arthritis Rheum."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Fardet, L., Petersen, I., and Nazareth, I. (2016). Common Infections in Patients Prescribed Systemic Glucocorticoids in Primary Care: A Population-Based Cohort Study. PLoS Med., 13.","DOI":"10.1371\/journal.pmed.1002024"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1056\/NEJMoa1702079","article-title":"Mepolizumab or Placebo for Eosinophilic Granulomatosis with Polyangiitis","volume":"376","author":"Wechsler","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1002\/art.43146","article-title":"EGPA Mepolizumab Open-Label Extension Study Group. Long-Term Safety and Efficacy of Mepolizumab in Eosinophilic Granulomatosis with Polyangiitis","volume":"77","author":"Wechsler","year":"2025","journal-title":"Arthritis Rheumatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1056\/NEJMoa2311155","article-title":"Benralizumab versus Mepolizumab for Eosinophilic Granulomatosis with Polyangiitis","volume":"390","author":"Wechsler","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.anai.2024.11.004","article-title":"Real-world mepolizumab treatment in eosinophilic granulomatosis with polyangiitis reduces disease burden in the United States","volume":"134","author":"Mathur","year":"2025","journal-title":"Ann. Allergy Asthma Immunol."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/5\/241\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T11:07:12Z","timestamp":1777547232000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/5\/241"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":56,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jpm16050241"],"URL":"https:\/\/doi.org\/10.3390\/jpm16050241","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}