Anesthesia for patient with anti-N-methyl-D-aspartate receptor encephalitis: A case report with a brief review of the literature

Medicine (Baltimore). 2018 Dec;97(50):e13651. doi: 10.1097/MD.0000000000013651.

Abstract

Rationale: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an immune-mediated syndrome caused by the production of antibodies against NMDA receptors. As NMDA receptors are important targets of many anesthetic drugs, the perioperative management of patients with anti-NMDA receptor encephalitis is challenging for anesthesiologists.

Patient concerns: A 31-year-old woman presented with akinesia and aphasia, which worsened despite steroid therapy.

Diagnosis: Anti-NMDA receptor encephalitis associated with ovarian teratoma.

Interventions: Laparoscopic ovarian cystectomy was performed under total intravenous anesthesia (TIVA) with peripheral nerve block (PNB).

Outcomes: The patient recovered without postoperative complications or any adverse events after surgery.

Lessons: Ideal anesthesia for a patient with anti-NMDA receptor encephalitis is still under discussion. We decided to perform TIVA with PNB because the effect of propofol on NMDA receptors is considered less than that of volatile anesthetics; moreover, PNB may reduce the amount of propofol and opioids required for anesthesia. To conclude, TIVA with PNB may be the most appropriate method for anesthesia in a patient with anti-NMDA receptor encephalitis undergoing ovarian cystectomy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Analgesics, Opioid* / administration & dosage
  • Analgesics, Opioid* / adverse effects
  • Anesthesia, Intravenous / methods*
  • Anesthetics, Intravenous / administration & dosage
  • Anesthetics, Intravenous / adverse effects
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / etiology
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / immunology
  • Antibodies / blood
  • Female
  • Humans
  • Nerve Block / methods*
  • Ovarian Neoplasms* / complications
  • Ovarian Neoplasms* / pathology
  • Ovarian Neoplasms* / surgery
  • Ovariectomy* / adverse effects
  • Ovariectomy* / methods
  • Postoperative Complications / prevention & control*
  • Propofol* / administration & dosage
  • Propofol* / adverse effects
  • Receptors, N-Methyl-D-Aspartate / immunology*
  • Teratoma* / complications
  • Teratoma* / pathology
  • Teratoma* / surgery
  • Treatment Outcome

Substances

  • Analgesics, Opioid
  • Anesthetics, Intravenous
  • Antibodies
  • Receptors, N-Methyl-D-Aspartate
  • Propofol