Anesthesia Management for Patients with Anti-NMethyl-D-Aspartate Receptor Encephalitis

Background: Neurologic paraneoplastic syndromes rarely act as the first sign of tumors. Being an important part of neurologic paraneoplastic syndromes, anti-N-Methyl-D-Aspartate receptor encephalitis is disclosed by Josep Dalmau in 2007. It's ranked as the second autoimmune encephalitis in frequency with strong association with ovarian teratoma. Even though immunotherapy is effective, dramatic outcomes will be reached by tumor resection at the early phase. Thus there is a great challenge for anesthesiologists to manage such kind of patients. As the target of many anesthetics, NMDA receptor's function, influenced by anti-NMDA receptor antibodies, is of the first consideration when anesthesia is applied. Case: A 15-year-old girl and a 17-year-old girl developed to a state of confusion, seizure, echolalia and paroxysmal sympathetic hyperactivity, who were suspected to have anti-NMDA receptor encephalitis and then scheduled for laparoscopic oophorocystectomy. According to the different states of the patients and bearing the pharmacodynamics and pharmacokinetics in mind, we made some adjustments of the anesthetics and anesthesia management applied. Results: These patients completely recovered. Conclusion: Enough sedation, sufficient infusion before induction and extubation under deep sedation can get rid of stress and fluctuation of circulation. Sandwich of anesthesia management can take advantage of immune suppression of sevoflurane and anti-nausea effect of propofol, which are not the main pharmacologic actions. Precise anesthesia management provides enough depth of anesthesia and analgesia that can provide satisfying muscle relaxation and reduce the usage of muscle relaxants. All of these do good to such kind of patients. Anesthesia is not only to sedate but also to treat the patients.