Anti-N-methyl-D-aspartate receptor encephalitis associated with an ovarian teratoma: two cases report and anesthesia considerationsReport as inadecuate




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BMC Anesthesiology

, 15:150

First Online: 16 October 2015Received: 08 May 2015Accepted: 08 October 2015

Abstract

BackgroundAnti-N-methyl-D-aspartate receptor NMDAR encephalitis is an immune-mediated syndrome caused by the production of anti-NMDAR receptor antibodies. The syndrome characterised by psychosis, seizures, sleep disorders, hallucinations and short-term memory loss. Ovarian teratoma is the confirmed tumour associated with anti-NMDAR antibodies. The patients with anti-NMDAR encephalitis complicated by ovarian teratoma require surgical treatment under general anesthesia. NMDARs are important targets of many anesthetic drugs. The perioperative management and complications of anti-NMDAR encephalitis, including hypoventilation, paroxysmal sympathetic hyperactivity PSH and epilepsy, are challenging for ansthesiologists.

Case presentationThis report described two female patients who presented for resection of the ovarian teratoma, they had confirmed anti-NMDAR encephalitis accompanied by ovarian teratoma. Two patients received gamma globulin treatments and the resection of the ovarian teratoma under total intravenous anesthesia. They were recovered and discharged on the 20 and 46 postoperative day respectively.

ConclusionsThere is insufficient evidence about the perioperative management, monitoring and anesthesia management of anti-NMDAR encephalitis. This report was based on the consideration that controversial anesthetics that likely act on NMDARs should be avoided. Additionally, BIS monitoring should to be prudently applied in anti-NMDAR encephalitis because of abnormal electric encephalography EEG. Anesthesiologists must be careful with regard to central ventilation dysfunctions and PSH due to anti-NMDAR encephalitis.

KeywordsAnesthesia Teratoma Anti-NMDAR encephalitis AbbreviationsNMDARN-methyl-D-aspartate receptor

PSHParoxysmal sympathetic hyperactivity

EEGEncephalography

ECGElectrocardiography

etCO2End-tidal carbon dioxide

RRRespiratory rate

BISBispectral index

TVTidal volume

CSFCerebrospinal fluid

OIHOpioid-induced hyperalgesia

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Author: Haiyang Liu - Minyu Jian - Fa Liang - Hongli Yue - Ruquan Han

Source: https://link.springer.com/







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