Abstract

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder caused by production of anti-NMDAR antibodies that is often associated with ovarian teratoma and exhibits various manifestations including psychiatric symptoms, seizures, hypoventilation, and autonomic nerve instability. Patients with this disorder who receive early surgical tumor resection along with immunotherapy have better outcome than the rest of the patients. To establish an anesthetic plan, it is important to understand the pharmacological interaction between the anesthetic agents and the disabled NMDAR, because NMDAR is one of the major sites of action for commonly-used anesthetic agents. Herein, we describe two young female patients with anti-NMDAR encephalitis who required surgical resection of ovarian teratoma under general anesthesia using propofol, remifentanil, and fentanyl. In both of these anesthetic courses, neither psychoneuronal modification nor autonomic instability by propofol was evident. Furthermore, propofol has been reported to suppress the effects of ketamine on the posterior cingulate cortices, which is the area of the brain concerned with psychotomimetic activity and neural damage of NMDAR antagonists. Our cases imply that propofol is safely used in patients with anti-NMDAR encephalitis, although it has some pharmacological effects on NMDAR.

Highlights

  • Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune neurological disorder caused by production of antibodies to NMDAR and has become the most common autoimmune encephalitis described, since its first description in 2007 [1]

  • Nakao et al reported that propofol inhibits ketamineinduced psychotomimetic activities via the activation of gamma-aminobutyric acid type A (GABAA) receptor activation in the rat posterior cingulate and retrosplenial cortices, which are suggested to be the regions of brain concerned with psychotomimetic activity and neural damage of NMDAR antagonists [9]

  • These findings suggest that propofol, a GABAergic agent, is effective in suppressing psychotomimetic complications induced by ketamine, but is acceptable for the suppressing NMDAR-related pathological mechanisms of anti-NMDAR encephalitis

Read more

Summary

Background

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune neurological disorder caused by production of antibodies to NMDAR and has become the most common autoimmune encephalitis described, since its first description in 2007 [1]. The treatment with gamma globulin and methylprednisolone for anti-NMDAR encephalitis was initiated from day 10 for 3 days. Case 2 A 28-year-old woman (159 cm, 45 kg) presented to a mental health clinic with language disorder, shortterm memory disturbance, seizure, and hallucination 2 weeks prior. She was transferred to our hospital and abdominal computed tomography revealed right ovarian teratoma. On day 4 after admission, treatment with gamma globulin and methylprednisolone for anti-NMDAR encephalitis was initiated for 3 days. After two courses of gamma globulin and methylprednisolone treatment, the patient recovered smoothly and was discharged on day 54 after admission with no neurological symptoms

Findings
Discussion
Conclusions
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call