Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2017 Jul 6;17(1):90.
doi: 10.1186/s12871-017-0379-2.

Case report: anaesthetic management of radical gastrectomy for gastric cancer associated with anti-N-methyl-D-aspartate receptor encephalitis

Lei Ding  1 , Hongyu Tan  2 , Ziyu Li  3 , Jiafu Ji  3 , Xuejun Song  1
Affiliations
Case Reports

Case report: anaesthetic management of radical gastrectomy for gastric cancer associated with anti-N-methyl-D-aspartate receptor encephalitis

Lei Ding et al. BMC Anesthesiol. .

Abstract

Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a rare neurological disorder that is caused by the production of antibodies against NMDARs. As many anaesthetic drugs interact with NMDARs and may worsen the disease and because the disease poses risks, such as cardiovascular events, hyperthermia and respiratory insufficiency, while under anaesthesia, administering anaesthesia to patients with this disorder is clinically challenging.

Case presentation: A 55-year-old man with gastric cancer associated with anti-NMDAR encephalitis who was diagnosed 8 months prior was admitted to Peking University Cancer Hospital for tumour resection. Before surgery, the patient's symptoms had been successfully controlled via aggressive immunotherapy. Radical gastrectomy was performed under general anaesthesia induced with remifentanil, propofol, and cisatracurium and maintained with sevoflurane and remifentanil. The patient had a favourable recovery without any adverse symptoms or post-operative complications.

Conclusions: Adequate preparation for surgery is essential for the anaesthetic management of patients with anti-NMDAR encephalitis. These rare patients may benefit from general anaesthesia induced using remifentanil, propofol and cisatracurium and maintained using sevoflurane and remifentanil. Additionally, the use of NMDA antagonists, such as ketamine, nitrous oxide and tramadol, should be avoided.

Keywords: Anaesthetic management; Anti-N-methyl-D-aspartate receptor encephalitis; Case report; Gastric cancer.

PubMed Disclaimer

References

    1. Pryzbylkowski PG, Dunkman WJ, Liu R, Chen L. Case report: anti-N-methyl-D-aspartate receptor encephalitis and its anesthetic implications. Anesth Analg. 2011;113:1188–1191. doi: 10.1213/ANE.0b013e31822b8a7d. - DOI - PMC - PubMed
    1. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008;7:1091–1098. doi: 10.1016/S1474-4422(08)70224-2. - DOI - PMC - PubMed
    1. Sansing LH, Tuzun E, Ko MW, Baccon J, Lynch DR, Dalmau J. A patient with encephalitis associated with NMDA receptor antibodies. Nat Clin Pract Neurol. 2007;3:291–296. doi: 10.1038/ncpneuro0493. - DOI - PMC - PubMed
    1. Kawano H, Hamaguchi E, Kawahito S, Tsutsumi YM, Tanaka K, Kitahata H, et al. Anaesthesia for a patient with paraneoplastic limbic encephalitis with ovarian teratoma: relationship to anti-N-methyl-D-aspartate receptor antibodies. Anaesthesia. 2011;66:515–518. doi: 10.1111/j.1365-2044.2011.06707.x. - DOI - PubMed
    1. Kamei S, Kuzuhara S, Ishihara M, Morita A, Taira N, Togo M, et al. Nationwide survey of acute juvenile female non-herpetic encephalitis in Japan: relationship to anti-N-methyl-D-aspartate receptor encephalitis. Intern Med. 2009;48:673–679. doi: 10.2169/internalmedicine.48.1898. - DOI - PubMed

Publication types

MeSH terms