Skip to main content

Advertisement

SpringerLink
Log in

Anesthesia management of cesarean section in parturient with anti-N-methyl-d-aspartate receptor encephalitis: a case report

  • Clinical Report
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

A 24-year-old woman at 29 weeks’ gestation, and with psychiatric symptoms, was admitted to hospital and diagnosed as having anti-N-methyl-d-aspartate receptor encephalitis. After 4 weeks of immunotherapy with little effect, an emergency cesarean section was performed at 33+4 weeks gestation under general anesthesia. The parturient was intubated after rapid sequence induction with etomidate, remifentanil and succinylcholine. Anesthesia was maintained with sevoflurane and remifentanil. Except for low weight, the infant was normal at birth. The surgery went uneventfully and teratoma or other masses were not found. The parturient was sent to ICU for further treatment without extubation after surgery. She was extubated on the 6th day after surgery and was transferred to the general ward of the neurology department to control her seizures. After the seizures were controlled, she was discharged home on the 80th postoperative day and her neurological symptoms had slowly improved half a year later. This case report presents the anesthetic considerations in patients with anti-NMDAR encephalitis undergoing cesarean section.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dalmau J, Tuzun E, Wu HY, Masjuan J, Rossi JE, Voloschin A, Baehring JM, Shimazaki H, Koide R, King D, Mason W, Sansing LH, Dichter MA, Rosenfeld MR, Lynch DR. Paraneoplastic anti-N-methyl-d-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61(1):25–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Tüzün E, Dalmau J. Limbic encephalitis and variants: classification, diagnosis and treatment. Neurologist. 2007;13(5):261–71.

    Article  PubMed  Google Scholar 

  3. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, Dessain SK, Rosenfeld MR, Balice-Gordon R, Lynch DR. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008;7(12):1091–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Mathis S, Pin JC, Pierre F, Ciron J, Iljicsov A, Lamy M, Neau JP. Anti-NMDA receptor encephalitis during pregnancy: a case report. Medicine (Baltimore). 2015; 94(26):e1034.

  5. Florance NR, Davis RL, Lam C, Szperka C, Zhou L, Ahmad S, Campen CJ, Moss H, Peter N, Gleichman AJ, Glaser CA, Lynch DR, Rosenfeld MR, Dalmau J. Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol. 2009;66(1):11–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kawano H, Hamaguchi E, Kawahito S, Tsutsumi YM, Tanaka K, Kitahata H, Oshita S. Anaesthesia for a patient with paraneoplastic limbic encephalitis with ovarian teratoma: relationship to anti-N-methyl-d-aspartate receptor antibodies. Anaesthesia. 2011;66(6):515–8.

    Article  CAS  PubMed  Google Scholar 

  7. 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(5):1188–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Broderick DK, Raines DE, Nanji KC. Total intravenous anesthesia using N-methyl-d-aspartate (NMDA) receptor-sparing drugs in a patient with anti-NMDA receptor encephalitis. A A Case Rep. 2014;2(7):83–5.

    Article  PubMed  Google Scholar 

  9. Liu H, Jian M, Liang F, Yue H, Han R. Anti-N-methyl-d-aspartate receptor encephalitis associated with an ovarian teratoma: two cases report and anesthesia considerations. BMC Anesthesiol. 2015;15:150.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hughes EG, Peng X, Gleichman AJ, Lai M, Zhou L, Tsou R, Parsons TD, Lynch DR, Dalmau J, Balice-Gordon RJ. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci. 2010;30(17):5866–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011;10(1):63–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Titulaer MJ, McCracken L, Gabilondo L, Armangué T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F, Dalmau J. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013;12(2):157–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Chau PL. New insights into the molecular mechanisms of general anaesthetics. Br J Pharmacol. 2010;161(2):288–307.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Solt K, Eger EI 2nd, Raines DE. Differential modulation of human N-methyl-d-aspartate receptors by structurally diverse general anesthetics. Anesth Analg. 2006;102(5):1407–11.

    Article  CAS  PubMed  Google Scholar 

  15. Devroe S, Van de Velde M, Rex S. General anesthesia for caesarean section. Curr Opin Anaesthesiol. 2015;28(3):240–6.

    Article  CAS  PubMed  Google Scholar 

  16. Lapébie FX, Kennel C, Magy L, Projetti F, Honnorat J, Pichon N, Vignon P, François B. Potential side effect of propofol and sevoflurane for anesthesia of anti-NMDA-R encephalitis. BMC Anesthesiol. 2014;14:5.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kim J, Park SH, Jung YR, Park SW, Jung DS. Anti-NMDA receptor encephalitis in a pregnant woman. J Epilepsy Res. 2015;5(1):29–32.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Zhimin Liao, Xiaoqin Jiang & Juan Ni

  2. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, 610041, Sichuan, China

    Zhimin Liao, Xiaoqin Jiang & Juan Ni

Authors
  1. Zhimin Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaoqin Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juan Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juan Ni.

Ethics declarations

Conflict of interest

This work was supported by grants from the Support Program of Sichuan Science and Technology Agency (2013FZ0005, Chengdu, China). The authors report no conflicts of interest.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liao, Z., Jiang, X. & Ni, J. Anesthesia management of cesarean section in parturient with anti-N-methyl-d-aspartate receptor encephalitis: a case report. J Anesth 31, 282–285 (2017). https://doi.org/10.1007/s00540-016-2304-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-016-2304-0

Keywords

Search

Navigation