Potential Effect of Preoperative Immunotherapy on Anesthesia of Patients with Anti-N-methyl-D-aspartate Receptor Encephalitis

• Published in: Chinese medical journal 2015-11, Vol.128 (21), p.2972-2975
• Main Authors: Gong, Ya-Hong, Zhang, Ming-Zhu, Zhang, Xiu-Hua, Guan, Hong-Zhi, Xu, Xie-Qun, Huang, Yu-Guang
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia; Anesthesia - methods; Anesthesia; Anti-N-methyl-D-aspartate Receptor Encephalitis; Immunotherapy; Anesthesiology; Anti-N-Methyl-D-Aspartate Receptor Encephalitis - drug therapy; Care and treatment; Clinical Practice; Cystectomy; Disease control; Encephalitis; Female; Health aspects; Humans; Immunotherapy; Immunotherapy - methods; Intubation; Laboratories; Nitrous oxide; NMR; Nuclear magnetic resonance; Patients; Pneumonia; Surgery; Ventilators; Young Adult
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.168080

[1] However, poorly controlled encephalitis poses as a perioperative anesthetic risk. [...]timing of the surgery is of great concern and is a question yet to be answered. Approval from Institutional Review Board of Peking Union Medical College Hospital (PUMCH) was obtained. Data record include age, sex, clinical presentations, laboratory findings, diagnostic modalities (electroencephalogram [EEG], cranial magnetic resonance imaging [MRI], serum/cerebrospinal fluid [CSF] autoantibody test, and abdominal ultrasound), preoperation immunotherapy (drugs and dosage) and status of disease control, anesthesia course (anesthetic and emergence), and postoperative course (postoperative mechanical ventilation time, Intensive Care Unit [ICU] length of stay [LOS], and postoperative LOS). All six patients were diagnosed with anti-NMDA-R encephalitis by the combination of clinical presentation, EEG, MRI, and serum/CSF anti-NMDA-R antibody test. All the patients present with psychiatric symptoms, seizures, and disturbances of consciousness during the course of disease; four (Patient 1, 3, 4, and 5) had autonomic instability including arrhythmia (sinus tachycardia or sinus bradycardia) and central hypoventilation. Patients with poor disease control had longer postoperative invasive ventilation time, ICU LOS, postoperative LOS, or higher incidence of pulmonary complications while patients with better disease control had a smoother recovery. [...]it is assumed that although tumor removal may enhance the effectiveness of drug therapy, inadequate preoperative therapy may prolong postoperative ventilation time and result in unwanted pulmonary complications. NMDA-R can be strongly inhibited by nitrous oxide and ketamine. [...]it is presumed that patients with anti-NMDA-R encephalitis may be more sensitive to ketamine and nitrous oxide, which may aggravate the symptoms of...