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

Abstract

BackgroundAnti-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 presentationA 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.ConclusionsAdequate 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.

Paraneoplastic NMDA encephalitis, a case report and an extensive review of available literature

“… Gastric Cancer Ding et al. (2017) [ 19 ] M,55 NA Yes NA After, 4 mo after admission but he had symptoms for 2 y Methylprednisolone, IVIG prednisone Chemotherapy Surgery NA Disappearance of limb twitching which was the only residual finding after immunotherapy and chemotherapy, and before surgery. Total recovery at 2 mo of follow-up after surgery.…”

Anesthesia for pediatric patients with anti‐NMDA receptor encephalitis: A retrospective case series

“…Volatile anesthetics, propofol, and midazolam have indirect action on the NMDA receptor. Propofol and inhalational agents (except nitrous oxide) were used successfully in these case reports 1,5,8,9,11,12,15,17 . Agents considered free of NMDA receptor activity are opioids, muscle relaxants, and dexmedetomidine 12 .…”