Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2017, Vol. 13 ›› Issue (03): 270 -275. doi: 10.3877/cma.j.issn.1673-5250.2017.03.005

Special Issue:

Editorial

Anesthesia management of patients undergoing ovarian tumor excision with anti N-methyl-D-aspartate receptor encephalitis

Xingrong Gao1, Dong Luo1,()   

  1. 1. Department of Anesthesiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Chengdu 610041, Sichuan Province, China
  • Received:2017-03-01 Revised:2017-05-11 Published:2017-06-01
  • Corresponding author: Dong Luo
  • About author:
    Corresponding author: Luo Dong, Email:

Anti N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune encephalitis. Its clinical symptoms include psychiatric disorders, seizure disorders, autonomic instability, central hypoventilation and so on. Anti NMDA receptor encephalitis patients need respiratory support. This disease is directly associated with the immunoglobulin (Ig) G antibodies against NMDA receptor NR1 subunit. Anti NMDA receptor encephalitis is commonly associated with ovarian teratomas and typically occurs in young women. The removal of ovarian teratomas combined with immunotherapy, is always associated with a good prognosis. It is still not consistent on the ideal anesthesia method for this kind of patients undergoing ovarian tumor excision. We review the anesthesia management of patients with anti NMDA receptor encephalitis undergoing ovarian teratoma excision in order to provide references for such patients.

[1]
Dalmau J, Tüzün E, Wu HY, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma[J]. Ann Neurol, 2007, 61(1): 25-36.
[2]
Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies[J]. Lancet Neurol, 2008, 7(12): 1091-1098.
[3]
刘美云,谢琰臣,李继梅. 抗NMDA受体脑炎[J]. 中国神经免疫学和神经病学杂志,2010, 17(6): 449-451.
[4]
王得新,刘磊. 自身免疫性脑炎现代概念与分类[J]. 中国实用内科杂志,2012, 32(11): 824-825.
[5]
Mann AP, Grebenciucova E, Lukas RV. Anti-N-methyl-D-aspartate-receptor encephalitis: diagnosis, optimal management, and challenges[J]. Ther Clin Risk Manag, 2014, 10: 517-525.
[6]
袁馨,赵霞. 伴有卵巢成熟性畸胎瘤的抗NMDA受体脑炎1例[J]. 实用妇产科杂志,2016, 32(4): 302-304.
[7]
Vitaliani R, Mason W, Ances B, et al. Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma[J]. Ann Neurol, 2005, 58(4): 594-604.
[8]
乔娜娜. 儿童抗N-甲基-D-天冬氨酸受体抗体脑炎[J]. 国际儿科学杂志,2013, 40(5): 481-485.
[9]
Tüzün E, Zhou L, Baehring JM, et al. Evidence for antibody-mediated pathogenesis in anti-NMDAR encephalitis associated with ovarian teratoma[J]. Acta Neuropathol, 2009, 118(6): 737-743.
[10]
Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study[J]. Lancet Neurol, 2013, 12(2): 157-165.
[11]
Iizuka T, Sakai F, Ide T, et al. Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal[J]. Neurology, 2008, 70(7): 504-511.
[12]
Dalmau J, Lancaster E, Martinez-Hernandez E, et al. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis[J]. Lancet Neurol, 2011, 10(1): 63-74.
[13]
Kayser MS, Titulaer MJ, Gresa-Arribas N, et al. Frequency and characteristics of isolated psychiatric episodes in anti-N-methyl-D-aspartate receptor encephalitis[J]. JAMA Neurol, 2013, 70(9): 1133-1139.
[14]
Seki M, Suzuki S, Iizuka T, et al. Neurological response to early removal of ovarian teratoma in anti-NMDAR encephalitis[J]. J Neurol Neurosurg Psychiatr, 2008, 79(3): 324-326.
[15]
Clark RM, Lynch MP, Kolp R, et al. The N-methyl-D-aspartate receptor, a precursor to N-methyl-D-aspartate receptor encephalitis, is found in the squamous tissue of ovarian teratomas[J]. Int J Gynecol Pathol, 2014, 33(6): 598-606.
[16]
Boeck AL, Logemann F, Krauβ T, et al. Ovarectomy despite negative imaging in anti-NMDA receptor encephalitis: effective even late[J]. Case Rep Neurol Med, 2013, 2013: 843192.
[17]
Tanyi JL, Marsh EB, Dalmau J, et al. Reversible paraneoplastic encephalitis in three patients with ovarian neoplasms[J]. Acta Obstet Gynecol Scand, 2012, 91(5): 630-634.
[18]
郎宇,王天龙,吴岚,等. 抗NMDA受体脑炎患者行卵巢畸胎瘤切除术的麻醉管理[J]. 麻醉学大查房,2013, 4(2): 119-125.
[19]
Kawano H, Hamaguchi E, Kawahito S, et al. Anaesthesia for a patient with paraneoplastic limbic encephalitis with ovarian teratoma: relationship to anti-N-methyl-D-aspartate receptor antibodies[J]. Anaesthesia, 2011, 66(6): 515-518.
[20]
Pryzbylkowski PG, Dunkman WJ, Liu R, et al. Case report: anti-N-methyl-D-aspartate receptor encephalitis and its anesthetic implications[J]. Anesth Analg, 2011, 113(5): 1188-1191.
[21]
Gao XR, Liao ZM, Luo LL, et al. The use of epidural anesthesia in excision of ovarian teratoma associated with anti-N-methyl-D-aspartate receptor encephalitis: a case report[J]. Int J Clin Exp Med, 2016, 9(8): 16927-16929.
[22]
Chaw SH, Foo LL, Chan L, et al. Anesthesia in anti-N-methyl-D-aspartate receptor encephalitis - is general anesthesia a requisite? A case report[J]. Rev Bras Anestesiol, 2016, 16: 3.
[23]
Orser BA, Pennefather PS, MacDonald JF. Multiple mechanisms of ketamine blockade of N-methyl-D-aspartate receptors[J]. Anesthesiology, 1997, 86(4): 903-917.
[24]
Kohrs R, Durieux ME. Ketamine: teaching an old drug new tricks[J]. Anesth Analg, 1998, 87(5): 1186-1193.
[25]
Olney JW, Labruyere J, Price MT. Pathological changes induced in cerebrocortical neurons by phencyclidine and related drugs[J]. Science, 1989, 244(4910): 1360-1362.
[26]
Nishikawa K, MacIver MB. Excitatory synaptic transmission mediated by NMDA receptors is more sensitive to isoflurane than are non-NMDA receptor-mediated responses[J]. Anesthesiology, 2000, 92(1): 228-236.
[27]
Cheng G, Kendig JJ. Enflurane directly depresses glutamate AMPA and NMDA currents in mouse spinal cord motor neurons independent of actions on GABAA or glycine receptors[J]. Anesth, 2000, 93(4): 1075-1084.
[28]
Hollmann MW, Liu HT, Hoenemann CW, et al. Modulation of NMDA receptor function by ketamine and magnesium. Part II: interactions with volatile anesthetics[J]. Anesth Analg, 2001, 92(5): 1182-1191.
[29]
Lapébie FX, Kennel C, Magy L, et al. Potential side effect of propofol and sevoflurane for anesthesia of anti-NMDA-R encephalitis[J]. BMC Anesthesiol, 2014, 14(1): 5.
[30]
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[J]. A A Case Rep, 2014, 2(7): 83-85.
[31]
Liu H, Jian M, Liang F, et al. Anti-N-methyl-D-aspartate receptor encephalitis associated with an ovarian teratoma: two cases report and anesthesia considerations[J]. BMC Anesthesiol, 2015, 15: 150.
[32]
高兴蓉,罗林丽,罗东. BIS用于抗NMDA受体抗体脑炎患者术中麻醉深度监测1例报告[J]. 四川大学学报(医学版), 2017, 48(1): 172.
[1] Shuqin Zhang, Lian Chen. Diagnosis and treatment of postpartum intrauterine retained products of conception[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 493-497.
[2] Jiechun Shi, Ziyu Fan, Yan Xing. Early warning efficiency of different screening methods on cervical adenocarcinoma in situ[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 575-581.
[3] Dan Tang, Xiaoxi Yao, Bowen Yang, Shaolong Xue, Mengyao Li, Liuxing Wei, Mingrong Xi. The impact of doublecortin-like kinase 1 on the clinical characteristics of endometrioid adenocarcinoma patients[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 582-590.
[4] Yi Wei, Yuxi Zhou, Ye Yang, Xiufeng Ling, Chun Zhao. Current research status on roles of microRNA on endometrial receptivity[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(03): 266-270.
[5] Lin Lin, Simeng Tian, Yonghua Yu, Feifei Xu, Mingli Huang. Current research status on treatment of intrauterine adhesion by stem cells and their exosomes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(03): 271-275.
[6] Xin Li, Yi Wei, Juan Zhang, Juanjuan Zhang, Xiufeng Ling, Chun Zhao, Mianqiu Zhang. Influencing factors on clinical pregnancy outcomes of frozen-thaw embryo transfer cycle in women of advanced age[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(03): 276-283.
[7] Lin Yang, Rutie Yin. Current research status on etiology and treatment of patients with white lesions of vulva[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(02): 157-165.
[8] Weicong Gao, Li Li, Zhonghua Zhang, Xianghui Zhu, Suqiao Liu. Impact of impaired glucose regulation on recurrence within 2 years after modified radical surgery in patients with cervical cancer[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(02): 231-237.
[9] Yuping Li, Hui Ma, Hang Yu. Clinical efficacy of laparoscopic uterine artery ligation combined with myomectomy for the treatment of uterine fibroids[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(02): 238-244.
[10] Li Wang, Yueying Wang, Fen Zhou, Yukun Guo, Lina Wei. Current research status in effect of gonadotropin-releasing hormone antagonist on endometrial receptivity[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(06): 629-635.
[11] Likun Wei, Xuhong Zhang, Ying Luo, Fengxia Xue, Yingmei Wang, Xueru Song, Lina Tian, Yanfang Zhang, Yanxia Wang, Wenyan Tian. Malignant transformation of ovarian endometrioma and pelvic abscesses: a case report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(06): 696-702.
[12] Liang Wang, Jincheng Fu, Wei Xu, Yanqing Li, Yongbo Guo, Kejian Zou. A case of mature cystic teratoma of rectum with rectovaginal fistula and literature review[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 117-118.
[13] Liangyan Zhang, Zhen Cao, Zijia Liu. Anesthesia management in adult inguinal hernia ambulatory surgery[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(01): 25-29.
[14] Jun Wang, Kunpeng Liu, Lan Yao, Hua Zhang, Yue Wei, Libin Suo, Jun Chen, chengli Miao, Chenghua Luo. Retrospective analysis of anesthesia management of massive transfusion patients undergoing retroperitoneal tumor resection[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 844-849.
[15] Libin Suo, Kunpeng Liu, Lan Yao, Hua Zhang, Yue Wei, Jun Wang, Jun Chen, Chengli Miao, Chenghua Luo. Key points of anesthesia management and prognostic factors in patients undergoing primary retroperitoneal paraganglioma resection[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 771-776.
Viewed
Full text


Abstract