Total Intravenous Anesthesia Using N-Methyl-D-Aspartate (NMDA) Receptor-Sparing Drugs in a Patient with Anti-NMDA Receptor Encephalitis

Broderick, Daniel K. MD; Raines, Douglas E. MD; Nanji, Karen C. MD, MPH

doi: 10.1213/XAA.0000000000000003
Case Reports: Case Report

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a recently identified syndrome characterized by psychosis and dysautonomia. Treatment includes resection of the underlying tumor. While the pathologic mechanism involves disruption of NMDA function by anti-NMDA receptor autoantibodies, there are few descriptions of the perioperative management or anesthetic approach for such patients. We report a classic presentation of anti-NMDA receptor encephalitis and describe the use of total IV anesthesia with NMDA receptor-sparing drugs. Modest postoperative analgesic requirements, not reported in prior cases, are also described in our report.

From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.

Accepted for publication September 30, 2013.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Karen C. Nanji, MD, MPH, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114. Address e-mail to knanji@partners.org.

© 2014 International Anesthesia Research Society