Potential side effect of propofol and sevoflurane for anesthesia of anti-NMDA-R encephalitis

BMC Anesthesiology

Case Report

Jérôme Honnorat¹  Laurent Magy²  Nicolas Pichon³  Philippe Vignon³  François-Xavier Lapébie³  Céline Kennel³  Bruno François⁴  Fabrice Projetti⁵ 

[1] Centre for diagnosis and treatment of paraneoplastic neurological syndromes, Hospices Civils de Lyon, Centre de recherche en neurosciences de Lyon, Université Claude Bernard Lyon 1, Inserm 1028/CNRS, 5292, Lyon, France;Department of Neurology, University Hospital Dupuytren, Limoges, France;Intensive Care Unit, University Hospital Dupuytren, Limoges, France;Intensive Care Unit, University Hospital Dupuytren, Limoges, France;Service de Réanimation Polyvalente Centre, hospitalier universitaire Dupuytren, 2, avenue Martin Luther King, 87042, Limoges, Cedex, France;Pathology Laboratory, University Hospital Dupuytren, Limoges, France;

关键词: Encephalitis;    General anesthesia;    NMDA;    Propofol;    Sevoflurane;   

DOI  :  10.1186/1471-2253-14-5

 received in 2013-06-07, accepted in 2014-01-13,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundMany anesthetic drugs interact with the NMDA receptor and may therefore alter the clinical presentation of anti-NMDA-R encephalitis.Case presentationA 24-year-old woman was admitted to hospital for decreased consciousness and hyperthermia. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis, and elevated protein. Cultures were negative. Patient state worsened with agitation, facial dyskinesia, ocular deviation, and limb dystonia. Diagnosis of anti-NMDA-R encephalitis was evidenced by specific antibodies. High doses of methylprednisolone were administered. CT scan disclosed an ovarian teratoma and tumor resection was scheduled under anesthesia with propofol, sufentanil, atracurium and sevoflurane. Sedation after surgery was maintained with propofol. Rapidly after surgery, patient’s condition deteriorated with increase of dyskinesias, and two tonic-clonic generalized seizure events.ConclusionIn patients with anti-NMDA-R encephalitis, anesthesia using benzodiazepines, opiates and curares, which fail to interfere with the NMDA pathway, should be preferred.

【 授权许可】

Unknown   
© Lapébie et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.