Al Ghamdi Faris, Uffman Joshua C, Kim Stephani S, Nafiu Olubukola O, Tobias Joseph D
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Saudi J Anaesth. 2020 Apr-Jun;14(2):164-168. doi: 10.4103/sja.SJA_720_19. Epub 2020 Mar 5.
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, an autoimmune disorder resulting from antibodies directed against the NMDA (glutamate) receptor, is the second most frequent cause of immune-mediated encephalitis. To date, the information related to the anesthetic care of children with this disorder is limited to anecdotal reports.
We reviewed the anesthetic care of six patients with anti-NMDA receptor encephalitis who underwent 21 procedures at our institution from 2014 through 2019.
The study cohort included six patients, ranging in age from 2 to 18 years, who required anesthetic care during 21 procedures. Airway management included a laryngeal mask airway ( = 8), endotracheal intubation ( = 12), and native airway with spontaneous ventilation ( = 1). Intravenous (IV) induction with propofol was used in 17 procedures for five patients, including three that required rapid sequence intubation using rocuronium or succinylcholine. Inhalation induction with sevoflurane in nitrous oxide (NO)/oxygen (O) was chosen for two procedures in two patients. A combination of both induction techniques was used for two patients in two procedures. Maintenance anesthesia was accomplished with a volatile agent, predominantly sevoflurane, for 18 of the 21 procedures; propofol infusion for one procedure; and single dose of propofol was used for two short procedures. NO was not used for maintenance anesthesia in any of the encounters. None of the patients exhibited adverse events, including hemodynamic instability, thermoregulatory problems, or respiratory events perioperatively. Postoperatively, there was no observed deterioration in clinical status attributed to anesthetic care.
Multisystem involvement in anti-NMDA receptor encephalitis includes memory loss, behavior irregularity, psychosis, arrhythmias, blood pressure (BP) instability, and hypoventilation. In our study cohort, we noted no intraoperative issues and deterioration in clinical status following the use of volatile anesthetic agents, opioids, dexmedetomidine, and propofol for general anesthesia (GA) or sedation. As ketamine, xenon, and NO mediate their anesthetic effects, primarily, through antagonism of NMDA receptors, theoretical concerns suggest that they should be avoided.
抗N-甲基-D-天冬氨酸（NMDA）受体脑炎是一种由针对NMDA（谷氨酸）受体的抗体引起的自身免疫性疾病，是免疫介导性脑炎的第二大常见病因。迄今为止，有关该疾病患儿麻醉护理的信息仅限于轶事报道。
我们回顾了2014年至2019年期间在我们机构接受21例手术的6例抗NMDA受体脑炎患者的麻醉护理情况。
研究队列包括6例年龄在2至18岁之间的患者，他们在21例手术中需要麻醉护理。气道管理包括喉罩气道（n = 8）、气管插管（n = 12）和自主通气的天然气道（n = 1）。5例患者在17例手术中采用丙泊酚静脉诱导，其中3例需要使用罗库溴铵或琥珀酰胆碱进行快速顺序插管。2例患者在2例手术中选择了在氧化亚氮（N₂O）/氧气（O₂）中使用七氟醚进行吸入诱导。2例患者在2例手术中采用了两种诱导技术相结合的方法。21例手术中的18例采用挥发性麻醉剂（主要是七氟醚）维持麻醉；1例手术采用丙泊酚输注；2例短手术采用单次剂量丙泊酚。在任何一次麻醉中均未使用N₂O维持麻醉。所有患者均未出现不良事件，包括围手术期的血流动力学不稳定、体温调节问题或呼吸事件。术后，未观察到因麻醉护理导致临床状态恶化。
抗NMDA受体脑炎的多系统受累包括记忆力丧失、行为异常、精神病、心律失常、血压（BP）不稳定和通气不足。在我们的研究队列中，我们注意到在使用挥发性麻醉剂、阿片类药物、右美托咪定和丙泊酚进行全身麻醉（GA）或镇静后，术中没有出现问题，临床状态也没有恶化。由于氯胺酮、氙气和N₂O主要通过拮抗NMDA受体来介导其麻醉作用，理论上认为应避免使用。
