title: Potential side effect of propofol and sevoflurane for anesthesia of anti-NMDA-R encephalitis.
abstract: BACKGROUND
  Many anesthetic drugs interact with the NMDA receptor and may therefore alter the clinical presentation of anti-NMDA-R encephalitis.
  
  
  METHODS
  A 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.
  
  
  CONCLUSIONS
  In patients with anti-NMDA-R encephalitis, anesthesia using benzodiazepines, opiates and curares, which fail to interfere with the NMDA pathway, should be preferred.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Lapébie
authors.forename: Céline
authors.initials: C
authors.lastname: Kennel
authors.forename: Laurent
authors.initials: L
authors.lastname: Magy
authors.forename: Fabrice
authors.initials: F
authors.lastname: Projetti
authors.forename: Jérôme
authors.initials: J
authors.lastname: Honnorat
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pichon
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon
authors.affiliation: Intensive Care Unit, University Hospital Dupuytren, Limoges, France. b.francois@unilim.fr.
authors.forename: Bruno
authors.initials: B
authors.lastname: François
mesh_terms: D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004409:Dyskinesia, Drug-Induced / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects*; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D000077149:Sevoflurane; D055815:Young Adult
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol