remimazolam and Anti-N-Methyl-D-Aspartate-Receptor-Encephalitis

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a type of autoimmune encephalitis that causes characteristic symptoms through the formation of antibodies against NMDA receptors. If ovarian teratomas are detected, surgical removal under general anesthesia is often considered. Many general anesthetic agents inhibit NMDA receptors. As such, anesthetic agents may have unexpected effects on disease progression. For anesthesiologists, providing general anesthesia for these patients is challenging and there are few studies on which anesthetic is most appropriate.. Two female patients were diagnosed with anti-NMDA receptor encephalitis and ovarian teratomas. Successful teratoma resection was performed under general anesthesia using remimazolam and remifentanil. After the surgery, one patient showed some improvement but died a month later. The other patient progressively improved over time.. Remimazolam and remifentanil are useful general anesthetic agents for patients with anti-NMDA receptor encephalitis. Further studies are warranted.

Topics: Anesthesia, General; Anesthetics, General; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Female; Humans; Receptors, N-Methyl-D-Aspartate; Remifentanil; Teratoma

Myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is one of auto-immune demyelinating diseases of nervous system. Although both regional anesthesia and general anesthesia has been successfully performed in the patient with demyelinating diseases of nervous system, it has been controversial which one is better.. Forty-four male patient was admitted for arthroscopic elbow surgery due to limitation of range of motion. The patient was diagnosed as MOGAD with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, and steroid was used to prevent and treat symptoms and signs.. He was diagnosed as MOGAD with anti-NMDA receptor encephalitis, 1 year ago. The patient complaint of dizziness, diplopia, nausea, vomiting, seizure, general weakness and so on when he was confirmed as MOGAD with anti-NMDA receptor encephalitis. The diagnosis of MOGAD was confirmed with positive anti-myelin oligodendrocyte glycoprotein (MOG) Immunoglobulin (Ig)G and negative anti-aquaporin 4 (AQP4) IgG in the blood.. After steroid cover, total intravenous anesthesia (TIVA) with remimazolam and remifentanil was established for the patients. Rocuronium was administered under monitoring of neuromuscular blockade, using train of 4 (TOF). The operation was performed without any event under right lateral decubitus position. The patient was uneventfully recovered from anesthesia.. The case report showed total intravenous anesthesia with remimazolam and remifentanil under proper monitoring was successfully performed in the patient with MOGAD.

Topics: Anesthesia, General; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Autoantibodies; Demyelinating Diseases; Humans; Male; Myelin-Oligodendrocyte Glycoprotein; Oligodendroglia; Remifentanil