Potential Effect of Preoperative Immunotherapy on Anesthesia of Patients with Anti-N-methyl-D-aspartate Receptor Encephalitis

Anti‐N‐methyl‐D‐aspartate receptor (anti‐NMDA‐R) encephalitis is a newly recognized neuro‐autoimmune disease. Patients usually present with a series of neurological and psychiatric syndromes including memory impairment, seizures, dyskinesia, autonomic nervous system dysfunction, etc. Anti‐NMDA‐R encephalitis usually affects young women with teratoma being a common co‐existing condition in nearly 47% of the diagnosed patients. Previous studies have shown that teratoma removal, being the current first‐line therapy, may enhance the effectiveness of autoimmune therapy and decrease the incidence of relapse.[1] However, poorly controlled encephalitis poses as a perioperative anesthetic risk. Therefore, timing of the surgery is of great concern and is a question yet to be answered. Due to low incidence of anti‐NMDA‐R encephalitis in general population, literature of the perioperative management in these group of patients is scarce. Only few case reports were found yet, none has discussed the issue of surgery timing. In this study, 6 patients with anti‐NMDA‐R encephalitis undergoing teratoma removal were reviewed, and timing of surgery and anesthetic management for these patients were discussed.