Anaesthetic management of laparotomy in a patient with anti-NMDA receptor antibody-mediated encephalitis.

Abstract

Management of cases of anti-N-methyl-D-aspartate (NMDA) antibody-mediated encephalitis is very challenging to anaesthesiologists as this receptor is the target of many anaesthetics. We report a woman diagnosed with anti-NMDA antibody-mediated encephalitis posted for laparotomy. She presented with generalised tonic-clonic seizures. Testing revealed anti-NMDA antibodies and anti-SOX antibodies. Ultrasonography of the abdomen showed a right adnexal cystic lesion; hence, the patient was taken up for right ovarian cystectomy after obtaining high-risk consent. A combination of total intravenous anaesthesia with endotracheal intubation under bispectral index monitoring and bilateral transversus abdominis plane block for postoperative analgesia was administered. Postoperatively, there was no excessive drowsiness or hypoventilation. Prioritising careful monitoring and tailored anaesthesia techniques to minimise the risk of triggering neurological exacerbations while ensuring optimum surgical conditions are met is of paramount importance. Meticulous planning and careful use of resources enabled the administration of safe anaesthesia.