Anesthesia management of cesarean section in parturient with anti-N-methyl-d-aspartate receptor encephalitis: a case report

A 24-year-old woman at 29 weeks’ gestation, and with psychiatric symptoms, was admitted to hospital and diagnosed as having anti-N-methyl-d-aspartate receptor encephalitis. After 4 weeks of immunotherapy with little effect, an emergency cesarean section was performed at 33⁺⁴ weeks gestation under general anesthesia. The parturient was intubated after rapid sequence induction with etomidate, remifentanil and succinylcholine. Anesthesia was maintained with sevoflurane and remifentanil. Except for low weight, the infant was normal at birth. The surgery went uneventfully and teratoma or other masses were not found. The parturient was sent to ICU for further treatment without extubation after surgery. She was extubated on the 6th day after surgery and was transferred to the general ward of the neurology department to control her seizures. After the seizures were controlled, she was discharged home on the 80th postoperative day and her neurological symptoms had slowly improved half a year later. This case report presents the anesthetic considerations in patients with anti-NMDAR encephalitis undergoing cesarean section.