• Nozomi Wada, Kayoko Tashima, Akira Motoyasu, Harumasa Nakazawa, Joho Tokumine, Mieko Chinzei, and Tomoko Yorozu.
• Department of Anesthesiology, Kyorin University School of Medicine, Shinkawa, Mitaka-shi, Tokyo, Japan.
• Medicine (Baltimore). 2018 Dec 1; 97 (50): e13651.

RationaleAnti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an immune-mediated syndrome caused by the production of antibodies against NMDA receptors. As NMDA receptors are important targets of many anesthetic drugs, the perioperative management of patients with anti-NMDA receptor encephalitis is challenging for anesthesiologists.Patient ConcernsA 31-year-old woman presented with akinesia and aphasia, which worsened despite steroid therapy.DiagnosisAnti-NMDA receptor encephalitis associated with ovarian teratoma.InterventionsLaparoscopic ovarian cystectomy was performed under total intravenous anesthesia (TIVA) with peripheral nerve block (PNB).OutcomesThe patient recovered without postoperative complications or any adverse events after surgery.LessonsIdeal anesthesia for a patient with anti-NMDA receptor encephalitis is still under discussion. We decided to perform TIVA with PNB because the effect of propofol on NMDA receptors is considered less than that of volatile anesthetics; moreover, PNB may reduce the amount of propofol and opioids required for anesthesia. To conclude, TIVA with PNB may be the most appropriate method for anesthesia in a patient with anti-NMDA receptor encephalitis undergoing ovarian cystectomy.

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