Anesthetic Management of Narcolepsy Patients During Surgery: A Systematic Review

Abstract

We found a paucity of prospective clinical trials in this patient population, as most of the studies were case reports or observational studies. Continuation of preoperative medications, depth of anesthesia monitoring, use of multimodal analgesia with short-acting agents and regional anesthesia techniques were associated with favorable outcomes. Obstetric patients may be at greater risk for worsening narcolepsy symptoms, possibly related to a reduction or discontinuation of medications. For neurosurgical procedures involving the hypothalamus or third and fourth ventricle, postoperative considerations should include monitoring for symptoms of narcolepsy. Future studies are needed to better define perioperative risks associated with anesthesia and surgery in this population of patients.

Observation of single spinal anesthesia by 25G needle puncture through a lateral crypt for hip surgery in elderly patients

“…[5] In conventional lumbar–hard combined block, given the thick epidural needle and the needle point incision slope, repeated puncture can increase the physical damage to ligaments, cause peripheral tissue edema, result in aseptic inflammation, release pain-causing media and produce or aggravate lumbar pain discomfort after anesthesia. [9] 25G spinal anesthesia holds the advantages of high flexibility, easy passing through narrow bone space, low damage to ligaments and surrounding tissues, reduced leakage of cerebrospinal fluid after spinal anesthesia leading to low-pressure headache [6–8] and anesthesia operation with high application value and can hence improve the puncture success rate and safety. In this study, single spine anesthesia with a 25G needle was performed.…”

Sleep and Anesthesia

“…To back up further, propofol and remifentanil have been found to be safe during heart surgery in narcoleptics [100]. Besides, Hu et al [101] listed some recommendations for the clinicians who are performing anesthesia on narcoleptics. In general, when anesthesia is conducted to patients with narcolepsy, sedation should be prevented and the treatment of narcolepsy should be continued until the day of operation.…”

“…In general, when anesthesia is conducted to patients with narcolepsy, sedation should be prevented and the treatment of narcolepsy should be continued until the day of operation. Use of short-acting anesthetics, such as propofol and remifentanil, is recommended [101]. It is also necessary to pay attention to the interaction with the patient's existing drugs, such as stimulants such as modafinil [101].…”

“…Use of short-acting anesthetics, such as propofol and remifentanil, is recommended [101]. It is also necessary to pay attention to the interaction with the patient's existing drugs, such as stimulants such as modafinil [101]. Meanwhile, bispectral index monitoring is advantageous to preserve sevoflurane concentration at a reasonable level and to observe changes in status which are due to oversedation and preoperative drug use [101].…”

“…It is also necessary to pay attention to the interaction with the patient's existing drugs, such as stimulants such as modafinil [101]. Meanwhile, bispectral index monitoring is advantageous to preserve sevoflurane concentration at a reasonable level and to observe changes in status which are due to oversedation and preoperative drug use [101]. Furthermore, studies on mice with orexin deficiency have indicated that the control of temperature is important in patients with narcolepsy during anesthesia [102].…”