Perioperative risks of narcolepsy in patients undergoing general anesthesia: A case-control study

• Published in: Journal of clinical anesthesia 2017-09, Vol.41, p.120-125
• Main Authors: Cavalcante, Alexandre N., MD, Hofer, Ryan E., MD, Tippmann-Peikert, Maja, MD, Sprung, Juraj, MD, PhD, Weingarten, Toby N., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Amphetamines; Anesthesia; Anesthesia & Perioperative Care; Anesthesia Recovery Period; Anesthesia, General - adverse effects; Anesthesiology; Antidepressants; Antidepressive Agents - therapeutic use; Case-Control Studies; Central Nervous System Stimulants - therapeutic use; Cerebrospinal fluid; Comorbidity; Dopamine; Electronic health records; Emergency response teams; Female; General anesthesia; Hemodynamic instability; Hospital Rapid Response Team - statistics & numerical data; Humans; Insomnia; Male; Medical personnel; Medical records; Middle Aged; Narcolepsy; Narcolepsy - complications; Narcolepsy - drug therapy; Nervous system; Pain Medicine; Perioperative Period - statistics & numerical data; Respiratory depression; Respiratory Insufficiency - epidemiology; Respiratory Insufficiency - etiology; Retrospective Studies; Risk Factors; Sleep apnea; Sleep Apnea, Obstructive - epidemiology; Sleep disorders; Surgical Procedures, Operative - adverse effects; Task forces; Tertiary Care Centers
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2017.04.008

Abstract Study objective To compare the perioperative outcomes between patients with narcolepsy and matched controls undergoing anesthetic management. Design Retrospective 2:1 matched study design. Setting Large tertiary medical center. Patients Narcoleptic patients who underwent general anesthesia from January 1, 2011, through September 30, 2015, were matched with controls by age, sex, and type and year of surgery. Measurements Medical records were reviewed for episodes of respiratory depression during phase I recovery and for other meaningful perioperative outcomes. Main results The perioperative courses of 76 narcoleptic patients and their controls were examined. Compared to controls, narcoleptic patients were more often prescribed central nervous system stimulants (73.7% vs 4.0%, P < 0.001) and antidepressants (46.1% vs 27.6%, P = 0.007) and more often had obstructive sleep apnea (40.8% vs 19.1%, P < 0.001). The intraoperative course was similar. The number of episodes of respiratory depression was not different between patients and controls (5 [6.6%] vs 12 [7.9%], respectively; P = 0.80). Narcoleptic patients had a higher frequency of emergency response team activations (5 of 76 [6.6%]; 95% CI, 2.2%–14.7%) compared to controls (2 of 152 [1.3%]; 95% CI, 0.2%–4.7%) ( P = 0.04). Hemodynamic instability was the indication for all emergency response team activations except 1, which was for a narcoleptic patient who had excessive postoperative sedation and respiratory depression. Conclusions Narcoleptic patients had similar intraoperative courses as the matched controls, including phase I anesthetic recovery. However, they had a higher rate of emergency response team activations than the controls, which suggests that patients with narcolepsy may be at increased perioperative risk.