• Alexandre N Cavalcante, Ryan E Hofer, Maja Tippmann-Peikert, Juraj Sprung, and Toby N Weingarten.
• Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States; Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, United States.
• J Clin Anesth. 2017 Sep 1; 41: 120-125.

Study ObjectiveTo compare the perioperative outcomes between patients with narcolepsy and matched controls undergoing anesthetic management.DesignRetrospective 2:1 matched study design.SettingLarge tertiary medical center.PatientsNarcoleptic 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.MeasurementsMedical records were reviewed for episodes of respiratory depression during phase I recovery and for other meaningful perioperative outcomes.Main ResultsThe 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.ConclusionsNarcoleptic 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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