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

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.

Keywords: Emergency response teams; General anesthesia; Hemodynamic instability; Narcolepsy; Respiratory depression.