Reactions 1239 - 14 Feb 2009

Ropivacaine

Narcolepsy-cataplexy episode during regionalanaesthesia?: case report

A 57-year-old man with a long history of a narcolepsy-cataplexy condition developed an episode of narcolepsy/cataplexy during regional anaesthesia with ropivacaine.Bispectral index monitoring (BIS) was used to monitor for apotential narcolepsy-cataplexy episode in order todetermine whether a distinctive BIS profile might be able toprovide an early warning of an impending episode.

BIS monitoring was initiated soon after the man wasadmitted to the operating theatre. He received 0.5%ropivacaine 30mL for femoral nerve block prior to lowerlimb surgery. No sedation was given during the surgery.Twenty minutes after BIS recording was started, hedeveloped a narcolepsy-cataplexy episode [time to onsetfrom drug administration not stated]; he went throughthree stages: a stage of prodromal intermittent lowvigilance (with drifting to high muscular activity), a stage ofcontinuous low vigilance with no muscular activity (BISaround 75), and a stage of full blown narcolepsy-cataplexyinvolving complete nonresponsive vigilance and completecataplectic muscle power loss (BIS around 45 for about halfan hour). There were no interventions during his episode ofnarcolepsy. His BIS increased with emergence from theepisode at the end of surgery. He had a full recovery, andthere did not appear to be any change in the duration orfrequency of his narcolepsy-cataplexy episodespostoperatively.

Author comment: "The purpose of presenting this reportis to emphasize the fact that narcoleptic patients can still runthe risk of loss of consciousness with atonia under regionalanaesthesia, and such an undesirable complication cannot beunder-estimated."Dahaba AA, et al. Bispectral index monitoring of a narcolepsy-cataplexy episodeduring regional anesthesia. Anesthesia and Analgesia 108: 613-615, No. 2, Feb2009 - China 801135554

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Reactions 14 Feb 2009 No. 12390114-9954/10/1239-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved