Perioperative anesthetic management of a patient with narcolepsy: a case report

Introduction and importance: Narcolepsy is a chronic neurological disorder that disrupts sleep–wake regulation and poses unique challenges in perioperative anesthetic management. Presentation of case: We report the successful perioperative management of a 21-year-old man with type 1 narcolepsy, accompanied by mild obstructive sleep apnea with an apnea–hypopnea index (AHI) of 14.3 events per hour, who underwent uvulopalatopharyngoplasty. Clinical discussion: Short-acting agents (propofol, remifentanil, and sevoflurane) were administered under continuous bispectral index (BIS) monitoring. Multimodal analgesia with sufentanil, flurbiprofen, and ropivacaine was used to optimize pain control and minimize respiratory risk. The patient recovered without delayed awakening after the primary anesthesia or worsening of narcolepsy symptoms, despite a postoperative bleeding episode requiring reoperation. Conclusion: This case highlights the importance of individualized anesthetic strategies for patients with narcolepsy, emphasizing BIS-guided anesthetic depth control and multimodal analgesia to ensure safe perioperative outcomes.