We assessed the utility of using BIS for monitoring a possible narcolepsy-cataplexy episode and whether a distinctive BIS profile could offer an early warning of an impending narcoleptic/ cataplectic spell. 4 We chose the BIS to monitor a patient with a long history of narcolepsy-cataplexy undergoing surgery under regional anesthesia because his EEG-derived BIS could possibly reflect the EEG changes of a potential narcolepsy episode, whereas monitoring of electromyographic (EMG) activity in decibel (dB) could offer an additional advantage of possibly predicting an ensuing cataplectic spell with its associated hazards of complete loss of muscle tone. Among the currently available monitors, the Bispectral Index (BIS) was shown to correlate to various conditions that could influence the EEG. Numerous electroencephalographic (EEG)-derived cerebral monitors are used in clinical practice for monitoring the effects of anesthetic/hypnotic drugs. However, regional anesthesia also seems to entail considerable risks to narcoleptic patients as two narcoleptic/ cataplectic spells were reported in a patient who underwent surgery under spinal anesthesia. The interactions of inhaled anesthetics with drugs used to treat narcolepsy 2 have also been studied. Postoperative complications after inhaled anesthesia have been reported in a narcoleptic patient who had increased sensitivity to general anesthetics.
1 Due to the rarity of the syndrome, guidelines for the anesthetic management and/or monitoring of patients with narcolepsy during surgery have not been established. Narcolepsy or Gélineau syndrome is a chronic sleep disorder of unknown etiology characterized by uncontrollable attacks of deep sleep and is typically associated with cataplexy (sudden complete loss of muscle tone). BIS monitoring is a simple method that could offer an early warning of an imminent episode, with its associated hazards, in patients with narcolepsy-cataplexy undergoing surgery under regional anesthesia. The purpose of presenting this report is to emphasize the fact that narcoleptic patients can still run the risk of loss of consciousness with atonia under regional anesthesia, and such an undesirable complication cannot be under-estimated. This was followed by a second “continuous low-vigilance” phase of BIS around 75 with low electromyographic activity, ending with a third “nonresponsive vigilance” phase of a full-blown narcolepsy-cataplexy episode of BIS around 45 with complete loss of muscle power. The patient went through three stages: first a prodromal “intermittent low-vigilance” phase interrupted by high electromyographic activity. We recorded both hemispheres, using two synchronized BIS-XP monitors, during a narcolepsy-cataplexy episode in a 57-yr-old male patient undergoing lower limb surgery under femoral nerve block regional anesthesia. We assessed the utility of using BIS for monitoring a possible narcolepsy-cataplexy episode and whether a distinctive BIS profile might offer an early warning of an impending narcoleptic/cataplectic spell. The Bispectral Index (BIS), an electroencephalographic-derived cerebral monitor, used for monitoring the effects of anesthetic/hypnotic drugs was shown to correlate to various conditions that could influence the eletroencephalogram. Narcolepsy or Gélineau syndrome is an extremely incapacitating chronic sleep disorder of unknown etiology that is characterized by uncontrollable attacks of deep sleep and is typically associated with cataplexy sudden loss of muscle tone.
0 kommentar(er)
