Here, we report anesthetic management of a narcoleptic patient undergoing left anterior cruciate ligament (ACL) reconstruction under a combination of total intravenous anesthesia (TIVA) with femoral nerve block. Thus, the combination of general and regional anesthesia may be one of the best options. The desirable anesthetic management of patients with narcolepsy is to decrease the dosage of general anesthetic and analgesic agents and/or use short-acting agents to prevent delayed emergence. Thus, prolonged emergence from general anesthesia would be expected in patients with narcolepsy. In fact, it was reported that intracerebroventricular administration of orexin significantly decreased general anesthesia time in the rat. Therefore, it is possible that activation of orexinergic nervous system decrease anesthesia times. The mechanism of loss of consciousness by general anesthesia partially includes the activation and suppression of endogenous sleep- and wakefulness-promoting pathways. OXergic neurons widely project throughout the central nervous system (CNS) such as the noradrenergic locus coeruleus, the cholinergic basal forebrain, the dopaminergic ventral tegmental area, the serotonergic raphe nuclei, and the histaminergic tuberomammillary nucleus to regulates various physiological functions including not only sleep wakefulness but also analgesia, sympathetic nervous system, feeding behavior, and emotional behavior. Narcolepsy is a neurological disease characterized by excessive sleep during the day, catalepsy, and sleep paralysis due to malfunction of the orexinergic (oxergic) system such as loss of OXergic neurons and deficiency of orexins (Oxs).
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