Intravenous phenytoin and percutaneous arterial cannulation: the purple-glove syndrome.

propofol and remifentanil has been reported to be successfully used in a patient with narcolepsy who underwent cardiac surgery [6]. The authors of that report considered that perioperative monitoring of the patient’s hypnotic state would have added valuable information, but this kind of monitor was not available in their department [6]. There are limited data about inhalational anaesthesia in narcoleptic patients while there are no reports of using BIS and brain oximetry as adjuncts to the anaesthetic management of patients with narcolepsy. There is one case report in Spanish of using inhalational anaesthesia in Gélineau syndrome and the authors reported postoperative complications due to anaesthesia [9]. We used sevoflurane to maintain general anaesthesia. Although we do not know the impact of narcolepsy on BIS monitoring, we used BIS values to titrate the volatile anaesthetic agent, hoping to decrease our patient’s anaesthetic requirements. We maintained BIS values between 40 and 60 in order to avoid either awareness or prolonged recovery. The surgical procedure lasted 95 min. After discontinuation of general anaesthesia, the BIS values increased from 62 to 97 over a period of 14 min. The patient recovered and was extubated safely. There were no postoperative undesirable events related to general anaesthesia. Brain oximetry was also used for continuous monitoring of the regional cerebral oxygen saturation. We observed no significant changes in the intraoperative rRSO2 values as well as in the postoperative EEG when compared to the preoperative rRSO2 values and EEG. For the management of this narcoleptic patient, we avoided preoperative benzodiazepines, kept opioid analgesics to a minimum and used inhalational anaesthesia with sevoflurane. The anaesthetic technique was uneventful. Since non-invasive brain monitoring is harmless and might provide some information, we used BIS and cerebral oximetry despite the lack of evidence-based data of this monitoring in narcolepsy.