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Background and Aims Narcolepsy is a central hypersomnolence disorder characterized by excessive daytime sleepiness diagnosed by multiple sleep latency test coupled with polysomnography. In narcolepsy type 2, cataplexy is not present and hypocretin levels are normal or have not been evaluated. These patients undergoing surgery are at risk of several adverse events, such as worsening symptoms and perioperative complications. Obstetric patients may be at increased risk during their pregnancy and deliver.

Methods A 36-year-old pregnant woman, ASA-PS II, was scheduled for a c-section due to pelvic presentation. She had type II narcolepsy, obsessive compulsive disorder and depressive disorder, medicated with sertraline. She was intolerant to modafinil. She was a tobacco and cannabis smoker, which she suspended in the first trimester. Pregnancy was uneventful.

Results She received a sequential combined spinal epidural anaesthesia, and heavy bupivacaine and sufentanil were administered intrathecally. She needed ephedrine after spinal anaesthesia, in a total of 40mg. Intraoperative period was otherwise uneventful. Post-operative analgesia avoided opioid administration and privileged nonsteroidal anti-inflammatory drugs, paracetamol, and epidural analgesia with ropivacaine boluses, and she reported no pain.

Conclusions The anaesthesiologist must be aware of the implications surrounding narcoleptic patients. Perioperative complications may include altered sensitivity to anaesthetic agents, delayed emergence from anaesthesia, intraoperative awareness, and uncontrolled pain. Given the scarcity of cases described in the literature, it becomes relevant to continue sharing clinical experiences with these patients.