Delayed Emergence From Anesthesia After Esophagogastroduodenoscopy/Colonoscopy in an Adult Patient With Narcolepsy

Endoscopic procedures such as esophagogastroduodenoscopy and colonoscopy are commonly performed under propofol-based anesthesia due to its rapid onset and recovery. However, delayed emergence is a rare but clinically significant concern, especially in patients with neurological disorders such as narcolepsy. We report a 28-year-old woman (body mass index: 35.8) who exhibited delayed emergence approximately 10 hours after esophagogastroduodenoscopy and colonoscopy for evaluation of iron deficiency anemia. She received lidocaine 80 mg IV, followed by propofol 900 mg IV over 45 minutes. Postprocedure, she remained sedated despite unremarkable laboratory and neurologic imaging, including head computed tomography angiogram and perfusion studies. She was monitored in the ICU and gradually regained consciousness without intervention. Before discharge, she disclosed a history of narcolepsy, unrecognized preoperatively. This case underscores the importance of thorough preoperative screening for sleep disorders, as narcolepsy can alter anesthetic sensitivity and prolong sedation, necessitating close collaboration between gastroenterologists and anesthesiologists.