{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T12:25:06Z","timestamp":1792844706109,"version":"4.5.0"},"reference-count":14,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:p>Kleine-Levin syndrome (KLS) is a rare sleep disorder characterized by periodic hypersomnia and behavioral or cognitive disturbances. Although prolonged emergence from general anesthesia and postoperative hypersomnia may occur in a patient with KLS, there is little information about the safe anesthetic management of these patients. We describe the case of a 22-year-old female previously diagnosed with KLS who was scheduled to have her third molars extracted under general anesthesia. Because the patient had symptoms of periodic hypersomnia and hyperphagia, the surgery was scheduled during a KLS crisis interval. General anesthesia was induced with propofol, remifentanil, and rocuronium, and maintained with desflurane and remifentanil. To prevent overuse of anesthetic agents, an electroencephalogram (EEG)-based depth of anesthesia monitor (SedLine; Masimo Corporation) was used intraoperatively. A neuromuscular monitor was also used to carefully titrate use of a neuromuscular blocking agent. After surgery, sugammadex was administered, and the patient quickly emerged within 10 minutes, as also confirmed by the EEG monitor. She had no KLS recurrence postoperatively. When anesthetizing patients with KLS, an EEG-based depth of anesthesia monitor and neuromuscular monitor may be warranted to ensure complete emergence from general anesthesia. In addition, elective surgery should be planned during crises intervals.<\/jats:p>","DOI":"10.2344\/anpr-68-03-11","type":"journal-article","created":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T12:11:47Z","timestamp":1649074307000},"page":"39-41","source":"Crossref","is-referenced-by-count":2,"title":["General Anesthetic Management of a Patient With Kleine-Levin Syndrome"],"prefix":"10.2344","volume":"69","author":[{"given":"Masatoshi","family":"Fujita","sequence":"first","affiliation":[{"name":"Division of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Mizuta","sequence":"additional","affiliation":[{"name":"Division of Dento-oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1191","published-online":{"date-parts":[[2022,4,4]]},"reference":[{"key":"2022040416094223900_i0003-3006-69-1-39-b01","doi-asserted-by":"crossref","unstructured":"Kleine\n              W.\n            \n          \n          Periodische Schlafsucht.\n\t\t\t\t\tMonatsschrift f\u00fcr Psychiatrie und Neurologie.\n\t\t\t\t\t1925;\n\t\t\t\t\t57:\n\t\t\t\t\t285\u2013\n\t\t\t\t\t320.","DOI":"10.1159\/000190427"},{"key":"2022040416094223900_i0003-3006-69-1-39-b02","doi-asserted-by":"crossref","unstructured":"Levin\n              M.\n            \n          \n          Periodic somnolence and morbid hunger: a new syndrome.\n\t\t\t\t\tBrain.\n\t\t\t\t\t1936;\n\t\t\t\t\t59:\n\t\t\t\t\t494\u2013\n\t\t\t\t\t504.","DOI":"10.1093\/brain\/59.4.494"},{"key":"2022040416094223900_i0003-3006-69-1-39-b03","doi-asserted-by":"crossref","unstructured":"de Oliveira\n              MM,\n            \n            \n              Conti\n              C,\n            \n            \n              Prado\n              GF.\n            \n          \n          Pharmacological treatment for Kleine-Levin syndrome.\n\t\t\t\t\tCochrane Database Syst Rev.2016;\n\t\t\t\t\tCD006685.","DOI":"10.1002\/14651858.CD006685.pub4"},{"key":"2022040416094223900_i0003-3006-69-1-39-b04","doi-asserted-by":"crossref","unstructured":"de Araujo Lima\n              TF,\n            \n            \n              da Silva Behrens\n              NS,\n            \n            \n              Lopes\n              E,\n            \n            et al.\n\t\t\t\t\t\n          Kleine-Levin syndrome: a case report.\n\t\t\t\t\tSleep Sci.\n\t\t\t\t\t2014;\n\t\t\t\t\t7:\n\t\t\t\t\t122\u2013\n\t\t\t\t\t125.","DOI":"10.1016\/j.slsci.2014.09.001"},{"key":"2022040416094223900_i0003-3006-69-1-39-b05","doi-asserted-by":"crossref","unstructured":"Das\n              S,\n            \n            \n              Gupta\n              R,\n            \n            \n              Dhyani\n              M,\n            \n            \n              Raghuvanshi\n              S.\n            \n          \n          Kleine-Levin syndrome: a case report and review of literature.\n\t\t\t\t\tPediatr Neurol.\n\t\t\t\t\t2014;\n\t\t\t\t\t50:\n\t\t\t\t\t411\u2013\n\t\t\t\t\t416.","DOI":"10.1016\/j.pediatrneurol.2014.01.003"},{"key":"2022040416094223900_i0003-3006-69-1-39-b06","unstructured":"Mar\u010di\u0107\n              M,\n            \n            \n              Mar\u010di\u0107\n              L,\n            \n            \n              Titli\u0107\n              M.\n            \n          \n          A case of Kleine-Levin syndrome: diagnostic and therapeutic challenge.\n\t\t\t\t\tActa Med Iran.\n\t\t\t\t\t2018;\n\t\t\t\t\t56:\n\t\t\t\t\t62\u2013\n\t\t\t\t\t66."},{"key":"2022040416094223900_i0003-3006-69-1-39-b07","doi-asserted-by":"crossref","unstructured":"Doyle\n              A,\n            \n            \n              Wilkinson\n              D.\n            \n          \n          Day case general anaesthesia in a patient with narcolepsy.\n\t\t\t\t\tAnaesthesia.\n\t\t\t\t\t2008;\n\t\t\t\t\t63:\n\t\t\t\t\t880\u2013\n\t\t\t\t\t882.","DOI":"10.1111\/j.1365-2044.2008.05501.x"},{"key":"2022040416094223900_i0003-3006-69-1-39-b08","doi-asserted-by":"crossref","unstructured":"Arnulf\n              I,\n            \n            \n              Zeitzer\n              JM,\n            \n            \n              File\n              J,\n            \n            \n              Farber\n              N,\n            \n            \n              Mignot\n              E.\n            \n          \n          Kleine-Levin syndrome: a systematic review of 186 cases in the literature.\n\t\t\t\t\tBrain.\n\t\t\t\t\t2005;\n\t\t\t\t\t128:\n\t\t\t\t\t2763\u2013\n\t\t\t\t\t2776.","DOI":"10.1093\/brain\/awh620"},{"key":"2022040416094223900_i0003-3006-69-1-39-b09","doi-asserted-by":"crossref","unstructured":"Usuda\n              M,\n            \n            \n              Kodaira\n              M,\n            \n            \n              Ogawa\n              Y,\n            \n            \n              Kanbayashi\n              T,\n            \n            \n              Yanagisawa\n              S,\n            \n            \n              Sekijima\n              Y.\n            \n          \n          Fluctuating CSF hypocretin-1 levels in mild brain trauma-induced Kleine-Levin syndrome.\n\t\t\t\t\tJ Neurol Sci.\n\t\t\t\t\t2018;\n\t\t\t\t\t391:\n\t\t\t\t\t10\u2013\n\t\t\t\t\t11.","DOI":"10.1016\/j.jns.2018.05.011"},{"key":"2022040416094223900_i0003-3006-69-1-39-b10","doi-asserted-by":"crossref","unstructured":"Rezvanian\n              E,\n            \n            \n              Watson\n              NF.\n            \n          \n          Kleine-Levin syndrome treated with clarithromycin.\n\t\t\t\t\tJ Clin Sleep Med.\n\t\t\t\t\t2013;\n\t\t\t\t\t9:\n\t\t\t\t\t1211\u2013\n\t\t\t\t\t1212.","DOI":"10.5664\/jcsm.3176"},{"key":"2022040416094223900_i0003-3006-69-1-39-b11","doi-asserted-by":"crossref","unstructured":"Nishikuni\n              K,\n            \n            \n              Oliveira\n              MF,\n            \n            \n              Takahashi\n              LR,\n            \n            \n              Rotta\n              JM.\n            \n          \n          Transient Kleine-Levin syndrome following a neuroendoscopic procedure.\n\t\t\t\t\tJ Neuropsychiatry Clin Neurosci.\n\t\t\t\t\t2014;\n\t\t\t\t\t26:\n\t\t\t\t\tE53\u2013\n\t\t\t\t\tE55.","DOI":"10.1176\/appi.neuropsych.13080192"},{"key":"2022040416094223900_i0003-3006-69-1-39-b12","doi-asserted-by":"crossref","unstructured":"Mesa\n              A,\n            \n            \n              Diaz\n              AP,\n            \n            \n              Frosth\n              M.\n            \n          \n          Narcolepsy and anesthesia.\n\t\t\t\t\tAnesthesiology.\n\t\t\t\t\t2000;\n\t\t\t\t\t92:\n\t\t\t\t\t1194\u2013\n\t\t\t\t\t1196.","DOI":"10.1097\/00000542-200004000-00040"},{"key":"2022040416094223900_i0003-3006-69-1-39-b13","doi-asserted-by":"crossref","unstructured":"Morimoto\n              Y,\n            \n            \n              Nogami\n              Y,\n            \n            \n              Harada\n              K,\n            \n            \n              Shiramoto\n              H,\n            \n            \n              Moguchi\n              T.\n            \n          \n          Anesthetic management of a patient with narcolepsy.\n\t\t\t\t\tJ Anesth.\n\t\t\t\t\t2011;\n\t\t\t\t\t25:\n\t\t\t\t\t435\u2013\n\t\t\t\t\t437.","DOI":"10.1007\/s00540-011-1127-2"},{"key":"2022040416094223900_i0003-3006-69-1-39-b14","doi-asserted-by":"crossref","unstructured":"Drover\n              D,\n            \n            \n              Ortega\n              HR.\n            \n          \n          Patient state index.\n\t\t\t\t\tBest Pract Res Clin Anaesthesiol.\n\t\t\t\t\t2006;\n\t\t\t\t\t20:\n\t\t\t\t\t121\u2013\n\t\t\t\t\t128.","DOI":"10.1016\/j.bpa.2005.07.008"}],"container-title":["Anesthesia Progress"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/meridian.allenpress.com\/anesthesia-progress\/article-pdf\/69\/1\/39\/3036856\/i0003-3006-69-1-39.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/meridian.allenpress.com\/anesthesia-progress\/article-pdf\/69\/1\/39\/3036856\/i0003-3006-69-1-39.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T14:51:18Z","timestamp":1705589478000},"score":1,"resource":{"primary":{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/69\/1\/article-p39.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,1]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,4,4]]},"published-print":{"date-parts":[[2022,4,1]]}},"URL":"https:\/\/doi.org\/10.2344\/anpr-68-03-11","relation":{},"ISSN":["1878-7177","0003-3006"],"issn-type":[{"value":"1878-7177","type":"electronic"},{"value":"0003-3006","type":"print"}],"subject":[],"published":{"date-parts":[[2022,4,1]]}}}