Airway Rescue and Extended Recovery in Prone Nonintubated Anesthesia: A Narcolepsy Type 2 Case Report

Narcolepsy presents unique perioperative challenges, particularly during postoperative recovery, while the prone position limits airway access. We present the case of a 32-year-old woman with untreated narcolepsy who underwent prone jackknife hemorrhoidectomy after declining neuraxial anesthesia. Following preoperative counseling and awake positioning, nonintubated intravenous anesthesia was maintained with remimazolam and propofol during spontaneous ventilation with high-flow nasal oxygen. A stop-and-supine airway rescue plan was prepared. She regained full orientation 13 min following anesthetic discontinuation and reported no worsening of daytime sleepiness or unintended sleep episodes during one-month follow-up. Airway rescue, emergence, and narcolepsy-related recovery were assessed as separate perioperative considerations.