Modafinil's effects on recovery from sedation and anesthesia

¶ … Modafinil on the rate of recovery after general anesthesia before the work of Larijani et al. (2004) are rare. However, after the publication of their article, a series of articles on Modafinil followed. Galvin et at., (2010) carried out a study to prove that modafinil can effectively reduce the level of patient-reported tiredness that is experienced after sedation or analgesia. Their article however was an improvement on the work of Larijani since it also investigated the proposition that in the process of reducing the level of tiredness, the drug has no improvement on the psychomotor skills of the patient.Their article was written against a backdrop of information that suggest that the early recovery of patients who have been sedated as well as after anesthesia in the ambulatory practice. The aim of their study was to conclusively assess if modafinil employed for the treatment of narcolepsy significantly improves the recovery from analgesia/sedation. Their methodology involved the random assignment of patients who have been scheduled to undergo extracorporeal shock wave lithotripsy to one of a total of four groups. The methodology involved the administration of a combination of the drug, fentanyl/midazolam with placebo or modafinil to two groups. The remaining two groups The two groups were then compared digital by means of digital symbol substitution test (DSST), observer scale of sedation and analgesia (OAA/S),Aldete score and trail making test (TMT).The secondary variables were captured using the verbal rating scale (VRS) scores. This included variables such as energy, dizziness as well as tiredness all of which were recorded prior to and after the treatment. The outcome of their work indicated that 67% of the patients managed to complete the study successfully.The groups never had any statistically significant difference for the DSST between all the groups. For the TMT, Aldrete and OAA/S scores, no significant statistical difference was noted. The work of Galvin et al., (2010) concluded that Modafinil effectively reduces the level of patient-reported tiredness after sedation bit with no improvement on the psychomotor skills of the patient.This study therefore corroborated the work of Larijani et al.,(2004) since it indicates that the drug improves recovery of patients after anesthesia-based treatment. Doyle and Wilkinson (2008) reported a patient who was suffering from narcolepsy while undergoing a gynaecological surgery while under general anaesthesia.The symptoms in the patient were pointed out by the duo to be well controlled by the administration of modafinil therapy. The modafinil therapy was omitted at the time of her surgery.Modafinil is pointed out to be a unique drug with various interactions with multiple anaesthetic agents. Narcolepsy is a very chronic neurological condition which is characterized by uncontrollable and recurrent brief episodes of deep sleep (Dorland,2000).Modafinil has been pointed out to treat the excessive sleepiness that affects narcoleptic patients as pointed out by the U.S. Modafinil in Narcolepsy Multicenter Study Group (1998).Kumar (2008) conducted an evidence-based review of the approved as well as the investigational applications of Modafinil. He pointed out that the drug is approved by FDA for use for same-day surgery after general surgery.He pointed out that a single dose of Modafinil was administered and compared against placebo. Morimoto et al. (2011) presented a report on the management of a patient suffering from narcolepsy using anesthetics. Modafinil was used to control narcolepsy. Valentino and Foldvary-Schaefer (2007) studied the effects of Modafinil as a medication for treating excessive sleepiness.

A critique of the article "Modafinil improves recovery after general anesthesia" by Larijani et al. (2004)

Summary

The article by Larijani et (2004) discusses a situation on how Modafinil was studied in regards to how it improves the rate of recovery after exposure to general anesthesia. The article indicates that the recovery of a patient from general anesthesia usually involves sedation, fatigue, drowsiness as well as a general lack of energy. Modafinil is a drug that promotes wakefulness and has been approved by FDA for use in patients suffering from excessive daytime sleepiness as a consequence of narcolepsy. The work evaluated the influence of modafinil (200 mg) doses and placebo in various patients who were recovering from the effect of general anesthesia. A total of 34 subjects were participants in this study in a randomized as well as a double-blind study were duly approved by their IRB. The study involved the process of asking preoperative patients to rate the symptoms that they had earlier on experienced within 24 hours via a verbal analogue scale (VAS) ranging from 0 to 10. Discrete scales too were also indicated. The study involved the process of determining postoperatively whether a patient was capable of tolerating an oral intake to warrant or meet the laid down institutional discharge criteria prior to the administration of the drugs (Modafinil 200 mg 0or the placebo) with a sip of water. The evaluation of the post discharge symptoms was carried out after 24 hours. The results indicated that the patients who were in the placebo group said that they experienced a significant level of postoperative fatigue (8 [3.3] against 1.4 [1.8]), they also reported exhaustion (4.3 [3.3] against 2.4 [3.1]) as well as a feeling of being worn out and exhaustion (4.7 [3.6] against 2.9 [2.4]).In the placebo group, there were reports of severe fatigue with 65% feeling fatigue against 2%. The study generally indicated that patients who were recovering from the effects of general anesthesia can gain significant benefits from the administration of Modafinil.

Strengths of the study

The strengths of this article are numerous. This is because a review of all literature in regard to the effects of Modafinil on recovery from the effects of anesthesia reveals that it is the pioneering document that has details on this proposition.In other words, it was the first article to address the use of Modafinil as a drug for improving recovery from anesthesia after surgery such as narcolepsy. The article also used a control (placebo tablets) so as to ensure that the true effects of Modafinil are noted and recorded. The fact that the control was employed is a plus in the methodology and conceptual framework that was used in the study. The use of data analysis techniques in the evaluation of the exactness of the proposition is yet again strength of the article.

Reviewer recommendations

The authors used statistical analysis in an effort of controlling the effects of contamination. The study however clearly lacks external validity needed to generalize beyond the sample chosen.

Future directions

The future of research in regard to the effects of Modafinil on the rate of recovery is dependent on the extensive review of the deficiencies in the extant literature. The improvements in computing power and biomedical technologies should be used in mapping out the exact mechanism and routes that the drug follows in order for its useful effects to be realized. More studies should also be dedicated to the study of the negative effects or rather side effects of Modafinil in the acceleration of recovery from anesthesia. The exact mechanisms should also be explained in order to provide a framework for formulating policies to be used in the administration of the drug to patients of all ages. The age variable should also be factored in all of the future studies.

Conclusion

The study of the effects of Modafinil is important for ensuring that narcoleptic patients receive a quick recovery from the effects of anesthesia. It is however important for administration of the drug to be done with caution in order to avoid any negative effects of the drug on the patients. More research should therefore be carried out so as to ensure that the drug does not cause any harm to the persons to whom it is administered. Modafinil is therefore an important drug for ensuring the quick recovery of patients who have undergone a same-day surgery.