Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve patient psychomotor skills.
BACKGROUND
Early recovery of patients following sedation/analgesia and anesthesia is important in ambulatory practice. The aim of this study was to assess whether modafinil, used for the treatment of narcolepsy, improves recovery following sedation/analgesia.


METHODS
Patients scheduled for extracorporeal shock wave lithotripsy were randomly assigned to one of four groups. Two groups received a combination of fentanyl/midazolam with either modafinil or placebo. The remaining groups received remifentanil/propofol with either modafinil or placebo. Modafinil 200 mg was administered to the treatment group patients 1 h before sedation/analgesia. Groups were compared using the digital symbol substitution test (DSST), trail making test (TMT), observer scale of sedation and analgesia (OAA/S) and Aldrete score. Verbal rating scale (VRS) scores for secondary outcome variables e.g. energy, tiredness and dizziness were also recorded before and after treatment.


RESULTS
Sixty-seven patients successfully completed the study. Groups received similar doses of sedation and analgesic drugs. No statistically significant difference was found for DSST between groups. No significant adverse effects occurred in relation to modafinil. No statistically significant difference between groups was identified for TMT, OAA/S and Aldrete scores. The mean VRS score for tiredness was lesser in the modafinil/fentanyl/midazolam group [1.3 (2.0)] compared with the placebo group [3.8 (2.5)], P=0.02. Such a difference was not found between the remifentanil/propofol groups [placebo 2.6 (2.2) vs. modafinil 3.1(2.7)], p>0.05. Dizziness was greater in the modafinil/remifentanil/propofol group 1.7 (2.0) vs. placebo 0.0 (0.5), p<0.05.


CONCLUSIONS
Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve recovery in terms of objective measures of patient psychomotor skills.
Galvin
E
E
Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands. eilishgalvin@hotmail.com
Boesjes
H
H
Hol
J
J
Ubben
J F
JF
Klein
J
J
Verbrugge
S J C
SJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D001066:Appetite / Q000187:drug effects; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D054810:Deep Sedation; D004244:Dizziness / Q000517:prevention & control; D005221:Fatigue / Q000517:prevention & control*; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D008096:Lithotripsy; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D000077408:Modafinil; D009325:Nausea / Q000517:prevention & control; D009483:Neuropsychological Tests; D010146:Pain / Q000517:prevention & control; D010880:Piperidines / Q000008:administration & dosage; D010919:Placebos; D015742:Propofol / Q000008:administration & dosage; D011595:Psychomotor Agitation / Q000517:prevention & control; D011597:Psychomotor Performance / Q000187:drug effects*; D012063:Relaxation; D000077208:Remifentanil; D012894:Sleep Stages / Q000187:drug effects; D055815:Young Adult
D018685:Anesthetics, Inhalation; D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D010880:Piperidines; D010919:Placebos; D000077208:Remifentanil; D000077408:Modafinil; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol