The effects of Modafinil on the rate of recovery after general anesthesia
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Literature review
Prior to on the study of the effects of 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., (2009) 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., 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 gynecological surgery while under general an aesthesia. 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 anesthetic agents. Narcolepsy is a very chronic neurological condition which is characterized by uncontrollable and recurrent brief episodes of deep sleep. Modafinil has been pointed out to treat the excessive sleepiness that affects narcoleptic patients as pointed out by the US 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.
Abstract
In this article we presents an in-depth critique of the article “Modafinil improves recovery after general anesthesia” by Larijani et al. (2004).WE focus our analysis on the way the authors have handled matters related to the definition of the problem, the literature review, the theoretical or conceptual framework employed, research variables, hypotheses, sampling, research design, data collection, data analysis and the interpretation and the analysis of the findings. This is compared to the literature that existed before and after the publication of the article being critiqued.
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. Modafilin 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.
Reviewer reactions
In regard to the problem statement, the authors succeeded in defining their problem, the aims and objectives of the research. I however, feel that the objectives of the paper are limited and narrow. The paper should have aimed at showing the exact mechanism that Modafinil follows in order to effectively meet its intended purpose in the subjects. The possible side effects if any of the administration of the drug on the patients should have also been evaluated.
The study lacks an elaborate theoretical or conceptual framework. A theoretical or conceptual framework refers to the structure of the main principles, assumptions as well as rules that are responsible for holding together the various ideas that make up the broader concept under study. The theoretical framework is made up of the problem statement, purpose of the study, review of literature, methodology as well as techniques of data collection and analysis. The conceptual framework is important for this kind of a study as it acts as the maps that provide coherence to the given empirical inquiry. The fact that the study had elements of a conceptual framework with some such as literature review lacking indicates that it is not sufficient to provide coherence to the this study. The lack of a literature review is a serious limitation since a literature review is important in explaining what other scholars have done in the subject area. The lack of a literature review leads to the adoption of a poor conceptual framework and research methodology and variables in particular. The fact that the researchers sort for informed consent prior to the initiation of their work indicates that they are ethical in their conducts. This also indicates that they could have debriefed the patients prior to carrying out their study.
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.
References
Doyle.,A and Wilkinson.,D (2008)Day case general anaesthesia in a patient with narcolepsy.Anaesthesia, 2008, 63, pages 880–882
Galvin E, Boesjes H, Hol J, Ubben JF, Klein J, Verbrugge SJ (2010).Modafinil reduces
Patient-reported tiredness after sedation/analgesia but does not improve patient psychomotor skills. Acta Anaesthesiol Scand. 2010 Feb;54(2):154-61.
Kumar ,R (2008)Approved and Investigational Uses of Modafinil: An Evidence-Based
Review. Drugs 2008; 68 (13): 1803-1839
Larijani GE, Goldberg ME, Hojat M, Khaleghi B, Dunn JB, Marr AT (2004). Modafinil
improves recovery after general anesthesia. Anesth Analg. 2004 Apr;98(4):976-81.
Morimoto Y, Nogami Y, Harada K, Shiramoto H, Moguchi T.(2011).Anesthetic
management of a patient with narcolepsy. J Anesth. 2011 Jun;25(3):435-7.
US Modafinil in Narcolepsy Multicenter Study Group (2008). Randomized trial of
modafinil for the treatment of pathological somnolence in narcolepsy. Ann Neurol. 1998;43:88–97.
