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AMBULATORY ANESTHESIA

Modafinil Improves Recovery After General Anesthesia

Ghassem E. Larijani, PharmD^*, Michael E. Goldberg, MD^*, Mohammadreza Hojat, PhD, Behnam Khaleghi, MD^*, Jeffrey B. Dunn, MD, and Alex T. Marr, CRNA^*

Departments of *Anesthesiology and Psychiatry, University of Medicine and Dentistry of New Jersey, Cooper Health System, Camden, New Jersey, and the Center for Research in Medical Education, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

Address correspondence and reprint requests to G. E. Larijani, PharmD, Department of Anesthesiology, Cooper Hospital, One Cooper Plaza. Camden, NJ 08103. Address email to larijani-ghassem{at}cooperhealth.edu

Recovery from general anesthesia often involves residual sedation, drowsiness, fatigue, and lack of energy that may last hours to days. Modafinil is a wakefulness-promoting drug approved for patients with excessive daytime sleepiness associated with narcolepsy. We evaluated the effect of single doses of modafinil (200 mg) and placebo in patients recovering from general anesthesia. Thirty-four subjects participated in this prospective, randomized, double-blind study approved by our IRB. Preoperatively, patients were asked to rate various symptoms they had experienced over the previous 24-h using a verbal analog scale (VAS) of 0 to 10 as well as discrete scale when indicated. Postoperatively, once the patient was able to tolerate oral intake and met our institutional discharge criteria, the study drug (modafinil 200 mg or placebo) was administered with a sip of water. Patients were contacted 24 (1) hours after dosing to evaluate postdischarge symptoms. Patients in the placebo group reported significantly more postoperative fatigue (4.8 [3.3] versus 1.4 [1.8]), exhaustion (4.3 [3.3] versus 2.4 [3.1]), or degree of feeling worn out (4.7 [3.6] versus 2.9 [2.4]). Significantly more patients reported moderate to severe fatigue in the placebo group (65% versus 12%). Two major themes of "alertness" and "energy" were expressed by 71% of the patients receiving modafinil versus 18% of those receiving placebo. Patients recovering from general anesthesia can significantly benefit from modafinil.

IMPLICATIONS: Modafinil significantly reduces fatigue and improves feelings of alertness and energy in postoperative patients. Patients recovering from general anesthesia can significantly benefit from modafinil administration.

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