Document Type : Original Article(s)
Authors
1 Associate Professor, Research Center of Anesthesia and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Research Center of Anesthesia and Critical Care, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: Pulmonary complications following cardiopulmonary bypass (CPB) pump during coronary artery bypass grafting (CABG) are relatively common and the incidence of cognitive dysfunction is reported as ranging in rate from 30% to 80% in the early postoperative period. The purpose of this study was to assess the effect of modafinil administration on the prevention of pulmonary and cerebral complications and shortening the hospital stay after CABG surgery.METHODS: This randomized double-blind intervention-controlled clinical trial was performed on 74 patients (37 in the intervention group and 37 in the control group) undertaking CABG surgery. The intervention group was orally treated with doses of 200 mg of modafinil on the day of surgery, and on the morning of the day after surgery, the second dose of modafinil 200 mg was given to patients. The control group underwent a placebo with the same intervals.RESULTS: Administration of modafinil in intervention group significantly decreased the time to reach consciousness (P = 0.001), ventilator time in intensive care unit (ICU) (P < 0.001), length of stay in ICU (P = 0.009), duration of hospitalization (P = 0.008), and arterial blood carbon dioxide pressure (PaCO2) (P = 0.047). In the intervention group, no patients with delirium, agitation, respiratory depression, non-invasive respiratory ventilation, and endotracheal re-intubation were observed.CONCLUSION: Modafinil tablet as a respiratory and brain stimulant through the central nervous system (CNS) can improve the quality of breathing and arterial blood gases (ABGs) and also can increase the level of consciousness and shorten the recovery time.
Keywords
- Kaplan JA. Kaplan's cardiac anesthesia: In cardiac and noncardiac surgery. 7th ed. Philadelphia, PA: Elsevier Health Sciences; 2017. p. 1358-62.
- Bohm SH, Thamm OC, von SA, Bangert K, Langwieler TE, Tusman G, et al. Alveolar recruitment strategy and high positive end-expiratory pressure levels do not affect hemodynamics in morbidly obese intravascular volume-loaded patients. Anesth Analg 2009; 109(1): 160-3.
- Freitas ER, Soares BG, Cardoso JR, Atallah AN. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft. Cochrane Database Syst Rev 2007; (3): CD004466.
- Zarbock A, Mueller E, Netzer S, Gabriel A, Feindt P, Kindgen-Milles D. Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: A prospective, randomized, controlled trial in 500 patients. Chest 2009; 135(5): 1252-9.
- Ferrer M, Sellares J, Torres A. Noninvasive ventilation in withdrawal from mechanical ventilation. Semin Respir Crit Care Med 2014; 35(4): 507-18.
- NHS London. Chronic Obstructive Pulmonary Disease (COPD): Factsheet - Tower Hamlets Joint Strategic Needs Assessment 2010-2011 [Online]. [cited 2011]; Available from: URL: https://democracy.towerhamlets.gov.uk/documents/s24101/COPD%20JSNA%20Factsheet.pdf
- Marchetti N, Criner GJ, Albert RK. Preventing acute exacerbations and hospital admissions in COPD. Chest 2013; 143(5): 1444-54.
- Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124(23): e652-e735.
- GOV UK. Modafinil (Provigil): Now restricted to narcolepsy [Online]. [cited 2014 Dec 11]; Available from: URL: https://www.gov.uk/drug-safety-update/modafinil-provigil-now-restricted-to-narcolepsy
- Penaloza RA, Sarkar U, Claman DM, Omachi TA. Trends in on-label and off-label modafinil use in a nationally representative sample. JAMA Intern Med 2013; 173(8): 704-6.
- Larijani GE, Goldberg ME, Hojat M, Khaleghi B, Dunn JB, Marr AT. Modafinil improves recovery after general anesthesia. Anesth Analg 2004; 98(4): 976-81.
- Parnell H, Quirke G, Farmer S, Adeyemo S, Varney V. The successful treatment of hypercapnic respiratory failure with oral modafinil. Int J Chron Obstruct Pulmon Dis 2014; 9: 413-9.
- Carr ZJ, Vells B, Wood BR, Lowery JD, Rogers AM, Kunselman AA, et al. A double blind randomized placebo controlled pilot study of single-dose preoperative modafinil for functional recovery after general anesthesia in patients with obstructive sleep apnea. Medicine (Baltimore) 2018; 97(39): e12585.
- Oommen JK, Wang S, Axelrad A, Hanna A, Muralidharan R, Osias J, et al. Efficacy of modafinil, methylphenidate, amantadine, and zolpidem in consciousness recovery in intensive care unit patients with traumatic brain injury. P T 2019; 44(11): 676-81.
- Bivard A, Lillicrap T, Krishnamurthy V, Holliday E, Attia J, Pagram H, et al. MIDAS (Modafinil in Debilitating Fatigue After Stroke): A randomized, double-blind, placebo-controlled, cross-over trial. Stroke 2017; 48(5): 1293-8.
- Gajewski M, Weinhouse G. The use of modafinil in the intensive care unit. J Intensive Care Med 2016; 31(2): 142-5.
- Li J, Yang X, Zhou F, Liu C, Wei Z, Xin F, et al. Modafinil enhances cognitive, but not emotional conflict processing via enhanced inferior frontal gyrus activation and its communication with the dorsomedial prefrontal cortex. Neuropsychopharmacology 2020; 45(6): 1026-33.
)