Dexmedetomidine, Gastric Emptying, Ultrasound, Laparoscopic Cholecystectomy
Conditions
Brief summary
The aim of this study is to evaluate the effect of dexmedetomidine on gastric emptying assessed by gastric ultrasound in patients undergoing laparoscopic cholecystectomy.
Detailed description
Delayed return of normal gastrointestinal function, and postoperative nausea and vomiting (PONV) are common adverse events of laparoscopic cholecystectomy under general anesthesia. Sympathetic stimulation, intra-abdominal carbon dioxide insufflation, and the consequent visceral peritoneal irritation are all contributing factors. In addition, anesthetic agents and opioids can also have a harmful impact on gastric emptying. Dexmedetomidine, a potent and highly selective alpha-2 adrenoreceptor agonist, is frequently employed as an anesthetic adjunct in surgical procedures. By reducing the surgical stress response through its central sympatholytic and anti-inflammatory effects, dexmedetomidine offers distinct organ protection. Furthermore, its opioid-sparing effect reduces the need for perioperative analgesics. A recent meta-analysis reported a positive impact of perioperative dexmedetomidine use on postoperative gastrointestinal function by shortening the time to pass flatus.The use of gastric ultrasound to assess cross-sectional area of the stomach and it's volume may provide better insight into the effect of dexmedetomidine on gastrointestinal function.
Interventions
DRUGDexmeditomidine
Patients who will receive IV infusion of (0.2 µg/kg/hr dexmeditomidine).
DRUGNormal saline
Patients who will receive IV infusion of normal saline, at the same rate of dexmedetomidine infusion.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 21 to 65 years old. * Both sexes. * American Society of Anesthesiologists (ASA) physical status I-II. * Undergoing elective laparoscopic cholecystectomy surgery
Exclusion criteria
* Patient's refusal. * Patients with abnormalities in gastrointestinal tracts (including previous esophageal or gastric surgery, tumors or stricture). * Failure to follow preoperative fasting guidelines. * Patients with a body mass index ≥ 35 * Patients on regular treatment of antacids or prokinetic. * Presence of history of disease causing an increase in the incidence of delayed gastric emptying such as: diabetes mellitus, obesity or electrolyte disturbances. * Pregnancy. * Presence of hepatic or renal dysfunction. * Presence of existing condition causing bradycardia such as heart block, or patients on regular calcium channel blockers or beta blockers.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of gastric volume with the aid of ultrasound | 3 hours postoperatively | Gastric ultrasound will be used to measure gastric volume through cross-sectional area before induction, and 1 and 3 hours postoperatively. Estimated gastric volumes will be calculated using a previously validated formula: gastric volume (mL) = 27.0 + (14.6 ×CSA) - (1.28 ×Age). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Measurement of cross-sectional area of gastric antrum | 3 hours postoperatively | Gastric ultrasound will be used to measure gastric volume through cross sectional area. Gastric antrum images will be obtained using 2 - 5 MHz curvilinear probe which will be positioned in the sagittal plane of epigastric region. All imaging attempts will be carried out at 2 positions: semi-recumbent and right lateral. Images of gastric antrum will be obtained by identifying the following landmarks - left anterior lobe of the liver anteriorly, inferior vena cava and abdominal aorta posteriorly. |
| Gastric content assessment. | 3-hour post-operative marks in post anesthesia care unit (PACU). | We initially will assess the nature (nil, fluid, or solid particles) of the gastric contents. An empty stomach will appear as the antrum walls juxtaposed with a fat appearance. The clear fluid will appear as homogeneously hypoechoic liquid content without residues. Quantitative assessment of gastric contents will be carried out by measuring the anteroposterior (AP) and craniocaudal (CC) diameters of the gastric antrum 3 times for each ultrasonographic assessment. The mean value of the 3 will be recorded. The universally accepted 2 -diameter -method will be used for the measurement of antrum cross-sectional area (CSA) because it's simple and easy to perform. It will be assessed before induction of anesthesia and at the 1-hour and 3-hour post-operative marks in post anesthesia care unit (PACU). |
| Relation between gastric cross-sectional area to time of passage of flatus | 24 hours postoperatively | Time of passage of flatus will be recorded. |
Countries
Egypt
Outcome results
None listed