Aspiration Risk, Elective Surgery, Fasted Diabetic Patients, Gastric Residual Volume, Metoclopramide
Conditions
Brief summary
This study aimed to evaluate the effect of metoclopramide on preoperative gastric emptying in diabetic patients.
Detailed description
Perioperative aspiration of gastric contents is a rare but serious complication of anesthesia. Aspiration pneumonia is associated with significant morbidity, including prolonged mechanical ventilation, and carries a risk of mortality as great as 5%. Point-of-care (POC) gastric ultrasound has gained popularity in recent times. It has been adapted in the field of anesthesiology gradually to make the clinical decision before anesthetizing patients where the fasting status is uncertain and in emergency patients where surgery is mandated. Metoclopramide, a medication used for diabetic gastroparesis, is a cholinergic agent that acts by increasing the release of acetylcholine at the neuromuscular junction within the gastric wall. Further, metoclopramide has antidopaminergic properties that inhibit dopamine-induced gastric smooth muscle relaxation, and it also penetrates the blood-brain barrier and binds to medullary chemoreceptors.
Interventions
DRUGMetoclopramide
Diabetic patients received a single IV dose of metoclopramide 10 mg (2 mL) administered 30-60 minutes prior to POC gastric ultrasound assessment, to allow for peak prokinetic effect.
Sponsors
Kafrelsheikh University
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age from 18 to 65 years old. * Both sexes. * American Society of Anesthesiologists (ASA) physical status I-II. * Underwent elective surgery.
Exclusion criteria
* Patients taking drugs that affect gastric motility. * Patients with renal failure. * Hypothyroidism. * Obesity \[body mass index (BMI) \> 30kg/m2\]. * Connective tissue disorders. * History of gastrointestinal surgery. * Those with steroid-induced hyperglycemia. * Pregnancy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Antral cross-sectional area | 30 minutes after drug administration | Antral cross-sectional area (CSA) was measured by Point-of-Care (POC) ultrasound (cm²). Antral CSA was calculated using the standard ellipse formula: Antral CSA (cm²) = π/4 × antero-posterior (AP) (cm) × cranio-caudal (CC) (cm) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Gastric volume | 30 minutes after drug administration | Gastric volume (GV) was estimated using the validated formula described by Perlas et al.: GV (mL) = 27.0 + 14.6 × right lateral decubitus (RLD)-cross-sectional area (CSA)- 1.28 × Age |
| Antral gastric grade | 30 minutes after drug administration | Qualitative grading of gastric content was performed as follows, using the validated Perlas classification: Grade 0 - empty antrum in both semi-sitting (SS) and right lateral decubitus (RLD) positions (estimated GRV ≤0 mL, minimal aspiration risk); Grade 1 - fluid visible in RLD position only \[estimated gastric residual volume (GRV) approximately 100-300 mL, low-to-intermediate risk\]; Grade 2 - fluid visible in both SS and RLD positions (estimated GRV \>300 mL, high aspiration risk). |
| Fasting glucose | 30 minutes after drug administration | Post-intervention fasting serum glucose was measured. |
Countries
Egypt
Outcome results
None listed