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In emergencies, it may be necessary to anaesthetize who are not fully starved and consequently at risk of pulmonary aspiration. Pregnancy are recognized to be at increased risk of aspiration compared with non-pregnancy. Prokinetic agents such as metoclopramide can be used to reduce GRV. Metoclopramide is widely used as a prokinetic agent in adults and is licensed for premedication in pregnancy, but its use may be limited by its potential for producing extrapyramidal side effects. Erythromycin is an effective prokinetic agent in adults but there is no work examining its use for premedication in pregnancy. This study compared the effects of erythromycin and metoclopramide on GRV in full-term pregnant women
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group (C) | Sham Comparator | will be receive flavored water in total volume 15 ml |
|
| Group (M) | Active Comparator | will be receive 10 ml of oral metoclopramide (10mg) + 5 ml of flavored water in total volume 15 ml |
|
| Group (E) | Active Comparator | will be receive 10 ml of oral Erythromycin (400mg) + 5 ml of flavored water in total volume 15 ml |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Erythromycin (400mg) | Drug | oral Erythromycin (400mg) |
| |
| metoclopramide (10mg) |
| Measure | Description | Time Frame |
|---|---|---|
| Estimated Gastric volume | (ml/kg) after a six-hour fast using Roukhomovsky's equation after administration of the study drug. | UP TO 6 HOURE |
| Measure | Description | Time Frame |
|---|---|---|
| low-risk stomach six hours after drug administration | number of patient and % | up to 6 hours |
| Perlas grading system | Grade 0 antrum: absent fluid content in both supine and RLD positions Grade 1 antrum: fluid is observed only in the RLD position, but not in the supine position Grade 2 antrum: fluid is observed in both supine and RLD |
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Inclusion Criteria:
Non-laboring pregnant women ≥36 weeks gestational age
Parturient scheduled for elective caesarian delivery.
Singleton pregnancy
Age greater than 18 years
Having followed institutional fasting guidelines (a minimum of 2 h for clear fluids, 6 h for a light meal, and 8 h for a meal that included fried or fatty food)
2. Exclusion criteria:
Refusal of the patient
Deviation from fasting times
Patients with empty stomach
Emergency operation
Body mass index (BMI) greater than 40 kg/m2
American Society of Anesthesiologists (ASA) physical status class III, IV.
Gestational diabetes mellitus
Multiple gestations
Patients with polyhydramnios liquor.
Preeclampsia patients
Chronic kidney disease patients
Systemic diseases may cause delayed gastric emptying (eg: myopathies and myasthenia gravis).
Patients with gastrointestinal diseases such as hiatus hernia, intestinal disease and gastro-oesophageal reflux disease and patients with history of upper gastrointestinal surgeries.
Patients on antidepressants and monoamine oxidase inhibitors
Use of other medications known to affect gastric motility or secretions.
Allergy to macrolide or metoclopramide
only pregnancy women
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| Name | Affiliation | Role |
|---|---|---|
| Amr wahdan, MD | Cairo university , Cairo, Egypt | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of Medicine, Cairo University. | Cairo | Egypt | 11451 | Egypt |
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| ID | Term |
|---|---|
| D004917 | Erythromycin |
| D008787 | Metoclopramide |
| ID | Term |
|---|---|
| D018942 | Macrolides |
| D061065 | Polyketides |
| D007783 | Lactones |
| D009930 | Organic Chemicals |
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| Drug |
oral metoclopramide (10mg) |
|
| naturally flavored water | Dietary Supplement | naturally flavored water |
|
| UP TO 24 HOURE |
| Evaluation of the risk of aspiration | residual gastric volume < 1.5 mL/kg | UP TO 24 HOURE |
| quantitative gastric contents | every one hours estimated GV till ( < 1.5 ml/kg) post-drug administration | up to 24 hours |
| D001549 |
| Benzamides |
| D000577 | Amides |
| D062366 | para-Aminobenzoates |
| D062365 | Aminobenzoates |
| D001565 | Benzoates |
| D000146 | Acids, Carbocyclic |
| D002264 | Carboxylic Acids |
| D002723 | Chlorobenzoates |
| D062425 | Hydroxybenzoate Ethers |
| D062385 | Hydroxybenzoates |
| D006880 | Hydroxy Acids |
| D001555 | Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D010647 | Phenyl Ethers |
| D010636 | Phenols |