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This study aimed to evaluate the effect of metoclopramide on preoperative gastric emptying in diabetic patients.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group I | 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. |
| |
| Group II | Diabetic patients who did not receive metoclopramide or any other prokinetic agent preoperatively. | ||
| Group III | Non-diabetic patients who did not receive metoclopramide, serving as a healthy reference group. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Metoclopramide | Drug | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Antral cross-sectional area | 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) | 30 minutes after drug administration |
| Measure | Description | Time Frame |
|---|---|---|
| Gastric volume | 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 | 30 minutes after drug administration |
| Antral gastric grade |
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Inclusion Criteria:
Exclusion Criteria:
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This study was carried out on 60 patients undergoing elective surgery admitted to Kafr- Elsheikh University Hospitals over a period of 6 months starting from approval of the Medical Sciences Ethics Committee of Kafr- Elsheikh Faculty of Medicine.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kafrelsheikh University | Kafr ash Shaykh | Kafrelsheikh | 33516 | Egypt |
The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
After the end of study for one year.
The data will be available upon a reasonable request from the corresponding author.
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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). |
| 30 minutes after drug administration |
| Fasting glucose | Post-intervention fasting serum glucose was measured. | 30 minutes after drug administration |
| ID | Term |
|---|---|
| D008787 | Metoclopramide |
| ID | Term |
|---|---|
| D001549 | Benzamides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| 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 |
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