Effect of Metoclopramide Versus Erythromycin on on Gastric Residual Volume

Cairo University50 enrolled

Overview

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

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

QUADRUPLE

Enrollment

Conditions

Gastric Residual Volume

Interventions

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

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

Outcomes

Primary Outcomes

Estimated Gastric volume

(ml/kg) after a six-hour fast using Roukhomovsky's equation after administration of the study drug.

Time frame: UP TO 6 HOURE

Secondary Outcomes

low-risk stomach six hours after drug administration

number of patient and %

Time frame: 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

Time frame: UP TO 24 HOURE

Evaluation of the risk of aspiration

residual gastric volume \< 1.5 mL/kg

Time frame: UP TO 24 HOURE

quantitative gastric contents

every one hours estimated GV till ( \< 1.5 ml/kg) post-drug administration

Time frame: up to 24 hours