Effect of metoclopramide on gastric fluid volumes in diabetic patients who have fasted before elective surgery.
BACKGROUND
Diabetes-induced gastroparesis is believed to increase fasting gastric fluid volume before elective surgery. Metoclopramide is routinely administered preoperatively to reduce gastric fluid volume in these patients. This study compared nondiabetic controls to non-insulin-dependent and insulin-dependent diabetics to determine the effect of metoclopramide, administered before surgery, on gastric volumes in patients who fasted before surgery.


METHODS
Control and diabetic patients fasted preoperatively before receiving either placebo or 10 mg intravenous metoclopramide 20 min before induction of anesthesia. After intubation, a gastric tube was placed, and stomach contents were aspirated with volumes compared among the groups.


RESULTS
Both groups of diabetic patients were older than the control group, and insulin-dependent patients had a higher incidence of comorbidities compared with the non-insulin-dependent group. Fasting blood sugar and hemoglobin A1C values were higher in both insulin-dependent and non-insulin-dependent patients. Gastric fluid volumes were similar in control, non-insulin-dependent, and insulin-dependent patients (8.0 +/- 2.6 vs. 9.6 +/- 4.1 vs. 17.7 +/- 2.5 ml, respectively). In insulin-dependent diabetic patients, metoclopramide decreased gastric volume compared with placebo treatment (17.7 +/- 2.5 vs. 7.8 +/- 2.9 ml; P = 0.027). After stratification, a subpopulation of patients with poorly controlled diabetes, regardless of type, were identified to have increased gastric residual volumes.


CONCLUSIONS
In elective surgical patients who have fasted before surgery, gastric volumes are minimal, even in diabetics with severe neuropathic symptoms. Metoclopramide prophylaxis to reduce gastric volumes seems to be unnecessary unless the patient has a prolonged history of poor blood glucose control.
Jellish
W Scott
WS
Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois 60153, USA. wjellis@lumc.edu
Kartha
Vyas
V
Fluder
Elaine
E
Slogoff
Stephen
S
D000368:Aged; D000768:Anesthesia, General; D001826:Body Fluids / Q000187:drug effects; D003920:Diabetes Mellitus / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism; D003929:Diabetic Neuropathies / Q000150:complications; D018492:Dopamine Antagonists / Q000494:pharmacology*; D017558:Elective Surgical Procedures; D005215:Fasting / Q000502:physiology*; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects; D005753:Gastric Mucosa / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008787:Metoclopramide / Q000494:pharmacology*; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000517:prevention & control; D011300:Preoperative Care; D013270:Stomach / Q000187:drug effects
D018492:Dopamine Antagonists; D006442:Glycated Hemoglobin; D008787:Metoclopramide