Effect of a Single Dose of Metoclopramide on Gastric Volume in Fasting Diabetic Patients Measured using Ultrasonography: A Randomised Controlled Trial

Abstract

Introduction: Diabetic patients have delayed gastric emptying time and even if adequately fasted before elective surgery, are found to have increased Gastric Volume (GV) compared to non diabetic patients. Increased GV poses them with an increased risk of aspiration during general anaesthesia. Metoclopramide is an Food and Drug Administration (FDA)-approved drug for diabetic induced gastroparesis which is given orally for a long duration unless there are any side-effects. Its intravenous use as a single dose in diabetic patients to increase gastric motility is not studied. With the use of portable ultrasound, the estimation of GV has become very easy and reliable compared to older techniques. Aim: To evaluate the effect of metoclopramide on GV in diabetic patients using Ultrasonography (USG). Materials and Methods: This prospective randomised double-blinded study was conducted in the Department of Anaesthesiology, Chandramma Dayanand Sagar Institute of Medical Education and Research (a tertiary care centre), Bengaluru, Karnataka, India between March 2023 and March 2024. A total of 60 diabetic patients posted for elective surgeries who had fasted for more than eight hours were enrolled in the present study to receive either injection Metoclopramide (group M) or Injection normal saline (group N). Ultrasonography was done in both supine and right lateral position to calculate the antral diameters (antero-posterior and cranio-caudal) before and after 30 minutes of giving the drug. The Cross-sectional Area (CSA) and the GV were calculated and compared. Independent sample t-test and Mann Whitney U test were performed to compare the mean and median values of GV between the groups. The p-value <0.05 was considered statistically significant. Results: The demographic parameters, the baseline CSA and the GV in both groups were similar. After the intervention, the GV was significantly less in group M than in group N in the right lateral position post intervention (p=0.0103). On intragroup comparison, a significant decrease in CSA and GVs was seen in the right lateral position after intervention in the study group (p<0.05). However, in the control group, there was a slight increase in the diameters and CSA but it was not significant statistically in both supine and right lateral positions. Conclusion: A single dose of intravenous metoclopramide drug accelerated gastric emptying in diabetic patients as compared to the placebo group.

Keywords

• aspiration
• autonomic neuropathy
• gastric antrum
• gastroparesis