Choosing a Prokinetic for Your Patient Beyond Metoclopramide

Gudsoorkar, Vineet; Quigley, Eamonn Martin

doi:10.14309/ajg.0000000000000463

Cited by 9 publications

(2 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Choosing a proper agent for accelerating gastric empting before induction of general anesthesia is based on many factors such as type of surgery, duration of surgery, possible side effects, potential drug interactions, and underlying disease. Metoclopramide, which has been used in the current study, is a well-known drug in this regard which could lead to extrapyramidal reactions and QT prolongation; so it is highly recommended to take a complete history, perform an electrocardiogram (ECG), review potential drug interactions and electrolyte abnormalities that can increase the QT interval (19).…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic Assessment of Metoclopramide Administration Effectiveness in Accelerating Gastric Emptying Before Urgent Surgery in Patients with Insufficient NPO Time

et al. 2020

View full text Add to dashboard Cite

Background: Aspiration is one of the important complications of general anesthesia, although infrequent as well as accompanying high morbidity and mortality. The volume of gastric content is considered as a risk factor in this regard. Therefore, it is normally mostly recommend to consider proper fasting time before induction of general anesthesia. Objectives: This study was conducted to assess the effect of metoclopramide on reducing gastric contents in patients with incomplete fasting before induction of general anesthesia. Methods: This quasi-experimental study was conducted on patients with urgent surgical indications with incomplete NPO time. Every other patient received metoclopramide or placebo. Patients in the intervention group received 10 mg (2 ml) of intravenous metoclopramide, and patients in the control group received 2 ml of distilled water as a placebo. Patients in both groups underwent ultrasonography before starting surgery by an expert radiologist to calculate gastric antral grade (GAG) and cross-sectional antral area (CSA). These measurements were then taken for the second time 30 minutes after intervention, before starting the surgery. The values were compared statistically. Results: The data of 60 patients were analyzed, of which 30 were in each group. The mean age, body mass index, type of the last consumed food (solid or fluid), NPO time in the two groups were not significantly different (P value > 0.05). The number of patients in the metoclopramide group with higher GAG (P value = 0.001) and the mean CSA (P value = 0.004) before the intervention was more than the control group. The GAG and mean CSA after intervention were not significantly different between the two groups; but the mean difference of decrease in CSA in the metoclopramide group was more than the control group (4.3 vs. 0.99; P value = 0.001), and changes of GAG after intervention to lower levels in the metoclopramide group was more than the control group (P value < 0.05). Conclusions: In the current study in which ultrasonographic indexes, including GAG and CSA, were assessed as a suboptimal gastric emptying test method, it was found that metoclopramide could accelerate gastric emptying compared to placebo in patients with incomplete fasting before induction of general anesthesia.

show abstract

Section: Discussionmentioning

confidence: 99%

Ultrasonographic Assessment of Metoclopramide Administration Effectiveness in Accelerating Gastric Emptying Before Urgent Surgery in Patients with Insufficient NPO Time

et al. 2020

View full text Add to dashboard Cite

show abstract

“…6 These are more effective in patients with FGIDs having delayed gastric emptying or postprandial distress. 7 However, prokinetics vary in their safety profiles. Given that FGIDs in India are quite common and because they are observed even in school children, it is essential that they are diagnosed in a timely manner and effectively managed.…”

mentioning

confidence: 99%

Prokinetics in the management of upper gastrointestinal motility disorders: an Indian expert opinion review

Roop¹,

Prasad

2021

Int J Adv Med

View full text Add to dashboard Cite

Functional gastrointestinal disorders (FGIDs) are disorders of gut-brain interaction. Nearly 40% of individuals globally suffer from FGIDs and have chronic fluctuating symptoms. Of all GI conditions, 30-45% are referable to intestinal motility disorders. Prokinetics act by different mechanisms and are effective in FGIDs with delayed gastric emptying or postprandial distress. When choosing a prokinetic, safety is the primary concern, particularly with regard to the central nervous system and cardiovascular risk. Here, we review the efficacy and safety of prokinetics in functional GI motility disorders and provide expert opinions for the use of prokinetics to manage upper GI motility disorders in the Indian context.

show abstract