Effect of I. V. Metoclopramide on Gastric Emptying After Opioid Premedication

McNeill, M. J.; Ho, Eriksen

doi:10.1093/bja/64.4.450

Cited by 24 publications

(18 citation statements)

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“…The effect of anaesthesia without opioids on gastric emptying is unclear and may depend upon the combination of drugs, the nature of the operation and the duration of the procedure [20,21]. Other drugs commonly Anaesthesia, February 1995, Volume 50 used in the peri-operative period may affect gastric emptying, including metoclopramide [22,23], naloxone after opioids [24], glycopyrrolate [25], isoprenaline, salbutamol and propranolol [26].…”

Section: Discussionmentioning

confidence: 99%

Gastric emptying in patients the day after cardiac surgery

Goldhill¹,

Whelpton²,

Winyard³

et al. 1995

Anaesthesia

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Summary Fourteen adults underwent cardiac surgery with a standard anaesthetic technique. Prior to surgery and the day after surgery, gastric emptying was determined using the paracetamol absorption technique. Resultsfrom 13patients were available for analysis.The mean time to reach the maximum plasma concentration was 14.1 min Key wordsGastrointestinal tract; stomach, emptying Pharmacology; stomach A decrease in gastric motility will adversely affect enteral nutrition and delay the absorption of most oral medication [I]. After uncomplicated cardiac surgery it is our practice to start oral medication and nutrition on the first postoperative day. Drugs prescribed include anti-arrhythmia and hypotensive agents and delayed absorption may have an important effect on cardiovascular stability. The major cause of impaired gastric motility in the postoperative period is opioid analgesia, although other drugs and physiological and pathological factors also have an effect [I, 21. We have therefore studied patients before and after elective cardiac surgery in order to determine the effect of anaesthesia and surgery on gastric motility. MethodsEthics committee approval and informed patient consent were obtained. Patients were studied 1 or 2 days before and the day after surgery, thereby acting as their own controls. All patients required cardiopulmonary bypass for coronary artery bypass grafting (10 patients), valve replacement (two patients), or both (two patients). Patients were studied in two equal groups; one group was cooled to a core temperature of 18 to 20°C and given 1-2 1 of ice-cold cardioplegia solution topically and as coronary artery perfusate. Core temperature in the other patients was maintained above 33°C and cardioplegia was not administered. In these patients surgery was performed after the aorta was crossclamped and the heart fibrillated.Routine cardiac medications were continued until the morning of surgery. Patients received a standard general anaesthetic consisting of premedication with oral lorazepam followed by intramuscular papaveretum and hyoscine. Induction of anaesthesia was with fentanyl, midazolam and thiopentone, and maintenance was with nitrous oxide, oxygen and enflurane with increments of fentanyl and midazolam as indicated. Pancuronium was used to produce neuromuscular blockade. Postoperative analgesia was with papaveretum given by infusion and, if additional sedation was required while the patient's trachea remained intubated, small bolus doses of midazolam were administered. Gastric emptying was measured using paracetamol absorption [ 11. In both pre-and postoperative studies, patients were given 1 g of paracetamol solution at approximately 0800 h after

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Section: Discussionmentioning

confidence: 99%

Gastric emptying in patients the day after cardiac surgery

Goldhill¹,

Whelpton²,

Winyard³

et al. 1995

Anaesthesia

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“…[61][62][63] Moreover, intravenous administration of metoclopramide was more effective than placebo for enhancing gastric emptying in patients with morphine-induced gastric dysfunction, 44,64 head injury, 65 diabetic gastroparesis, 27 and preterm infants; 66 however, only two of these studies 27,44 utilized the acetaminophen absorption model to assess gastric motility.…”

Section: !mentioning

confidence: 99%

“…This model has been used in other studies to assess gastric emptying in subsets of critically ill patients 41,42 and studies evaluating prokinetic agents. [23][24][25]43,44 Most studies to date have used non-compartmental or graphic methods to estimate AUC during a defined period of time (usually the first 60 mins after acetaminophen administration), peak concentration of acetaminophen, and the time at which the peak concentration was observed. However, several limitations exist with using these noncompartmental or graphic methods to evaluate gastric emptying.…”

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confidence: 99%

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

MacLaren

Kuhl

Gervasio

et al. 2000

Critical Care Medicine

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“…In a substantial proportion of cases, the patient has concomitantly overdosed one or more other drugs in addition to paracetamol [2,3,6,7]. Such drugs may affect the outcome of the paracetamol intoxication as a result of pharmacokinetic interaction with paracetamol or through independent toxic or hepato-protective properties [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Drug interactions with paracetamol may lead to reduced as well as enhanced hepatotoxicity.…”

Section: Introductionmentioning

confidence: 99%

“…Drug interactions with paracetamol may lead to reduced as well as enhanced hepatotoxicity. Suggested mechanisms of interaction include an increased or reduced rate of absorption of paracetamol, reduced conjugation of paracetamol, depletion of glutathione, and inhibition of cytochrome P450-mediated metabolism [9][10][11][12][13][14][15][16]. Independent hepatoprotective mechanisms may involve antioxidant, membrane stabilizing, or calcium channel blocking properties of drugs [17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Concomitant overdosing of other drugs in patients with paracetamol poisoning

Schmidt¹,

Dalhoff

2002

Brit J Clinical Pharma

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Aims Paracetamol is frequently involved in intended self‐poisoning, and concomitant overdosing of other drugs is commonly reported. The purpose of the study was to investigate further concomitant drug overdose in patients with paracetamol poisoning and to evaluate its effects on the outcome of the paracetamol intoxication. Methods Six hundred and seventy‐one consecutive patients admitted with paracetamol poisoning were studied and concomitant drug intake was recorded. The relative risk of hepatic encephalopathy, death or liver transplantation, hepatic dysfunction, liver cell damage, and renal dysfunction associated with concomitant overdosing of other drugs was evaluated by multivariate analysis. Results Concomitant drug overdose was found in 207 patients (31%, 95% confidence interval [CI] 27, 34%). Concomitant overdosing of benzodiazepines (99 cases), opioid analgesics (38 cases), acetylsalicylic acid (33 cases), and NSAID (32 cases) predominated. Concomitant benzodiazepine overdose was an independent risk factor in the development of hepatic encephalopathy (odds ratio [OR] 1.91; CI 1.00, 3.65) and renal dysfunction (OR 1.81; CI 1.00, 3.22). Concomitant overdosing of opioid analgesics was a protective factor in the development of hepatic encephalopathy (OR 0.26; CI 0.07, 0.96). Concomitant acetylsalicylic acid overdose was a risk factor in the development of hepatic encephalopathy (OR 4.87; CI 1.52, 15.7) and death or liver transplantation (OR 6.04; CI 1.69, 21.6). A tendency towards a more favourable outcome was observed in patients with concomitant NSAID overdose. Conclusions Concomitant overdosing of benzodiazepines or analgesics is frequent in patients admitted with paracetamol poisoning. Concomitant benzodiazepine or acetylsalicylic acid overdose was associated with more severe toxicity, whereas concomitant overdosing of opioid analgesics was associated with less toxicity.

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Effect of I. V. Metoclopramide on Gastric Emptying After Opioid Premedication

Cited by 24 publications

References 0 publications

Gastric emptying in patients the day after cardiac surgery

Gastric emptying in patients the day after cardiac surgery

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

Concomitant overdosing of other drugs in patients with paracetamol poisoning

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