Effect of metoclopramide on gastric residual volume as measured by ultrasonography in diabetes mellitus patients undergoing elective surgeries: A randomized controlled study

This study is about to compare the effect of metoclopramide on gastric residual volume as measured by ultrasonography in DM patients undergoing elective surgeries. All patients will be kept nil per oral for at least 8 hours before surgery. Baseline HbA1C, fasting blood sugar, duration of DM, treatment for DM, ASA-PS grade and duration of fasting in hours will be noted on arrival at the preoperative area. A wide bore intravenous line will be secured. ASA standard monitors will be attached, as well as baseline parameters will be recorded. After getting informed written consent, gastric ultrasonography will be done in right lateral decubitus position to assess the gastric residual volume -1 (GRV-1) by measuring the gastric antral cross-sectional area before administering metoclopramide or placebo.

After that, metoclopramide 10 mg (2ml) intravenous will be given to one set of patients with DM (group A), and 2 ml NS (placebo) will be given to another set of patients with DM (group B). After 30 minutes, gastric ultrasonography will be done again in right lateral decubitus position to measure the gastric antral CSA. From the CSA of the gastric antrum, we will calculate GRV-2 by the following formula described by Perlas et al.

[GRV: 27+ (14.6×RIGHT LATERAL CSA)-(1.28×AGE)}

a) Low risk: patients who have a GRV of less than 1.5mL/kg.

(b) High risk: patients who have a GRV of more than 1.5mL/kg.

Before conveying GRV findings, the anaesthesiologists responsible for intraoperative management but blinded to the group allocation will be asked about the anaesthesia and airway plan. Then these GRV values will conveyed to the anaesthesiologists. Based on these GRV values, the anaesthesiologists will decide the anaesthesia plan and airway plan (GETA or SGA). Gastric ultrasonography will again be done at the end of surgery before extubation to measure GRV-3. In patients whom the surgery has been completed will assess the post operative nausea, vomiting, regurgitation and aspiration at 6 hrs, 12 hrs and at 24 hrs.

Endpoint: Post operative nausea, vomiting, regurgitation and aspiration assessment for twenty-four hours after the completion of surgery.

Primary objective: To evaluate the effect of metoclopramide on GRV as measured by ultrasonography in DM patients undergoing elective surgeries.

Secondary objectives:

(1) To grade the aspiration risk by measuring GRV in DM patients undergoing elective surgeries.

(2) To compare post operative nausea, vomiting, regurgitation and aspiration among the two groups.

(3) To assess whether there is any change in the anaesthesia and airway plan based upon gastric ultrasonography findings