engleski

Metoclopramide does not stimulate the motility of gallbladder in cardiac surgery patients with early postoperative gastric supply of nutrients

INTRODUCTION: The gallbladder (GB) volume is a predictor of biliary stasis and the formation of biliary sludge. Biliary stasis and biliary sludge have been recognized as precursors of acute acalculous cholecysitits and idiopathic pancreatitis, rare but serious complications after cardiac surgery. Previously, we demonstrated that early postoperative gastric supply of nutrients after cardiac and noncardiac surgery diminishes volume and stimulates the motility of the GB 1. However, in the same study we found that GB volume was significantly higher in cardiac vs. noncardiac surgery patients, e.g. the stimulation of the motility of GB with nutrients was lesser in cardiac vs. noncardiac surgery patients. The aim of this study was to confirm does metoclopramide, a well-known prokinetic agent and dopamin antagonist, further stimulate motility of the GB in coronary artery by-pass graft (CABG) surgery patients with early postoperative gastric supply of nutrients. METHODS: In the prospective, randomized, placebo-controlled, double-blind study 40 patients treated at cardiosurgical ICU after CABG surgery were analyzed. The patients were divided in two groups: metoclopramide group M (20 patients ; age 60&#61617; 9 yr. ; male 85%), and control group C (20 patients ; age 59&#61617; 8 yr. ; male 70%), respectively. The duration of surgery, anesthesia and cardiopulmonary by-pass, the NYHA score, age and sex were not statistically different between groups. In the both groups postoperative gastric supply of standard isoosmotic enteral formula begun 18 hours after surgery (Fresubine, Frasenius Kabi ; 30/50 ml/h ; total 240 ml) by two-lumen nasogastric tube. After 6 hours the gastric supply was stopped and the patients received 10 mg of metoclopramide i.v. or 2 ml of saline i.v., regarding of the group in which they where randomized. In all patients sonographic measurement of GB volume was performed immediately before beginning of gastric supply (t-6), 6 hours later (t0), and after 15 (t+15), 30 (t+30), 60 (t+60) and 120 (t+120) min. The measurement was done with ultrasonographic scanner Hitachi 405 EUB (convex probe 3.5-5 MHz) by the same specialist, and the GB volume and gallbladder ejection fraction (GBEF % = [GB volume tx &#8211; GB volume ty] x 100) was calculated with ellipsoid method. RESULTS: The GB volume in both groups was significantly lower after the period of gastric supply of nutrients comparing to GB volume before: group M 50 ml (t-6) vs. 43 ml (t0) (p < 0.05) ; group C 58 ml (t-6) vs. 51 (t0) (p < 0.01). There is not any significant differences in GBEF between groups during the study (group M vs. group C: (t-6-t0) 7% vs. 5% ; (t0-t+15) -2% vs. -2% ; (t+15-t+30) 1% vs. 3% ; (t+30-t+60) 0% vs. 0% ; (t+60-t+120) 1% vs. 3% ; p =NS). CONCLUSION: An early postoperative gastric supply of nutrients in patients after CABG surgery diminishes the GB volume and probably stimulates the motility of GB. However, metoclopramide does not have any additional prokinetic effects on GB motility and GBEF in this patients.

Metoclopramide; gallbladder

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