Erythromycin for Gastric Emptying in Patients Undergoing General Anesthesia for Emergency Surgery: A Randomized Clinical Trial

摘要: Importance Patients undergoing emergency procedures under general anesthesia have impaired gastric emptying and are at high risk for aspiration of contents. Erythromycin has strong prokinetic properties. Objective To evaluate the efficacy erythromycin lactobionate in patients surgery. Design, Setting, Participants The Erythro-Emerge trial was a single-center, randomized, double-blinded, placebo-controlled clinical surgery Geneva University Hospitals. We included 132 from March 25, 2009, through April 10, 2013, all completed study. Randomization stratified trauma nontrauma procedures. randomization code opened on 23, analyses were performed July 26, 2013. an intention-to-treat analysis. Interventions randomized to intravenous lactobionate, 3 mg/kg, or placebo 15 minutes before tracheal intubation. followed up 24 hours. Main Outcomes Measures primary outcome clear stomach, defined as less than 40 mL liquids no solids identified endoscopy immediately after secondary pH level residual content. Results A stomach diagnosed 42 66 (64%) receiving compared with 53 (80%) (risk ratio, 1.26 [95% CI, 1.01-1.57]). In population nontrauma, association between receipt having (adjusted odds ratio CI]) statistically significant (13.4 [1.49-120]; P  = .02); trauma, it not (1.81 [0.64-5.16];  = .26). Median (interquartile range) liquid 2 (1-4) 36 6 (3-7) 16 (  = .002). had nausea (20 [30%] vs 4 [6%]) cramps (15 [23%] [3%]) more often those placebo. One patient vomited induction anesthesia. Conclusions Relevance procedures, administration increased proportion decreased acidity liquid. particularly efficacious population. Adverse effects minor. Further large-scale studies warranted confirm potential reduce incidence bronchoaspiration Trial Registration ClinicalTrials.gov identifier:NCT00827216