21 Jun Erythomycin Allows Gastric Emptying To Prevent Aspiration In ER Patients
MedicalResearch.com Interview with:
Christoph Czarnetzki MD, MBA
Division of Anesthesiology
Geneva University Hospitals
Medical Research: What is the background for this study? What are the main findings?
Dr. Czarnetzki: In the US, about 40 million patients undergo a general anesthetic each year, and approximately 12,000 broncho-aspirate. Broncho-aspiration of gastric juice may lead to acute respiratory distress syndrome, carrying a 40% mortality rate. The risk is increased 10-fold in patients undergoing emergency surgery. Trauma patients may have ingested food before their accident, or have swallowed blood from oral or nasal injuries. Also, gastric emptying is delayed due to head injury, stress, pain, and opioid medication. Non-trauma patients may have delayed gastric emptying due to paralytic ileus and critical illness, leading to significant residual stomach content even after long fasting periods. Erythromycin, a macrolide antibiotic, and motilin receptor agonist induces antral contractions, and increases the lower esophageal sphincter tone, which is an important barrier against gastro-esophageal reflux. Although gastric emptying properties of erythromycin are well known, its efficacy in patients undergoing emergency surgery has never been investigated before to our knowledge.
In our study we included 132 patients undergoing general anesthesia for emergency procedures and we could show that erythromycin increased the proportion of clear stomach and decreased acidity of residual gastric liquid. Dependent of the definition of empty stomach (less than 40 ml and absence of solid food or completely empty stomach) the absolute risk reduction ranged from 17% to 24%, equivalent to a number needed to treat of four to six patients to produce one completely cleared stomach. Erythromycin was particularly efficacious in non-trauma patients. Adverse effects were minor.
Medical Research: What should clinicians and patients take away from your report?
Dr. Czarnetzki: In emergency patients we have now a medication at hand with wich we can promote gastric emptying. 3 mg/kg of Erythromycin should be given intravenously at least 15 minutes prior to intubation. In patients which ingested solid food Erythomycin should be given earlier, maybe at arrival in the emergency room, as emptying of solid food takes more time than liquids.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Czarnetzki: Future research could investigate to what extent Erythromycine reduces bronchoaspiration and its consequences. On the other hand thousands of patients have to be included in a multicenter study to have sufficient power to investigate this outcome. In view of the strong results of our study it should be questioned if such a study is still necessary.
Christoph Czarnetzki MD, MBA, Division of Anesthesiology, Geneva University Hospitals, & Geneva, Switzerland (2015). Erythomycin Allows Gastric Emptying To Prevent Aspiration In ER Patients