This is a multicentre, investigator-blinded, randomised controlled trial evaluating whether the use of oral metoclopramide before surgery can reduce the amount of residual gastric content in patients who are taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight loss. These medications are known to slow down gastric emptying, which may increase the risk of pulmonary aspiration during anaesthesia. Patients will be randomly assigned to either receive metoclopramide 24 hours before surgery or continue with standard care. The primary outcome will be the presence or absence of residual gastric content on ultrasound before surgery. Secondary outcomes include nausea, vomiting, constipation, and any adverse effects of the medication.
Patients taking GLP-1 receptor agonists (for weight loss only)
Male and female patients aged 18 years or older
Able to provide written informed consent
ASA grade I-V
Inability to provide informed consent
Presence of hiatus hernia
History of any gastric surgery
Pregnancy
Parallel
Metoclopramide
DrugOral metoclopramide 10 mg, administered as three doses the day before surgery and one dose on the morning of surgery (total four doses over 24 hours). Used to enhance gastric emptying in patients taking GLP-1 receptor agonists.
Presence of residual gastric content on preoperative gastric ultrasound
Residual gastric content (RGC) will be defined as the presence of any of the following on ultrasound prior to induction of anaesthesia: (1) solid content, (2) thick fluid, or (3) clear fluid \>1.5 mL/kg in the gastric antrum. Ultrasound will be performed in the supine and right lateral decubitus positions by a blinded anaesthesiologist and reviewed by a second blinded assessor.
Nausea/vomiting in PACU
Nausea/Vomiting
Nausea/vomiting
Nausea/vomiting
Constipation
Constipation
Adverse Reactions to Metoclopramide
Adverse Reactions to Metoclopramide
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