Anaesthesia and emesis. Clinical usefulness of metoclopramide.

To the Editor: In the otherwise excellent review article "Anaesthesia and emesis, II" by Palazzo and Strunin, ~ the section devoted to metoclopramide is perhaps open to comment. Reference is made to Davies and Howells' paper on the ability of metoclopramide to empty the stomach following injury, 2 which did not differentiate between liquid and solid gastric content. Hancock 3 showed no difference in gastric emptying times in normal subjects following a solid meal when they were given a placebo or metoclopramide. It is suggested that this is an important difference which should be taken into consideration by the anaesthetist who is faced with a patient with a full stomach. Liquid gastric content may be reduced but solid contents will not. The authors claim that metoclopramide and domperidone have not proven to be effective in either prophylaxis or treatment of postoperative vomiting and refer, among others, to the work of Clark and Storrs 4 who in fact showed a significant reduction (p = 0.05) in postoperative vomiting after metoclopramide 20 mg. A number of investigators have in fact found metoclopramide to be effective in the treatment and prophylaxis of postoperative vomiting, s-9 There are two properties of metoclopramide which the authors did not discuss. Firstly the more potent action in males compared to females. This was published as raw data by Kreel and Howells m but not referred to in the paper and also by Diamond and Keeri-Szanto ~ who showed a significant reduction in postoperative vomiting in males by prophylaxis with metoclopramide (p much less than 0.001) as compared to females in a similar surgical group (N. S.).