From the Guidelines
Glucagon is not recommended for routine use in the intraoperative care of a patient undergoing cholecystectomy, as there is no direct evidence supporting its role in this specific context. When considering the use of glucagon in the perioperative period, it is essential to evaluate its potential benefits and risks. In the context of imaging procedures, such as CT scanning, glucagon may be used to minimize peristaltic movements, as noted in the study by the Italian Research Group for Gastric Cancer (GIRCG) guidelines 1. However, this specific use case does not directly apply to the intraoperative care during cholecystectomy. Some key points to consider about glucagon include:
- It can cause relaxation of smooth muscle, which could potentially be beneficial in certain procedures
- It is used in diagnostic imaging to reduce peristalsis, as seen in the GIRCG guidelines 1
- Its use requires careful consideration of patient-specific factors, such as history of diabetes, lactose hypersensitivity, or pheochromocytoma Given the lack of direct evidence supporting the use of glucagon in the intraoperative care of patients undergoing cholecystectomy, and prioritizing morbidity, mortality, and quality of life, the use of glucagon in this context is not recommended unless specifically indicated for another reason.
From the Research
Role of Glucagon in Intraoperative Care
The role of glucagon in the intraoperative care of a patient undergoing cholecystectomy is multifaceted, with various studies investigating its effects on intraoperative cholangiography. The key findings can be summarized as follows:
- Glucagon has been used to relax the sphincter of Oddi, facilitating the passage of contrast material and improving the diagnostic accuracy of intraoperative cholangiography 2, 3.
- The administration of glucagon has been shown to reduce the rate of false-positive intraoperative cholangiograms, thereby reducing the need for unnecessary endoscopic retrograde cholangiopancreatography (ERCP) 4.
- However, not all studies have found a significant improvement in cholangiograms obtained after glucagon injection, with one study finding no significant statistical improvement 5.
Effects on Intraoperative Cholangiography
The effects of glucagon on intraoperative cholangiography can be summarized as follows:
- Glucagon has been found to enhance the specificity and positive predictive value of intraoperative cholangiography, improving its diagnostic accuracy 4.
- The use of glucagon has been shown to reduce the degree of diagnostic uncertainty in cholangiographic examinations 3.
- However, the effectiveness of glucagon in improving the quality of cholangiograms has not been universally established, with some studies finding limited or no benefit 5.
Clinical Implications
The clinical implications of using glucagon in the intraoperative care of patients undergoing cholecystectomy are:
- Glucagon may be a useful adjunct to intraoperative cholangiography, particularly in cases where the diagnosis of choledocholithiasis is uncertain 4.
- The use of glucagon may help reduce the rate of unnecessary ERCPs and improve patient outcomes 4.
- However, further studies are needed to fully establish the benefits and limitations of using glucagon in this context 5, 4.