Abstract
The effect of oral ranitidine alone was compared with sequentially administered ranitidine, metoclopramide, and sodium citrate on gastric fluid volume and pH in 196 healthy, elective surgical inpatients, each of whom was randomly assigned to one of four groups. Patients in all groups received oral ranitidine 150 mg 2–3 hr before the scheduled time of surgery. Those in Group 1 also received oral metoclopramide 10 mg one hour before surgery, and sodium citrate 0.3 M 30 ml on call to the operating room; Group 2 received sodium citrate but no metoclopramide; Group 3 received metoclopramide but no sodium citrate; Group 4 received ranitidine alone. Following induction of anaesthesia a #18 Salem sump tube was passed into the stomach and all available gastric fluid was aspirated. Volumes were recorded and pH measured. In all groups mean pH was > 5.8, although at least one patient in each group had pH < 2.5. Mean volumes were significantly greater in patients who received citrate (Groups 1 and 2:22 and 19 ml) than in those in those who did not (Groups 3 and 4:10 and 8 ml). One patient in Group 2 and one in Group 3 had pH < 2.5 with volume > 25 ml. Our results do not demonstrate any advantage of double or triple prophylaxis over ranitidine alone. The practical difficulty of correctly administering two or even three medications, each at different but exact preoperative intervals, is emphasized.
Résumé
Nous avons évalué l’effet de la ranitidine employée seule et en combinaison avec du metoclopramide etlou du citrate de sodium sur le volume et le pH du liquide gastrique de 196 patients randomisés en quatre groupes avant leur intervention chirurgicale élective. Tous prirent 150 mg de ranitidine orale 2–3 hre avant l’intervention. Deplus, les patients du Groupe 1 reçurent 10 mg de métoclopramide oral 1 hre avant l’intervention et 30 ml de citrate de sodium 0,3 M au départ pour la salle d’opération; ceux du groupe 2, que du citrate de sodium et ceux du Groupe 3, que du métoclopramide. Après l’induction de l’anesthésie, nous aspirions le liquide gastrique à l’aide d’un tube de Salem de calibre 18 et en mesurions le volume et le pH. Même si dans tous les groupes, le pH moyen était supérieur à 5,8 il y avait dans chacun d’eux, au moins un patient dont le pH était inférieur à 2,5. Le volume moyen était significativement plus grand chez ceux ayant reçu du citrate (Groupes 1 et2 :22 et 19 ml) que chez les autres (Groupe 3 et 4 : 10 et 8 ml). Un patient du Groupe 2 et un autre du Groupe 3 avaient un pH de moins de 2,5 et un volume de plus de 25 ml. Il ne semble donc pas que la double ou triple prophylaxie soit plus efficace que la ranitidine seule. De plus, il est difficile de synchroniser adéquatement la prise de deux ou trois médicaments.
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Maltby, J.R., Elliott, R.H., Warnell, I. et al. Gastric fluid volume and pH in elective surgical patients: triple prophylaxis is not superior to ranitidine alone. Can J Anaesth 37, 650–655 (1990). https://doi.org/10.1007/BF03006484
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DOI: https://doi.org/10.1007/BF03006484