Rectal and oral cimetidine for prophylaxis of aspiration pneumonitis in paediatric anaesthesia

Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures

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Lansoprazole reduces preoperative gastric fluid acidity and volume in children

The purpose of this study was to explore the efficacy of lansoprazole, a proton pump inhibitor, in reducing the acidity and volume of gastric aspirate in children immediately following the induction of anaesthesia. One hundred healthy in-patients aged 3-11 yr undergoing elective surgery were randomly allocated to four groups (n = 25 each): lansoprazole-lansoprazole, placebo-placebo, placebo-lansoprazole, and lansoprazole-placebo. For each treatment regimen, the first medication was administered at 9:00 pm on the night before surgery and the second at 5:30 am on the morning of the day of surgery (three hours preoperatively). The dose of lansoprazole was 30 mg (approximately 1.4 mg.kg-1 mean). Children were offered 10 ml.kg-1 apple juice three hours before induction of anaesthesia. After induction of anaesthesia and tracheal intubation, gastric fluid was aspirated through a large-bore, multiorifice orogastric tube and analyzed for pH and total fluid volume. Lansoprazole increased gastric fluid pH and decreased gastric fluid volume regardless of whether it was administered before or after placebo. Two consecutive doses of lansoprazole was the most effective means of increasing the pH and reducing the volume of gastric aspirate; in this group, there were no subjects with gastric aspirate volume > 0.4 ml.kg-1 and pH < 2.5. Oral lansoprazole, at least 30 mg, given on the night before surgery or on the morning of surgery will improve the gastric environment at the time of induction of paediatric anaesthesia. The most effective regimen was two doses (at bedtime and on the morning) of lansoprazole.

Omeprazole reduces preoperative gastric fluid acidity and volume in children

To explore the effects of oral omeprazole on preoperative gastric fluid pH and volume in children, 104 healthy in-patients aged 4-9 yr were randomly allocated to four groups (n = 26). Subjects in the Omeprazole-Omeprazole Group received two doses of omeprazole (20 mg per dose), those in the Placebo-Placebo Group, two doses of placebo, those in the Placebo-Omeprazole and Omeprazole-Placebo Groups, one dose each of the two preparations by mouth. For each treatment regimen, the first medication was administered at 9:00 p.m. on the night before surgery and the second at 5:30 a.m. on the morning of the day of surgery (three hours preoperatively). Children undergoing elective surgery were offered 10 ml.kg-1 of apple juice three hours before induction of anaesthesia. After induction of anaesthesia and tracheal intubation, gastric fluid was aspirated through a large-bore, multiorifice orogastric tube and analyzed for pH and total fluid volume. The administration of omeprazole at bedtime before surgery increased gastric pH (3.3 +/- 1.3 vs 2.0 +/- 0.6, P < 0.05) in comparison with placebo, as did two doses of omeprazole (pH = 4.8 +/- 1.6, P < 0.05). A single dose of omeprazole administration on the morning of the day of surgery failed to increase gastric pH. There was a reduction in the number of children with a pH < 2.5 and a volume > 0.4 ml.kg-1 in the Omeprazole-Omeprazole and Omeprazole-Placebo Groups, compared with the Placebo-Placebo or Placebo-Omeprazole Groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Medication delivery in the short-bowel syndrome

Technologic advances such as total parenteral nutrition have prolonged the lives of individuals with short-bowel syndrome who previously would not have survived. However, the day-to-day management of these patients presents a significant challenge to those who take care of them. Providing medications on either an acute or chronic basis without the use of their central catheters is a difficult clinical problem. This article reviews the approach and methods of treating short-bowel patients on the basis of their individual circumstances and physiology.

The efficacy of ranitidine in children

The effect of preoperative oral ranitidine on intragastric pH and volume of aspirate was evaluated in anaesthetized children. Five groups of eight randomly assigned children were evaluated. The first group acted as control and the other groups received 2, 2.5, 3, 3.5 mg kg-1 ranitidine, respectively. The drug was administered 1-4 h preoperatively. The intragastric pH was measured by a pH electrode through an orogastric tube, and the volume of aspirate was recorded every hour. At the time of first measurement oral ranitidine was significantly effective (P less than 0.001) in increasing the pH of intragastric contents to above the safe level of 2.5 in 94% of the children. At the second measurement an hour later, it was effective in all the children. Ranitidine has no significant effect on the volume of gastric aspirate and also there was no significant difference in the effect on the pH of the various doses of ranitidine studied. Oral ranitidine at doses of 2-3.5 mg kg-1 is effective in decreasing gastric acidity in children.