The Effect of Intravenous Pantoprazole and Ranitidine for Improving Preoperative Gastric Fluid Properties in Adults Undergoing Elective Surgery

• Published in: Anesthesia and analgesia Vol. 97; no. 5; pp. 1360 - 1363
• Main Authors: Memiş, Dilek, Turan, Alparslan, Karamanlioglu, Beyhan, Saral, Pnar, Türe, Mevlüt, Pamukçu, Zafer
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-11-2003; Lippincott
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Aged; Anti-Ulcer Agents - administration & dosage; Anti-Ulcer Agents - pharmacology; Benzimidazoles - administration & dosage; Benzimidazoles - pharmacology; Biological and medical sciences; Digestive system; Double-Blind Method; Female; Gastric Acid - metabolism; Gastric Acidity Determination; Gastric Mucosa - metabolism; Humans; Hydrogen-Ion Concentration; Injections, Intravenous; Male; Medical sciences; Middle Aged; Omeprazole - analogs & derivatives; Pantoprazole; Pharmacology. Drug treatments; Pneumonia, Aspiration - prevention & control; Postoperative Period; Ranitidine - administration & dosage; Ranitidine - pharmacology; Risk Assessment; Stomach - anatomy & histology; Stomach - drug effects; Sulfoxides - administration & dosage; Sulfoxides - pharmacology; Human; Lung disease; Intravenous administration; Pantoprazole; Respiratory disease; General anesthesia; Antihistaminic; Trauma; Proton pump inhibitor; Prevention; Chemotherapy; Benzimidazole derivatives; Aspiration pneumonia; Volume; Antisecretory agent; Ranitidine; pH; Complication; Antagonist; Preoperative; Comparative study; Gastric juice; H2 Histamine receptor; Premedication
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ANE.0000086895.64140.B3

We studied pantoprazole, a new potent and fast-acting proton pump inhibitor. Its effects on preoperative gastric fluid volume and pH have not yet been determined. In this randomized, controlled trial, we examined the effects of preoperative IV pantoprazole or ranitidine on gastric pH and volume. Ninety patients (ASA status I and II, scheduled for elective surgery) were studied. One hour before surgery, patients in Group I (n = 30) were given IV saline 5 mL, those in Group II (n = 30) were given 40 mg of pantoprazole IV, and those in Group III (n = 30) were given 50 mg of ranitidine IV. A nasogastric tube was inserted immediately after anesthesia induction. Gastric contents were aspirated, and volume and pH were recorded. The pH values determined in Group I were 3.73 ± 0.82; in Group II, they were 5.30 ± 1.84; and in Group III, they were 4.80 ± 1.40. There was no statistical difference between Groups 2 and 3, but there was a significant difference between Group I and Groups 2 and 3 (P < 0.0005). The volume of the gastric contents was 28.67 ± 10.98 mL in Group I, 15.20 ± 15.52 mL in Group II, and 7.77 ± 11.17 mL in Group III. There was no statistical difference between Groups 2 and 3, but there was a statistically significant difference between Group I and Groups 2 and 3 (P < 0.0005). The proportion of patients considered “at risk” of significant lung injury should aspiration occur was 20% of Group I, 10% of Group II, and 3.3% of Group III. When statistically evaluated, there was no difference among groups. We concluded that the administration of IV pantoprazole and ranitidine 1 h before surgery is effective in reducing gastric pH and volume.