Advertisement

The effect of preoperative oral fluid and ranitidine on gastric fluid volume and pH

  • A. D. Sutherland
  • J. Roger Maltby
  • J. P. Sale
  • Crawford R. G. Reid
Article

Abstract

One hundred unpremedicated daycare patients were randomly assigned to one of four groups. Between two and three hours preoperatively all patients received either oral ranitidine 150 mg, or placebo, with bromosulphthalein (BSP) 50 mg in JO ml water, immediately followed by either ISO ml water or no further fluid.

The residual gastric volume (RGV) in the two placebo groups was significantly lower in patients given 150 ml water (20.6 ± 14.1 ml) than in those who continued fasting (29,9 ± 18.2 ml) (p <0.05). The RGV was further significantly decreased in the two ranitidine groups (10.0 ± 8.8, 9.7 ± 10.5ml) compared with the two placebo groups (20.6 ± 14.1, 29.9 ± 18.9 ml) (p <0.01).

Mean pH values were significantly higher in the two ranitidine groups (6.71 ± 0.99; 6.31 ± 1.81) than in the two placebo groups (2.05 ± 1.41; 1.72 ± 0.33) but were not significantly different in the fluid versus non-fluid groups. In patients who ingested 150 ml water there was no correlation between the premedication interval and either RGV or pH values. The extremely low percentage of the original BSP ( <0.9 per cent) in the gastric fluid of these patients demonstrated that gastric emptying of the ingested water was virtually complete prior to surgery.

The combination of RGV of 25 ml or more with pH less than 2.5 was present in 56 per cent of patients who had only a sip of water with placebo, in 28 per cent of those who received 150 ml water with placebo, and in only two per cent of those patients who received ranitidine.

Key words

anaesthesia outpatient histamine H2 receptor blockers ranitidine gastrointestinal tract stomach gastric emptying 

Résumé

Cent patients externes ont été randomisés en quatre groupes. Entre la première et la troisième heure pré-op, tous les patients ont reçu avec de la bromosulphthalein (BSP) (50 mg dans 10 ml ďeau) soit de la ranitidine 150 mg soit du placebo. Ceci fut suivi immédiatement soit par ľingestion de 150ml ďeau soit par aucune ingestion de liquide.

Le volume gastrique résiduel (RGV) dans les deux groupes placebo étaient significativement plus bas chez les patients ayant reçu 150ml ďeau (20.6 i 14.1ml) que ceux qui sont restés a jeun (29.9 ±18.2ml)(p < 0.05). Le RGV était encore plus significativement diminué dans les deux groupes ranitidine (10.0 ±8.8, 9.7 ± 10.5 ml) comparativement aux deux groupes placebo (20.6 ± 14.1, 29.9 í 8.9) (p < 0.01).

Les valeurs moyennes du pH étaient significativement plus élevées dans les groupes ranitidine (6.71 ± 0.99; 6.31 ± 1.81) que dans les deux groupes placebo mais n’étaient pas significativement différentes dans les deux groupes fluides versus groupe à jeun. Pour les patients ayant pris 150 ml ďeau il n’y avait aucune corrélation entre ľintervalle de la prémédication et soit la RGV ou les valeurs du pH. Le pourcentage extr êmement bas du BSP original (<0.9pour cent) dans le liquide gastrique de ces patients a démontré que la vidange gastrique de ľeau ingérée était presque complète avant la chirurgie.

La combinaison de RGV de 25 ml ou plus avec un pH inférieur à 2.5 était présente dans 56 pour cent des patients qui ont pris une simple gorgée ďeau avec le placebo, 20 pour cent chez ceux qui ont reçu 150 ml ďeau avec le placebo, et seulement deux pour cent chez ceux qui ont reçu la ranitidine.

References

  1. 1.
    Snow J On chloroform and other anaesthetics.London: Churchill, 1858:74-5.Google Scholar
  2. 2.
    Lister J On Anaesthetics, Part III. In: Holmes’ System of Surgery, Vol III, 3rd ed. London 1883. (Reprinted in: The Collected Papers of Joseph Lister. Birmingham: The Classics of Medicine Library, 1979: 171–2.)Google Scholar
  3. 3.
    Buxton W Anaesthetics: their uses and administration. London: Lewis, 1920: 24–5.Google Scholar
  4. 4.
    Boyle HEG, Hewer CL Practical anaesthetics. Third edition. London: Frowde, Hodder and Stoughton, 1923: 9.Google Scholar
  5. 5.
    Hunt JN Some properties of an elementary osmoreceptor mechanism. J. Physiol 1956; 132: 267–8.PubMedGoogle Scholar
  6. 6.
    Horowitz M, Pounder DJ Is the stomach a useful forensic clock? Aust NZ J Med 1985; 15: 273–6.Google Scholar
  7. 7.
    Moore JD, Christien PE, Coleman RE Gastric emptying of various meal weight and composition in man, Evaluation by dual liquid- and solid-phase method. Dig Dis Sci 1981; 26: 16–22.PubMedCrossRefGoogle Scholar
  8. 8.
    Guidelines for the basic standards of practice of anaesthesia. The Canadian Anaesthetists’ Society Inc., Toronto, Ontario. 1981: p. 6.Google Scholar
  9. 9.
    Atkinson RS, Rushman GB, Lee JA A synopsis of anaesthesia. 9th ed. Bristol: Wright 1982: 96.Google Scholar
  10. 10.
    Gregory 1C Anaesthesia and the gasto-intestinal tract. In:Churchill-Davidson HC, ed. A Practice of Anaesthesia. 9th ed. Chicago: Year Book Medical Publishers, 1984: 939–53.Google Scholar
  11. 11.
    Orkin FK Selection. In:BV Wetchler, ed. Anesthesia for Ambulatory Surgery. Philadelphia: Lippincott, 1985: 106.Google Scholar
  12. 12.
    Prior FM A manual of anaesthesia for the small hospital. New Delhi: Emmanuel Hospital Association 1974: 58–9.Google Scholar
  13. 13.
    Sutherland T, Davies JM, Stock J The price and value of preoperative outpatient fasting -effects on gastric contents and outpatient morbidity. Can Anaesth Soc J 1985; 32: S100.Google Scholar
  14. 14.
    Ong BY, Palahniuk RJ, dimming M Gastric volume and pH in outpatients. Can Anaesth Soc J 1978; 25: 36–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Miller M, Wishart HY, Nimmo WS Gastric contents at induction of anaesthesia. Is a four hour fast necessary? Br J Anaesth 1983; 55: 1185–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Morison DH, Dunn GL, Fargas-Babjak AM, Moudgil CC, Smedstad K, Woo J A double-blind comparison of cimetidine and ranitidine as prophylaxis against gastric aspiration syndrome. Anesth Analg 1982; 61: 988–92.PubMedCrossRefGoogle Scholar
  17. 17.
    Manchikanti L, Colliver JA, Marrero TC, Roush JR Assessment of age-related acid aspiration risk factors in pediatric, adult, and geriatric patients. Anesth Analg 1985; 64: 11–7.PubMedGoogle Scholar
  18. 18.
    Solanki DR, Suresh M, Ethridge HC The effects of intravenous cimetidine and metoclopramide on gastric volume pH. Anesth Analg 1984; 63: 599–602.PubMedCrossRefGoogle Scholar
  19. 19.
    Guyton AC Textbook of Medical Physiology, 7th ed. Philadelphia: WB Saunders 1986: 774–8.Google Scholar
  20. 20.
    Durrant JM, Strunin L Comparative trial of the effect of ranitidine and cimetidine on gastric secretion in fasting patients at induction of anaesthesia. Can Anaesth Soc J 1982; 29: 446–50.PubMedGoogle Scholar
  21. 21.
    Hjortso E, Mondorf T Does oral premedication increase the risk of gastric aspiration? Acta Anaesthesiol Scand 1982; 26: 505–6.PubMedGoogle Scholar
  22. 22.
    Gregory RA Some factors influencing the passage of fluid through intestinal loops in dogs. J Physiol 1950; 111: 119–37.PubMedGoogle Scholar
  23. 23.
    Bloom DS, Jacobson ED, Grossman Ml Validation of dilution indicators in the stomach. Gastroenterology 1967; 52: 205–10.PubMedGoogle Scholar
  24. 24.
    Adelhoj B, Petring OU, Hagelsten JO Inaccuracy of peranesthetic gastric intubation for emptying liquid stomach contents. Acta Anaesthesiol Scand 1986; 30: 41–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Roberts RB, Shirley MA Reducing the risk of acid aspiration during cesarean section. Anesth Analg 1974; 58: 859–68.CrossRefGoogle Scholar
  26. 26.
    Sutherland AD, Stock JG, Davies JM Effects of preoperative fasting on morbidity and gastric contents in patients undergoing day-stay surgery. Br J Anaesth 1986; 58: 876–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Wald A, Vanthiel DH, Hoechstetter L etal. Effect of pregnancy on gastrointestinal transit. Dig Dis Sci 1982; 27: 1015–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Cohen S The sluggish gallbladder of pregnancy. N Engl J Med 1980; 302: 397–8.PubMedGoogle Scholar
  29. 29.
    Fisher RS, Roberts GS, Grabowski CJ, Cohen S Inhibition of lower esophageal sphincter circular muscle by female sex hormones. Am J Physiol 1978; 234: E234–7.Google Scholar
  30. 30.
    Braverman DZ, Johnson ML, Kern F Effects of pregnancy and contraceptive steroids on gallbladder function. N Engl J Med 1980; 302: 362–4.PubMedGoogle Scholar
  31. 31.
    Maltby JR, Sutherland AD, Sale JP, Shaffer EA Preoperative oral fluids: is a five-hour fast justified prior to elective surgery? Anesth Analg 1986; 65: 112–6.CrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1987

Authors and Affiliations

  • A. D. Sutherland
    • 1
  • J. Roger Maltby
    • 1
  • J. P. Sale
    • 1
  • Crawford R. G. Reid
    • 1
  1. 1.Department of AnaesthesiaFoothills Hospital at the University of CalgaryCalgary, AlbertaCanada

Personalised recommendations