Failure of cimetidine prophylaxis in neurosurgery.
Three hundred and eight-one patients who underwent major neurosurgical procedures were given cimetidine prophylaxis against stress ulceration. Nine patients (2.4%) developed acute gastrointestinal complications; two patients had perforation and bleeding from gastroduodenal ulcers, and seven patients had bleeding alone. Six of these patients, all above the age of 70 years, died as a consequence of the complication. Univariate analysis showed that four variables--state of consciousness, syndrome of inappropriate secretion of antidiuretic hormone, nature of surgery, and age--were significant factors in predicting cimetidine failure. Multivariate analysis revealed that a patient's pre-operative state of consciousness and the presence of inappropriate secretion of antidiuretic hormone were of independent significance in predicting cimetidine failure. The risk was 52% and 0.07%, respectively, when both factors were either present or absent.
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
K H
KH
Chan
K S
KS
Mann
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000601:surgery*; D002927:Cimetidine / Q000627:therapeutic use*; D004341:Drug Evaluation; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000517:prevention & control*; D010439:Peptic Ulcer Perforation / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D011292:Premedication; D012307:Risk Factors; D013312:Stress, Physiological
D002927:Cimetidine