Gastric fluid pH and volume in gynaecologic out-patients. Influences of cimetidine and cimetidine-sodium citrate combination.
Eighty consecutive ASA physical status 1 women scheduled for day-case gynaecological laparoscopy under general anaesthesia were randomly allocated during the pre-operative visit to receive one of four premedication regimes. Patients in group 1 received hydroxyzine 100 mg; patients in group 2 received hydroxyzine 100 mg and cimetidine 400 mg; patients in group 3 received hydroxyzine 100 mg and effervescent cimetidine (cimetidine 200 mg + sodium citrate 1.8 g). All were given orally in 30 ml of water, 90 min before anaesthetic induction. Patients in group 4 received effervescent cimetidine orally in 30 ml of water 5 min before anaesthetic induction. Following induction of anaesthesia, gastric pH and residual volume (phenol red dilution technique) were measured. Gastric pH was higher (P < 0.05) in groups 2, 3 and 4 (medians: 5.71, 4.84, 6.07, respectively) than in group 1 (2.18). No patient had a gastric pH < or = 2.5 in group 4 compared with 13/14 n group 1, 1/15 in group 2 and 2/14 in group 3 (P < 0.0001). Mean gastric volumes were higher (P < 0.05) in group 4 (30.4 +/- 23.2 ml) than in groups 1, 2 and 3 (11.8 +/- 6.4, 15.8 +/- 11.2, 17.2. +/- 24.4 ml, respectively). Nine of the 19 patients in group 4 had a volume higher than 25 ml. Only one patient in group 1 had both gastric pH < or = 2.5 and volume > or = 25 ml. The administration of effervescent cimetidine 5 min prior to anaesthetic induction seems to be an easy and effective method of decreasing the acidity of gastric contents in day surgery.
Narchi
P
P
Département d'Anesthésiologie, Université de Paris-Sud, Hôpital Antoine Béclère, 92141 Clamart, France.
Edouard
D
D
Bourget
P
P
Otz
J
J
Cattaneo
I
I
D000328:Adult; D000768:Anesthesia, General; D000897:Anti-Ulcer Agents / Q000494:pharmacology*; D002927:Cimetidine / Q000494:pharmacology*; D002951:Citrates / Q000494:pharmacology*; D005260:Female; D005744:Gastric Acid / Q000502:physiology*; D005753:Gastric Mucosa / Q000378:metabolism; D013509:Gynecologic Surgical Procedures; D006634:Histamine H1 Antagonists / Q000494:pharmacology; D006635:Histamine H2 Antagonists / Q000494:pharmacology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006919:Hydroxyzine / Q000494:pharmacology; D010535:Laparoscopy; D011446:Prospective Studies; D000077559:Sodium Citrate; D013270:Stomach / Q000033:anatomy & histology / Q000187:drug effects*
D000897:Anti-Ulcer Agents; D002951:Citrates; D006634:Histamine H1 Antagonists; D006635:Histamine H2 Antagonists; D000077559:Sodium Citrate; D006919:Hydroxyzine; D002927:Cimetidine