title: The efficacy of preanesthetic proton pump inhibitor treatment for patients on long-term H2 antagonist therapy.
abstract: We previously reported that H2-antagonist medication given for longer than 4 wk may produce complete tolerance to preanesthetic H2 antagonist therapy. In this study, we evaluated the efficacy of preanesthetic proton pump inhibitor (PPI; oral rabeprazol) use in patients receiving regular H2-antagonist (oral famotidine) therapy for more than 4 wk. Forty-eight patients with assumed complete tolerance to H2 antagonists undergoing elective surgery were recruited and randomly assigned to receive either a preanesthetic PPI (rabeprazol 20 mg; n = 24) or H2-antagonist (H2 group; roxatidine 75 mg; n = 24) at 9:00 pm on the day before surgery and 2 h before the induction of anesthesia. Volume of gastric contents and pH values were measured after the induction of anesthesia. Gastric pH value in the PPI group (5.38 +/- 2.42) was significantly higher than in the H2 group (3.27 +/- 1.98; P < 0.01). Gastric volume in the PPI group (8.6 +/- 1.5 mL) was significantly smaller than in the H2 group (15.4 +/- 2.8 mL; P < 0.05; cf. PPI). Fourteen patients in the H2 group were at risk of acid aspiration pneumonia (gastric pH <2.5 or volume >25 mL), whereas only four patients in the PPI group (P < 0.05) were at risk. These data suggest that in patients receiving H2-antagonist therapy for longer than 4 wk, prophylaxis for acid aspiration pneumonia should include preanesthetic PPI medication.
  
  
  CONCLUSIONS
  We previously reported that more than 4 wk of administration of H2-antagonists may produce a full tolerance to preanesthetic H2-antagonists. The present study suggests that a proton pump inhibitor may be effective for prophylaxis of acid aspiration pneumonia in patients showing the full tolerance to H2 antagonists.
authors.affiliation: Department of Anesthesiology, University of Hirosaki School of Medicine, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Hirota
authors.forename: Mihoko
authors.initials: M
authors.lastname: Kudo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kushikata
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000494:pharmacology*; D001562:Benzimidazoles / Q000494:pharmacology; D004361:Drug Tolerance; D015738:Famotidine / Q000494:pharmacology; D005260:Female; D005745:Gastric Acidity Determination; D005755:Gastrins / Q000097:blood; D006635:Histamine H2 Antagonists / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives / Q000494:pharmacology; D010880:Piperidines / Q000494:pharmacology; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D011229:Preanesthetic Medication; D054328:Proton Pump Inhibitors; D064750:Rabeprazole
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D005755:Gastrins; D006635:Histamine H2 Antagonists; D010880:Piperidines; D054328:Proton Pump Inhibitors; D064750:Rabeprazole; D015738:Famotidine; D009853:Omeprazole; C053742:roxatidine acetate