Efficacy of a single 24-hour pre-anesthetic dose of proton pump inhibitors.
OBJECTIVE
The H(2) receptor antagonist roxatidine is routinely used as an oral pre-anesthetic medication in surgical patients at night and 2 h before surgery. In the present study, we have compared the effects of roxatidine, rabeprazole and lansoprazole given singly at night as an alternative to the standard double roxatidine medication.


METHODS
120 adult patients undergoing urological surgery were randomly assigned to three groups: roxatidine, rabeprazole and lansoprazole (n = 40 each). Following induction of anesthesia, gastric fluid was obtained by aspiration using a syringe to measure pH and volume of gastric contents.


RESULTS
Gastric volume (14.1 +/- 1.9 mL) in the lansoprazole group was significantly larger than that in roxatidine (8.6 +/- 1.7 mL) and rabeprazole (7.5 +/- 1.1 mL) groups (P < 0.05). Gastric pH in lansoprazole group (4.10 +/- 0.38) was also significantly lower than that in the roxatidine group (5.41 +/- 0.31, P < 0.05). The numbers of patients with critical factors for acid aspiration pneumonia (gastric pH < 2.5 or volume > 25 mL) in the lansoprazole group was significantly higher than in the roxatidine group (P < 0.05). Gastric pH and volume in all groups were constant even in the afternoon.


CONCLUSIONS
Single rabeprazole (but not lansoperazole) medication may be a suitable alternative to standard roxatidine for prophylaxis of acid aspiration pneumonia.
Hirota
Kazuyoshi
K
Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. hirotak@cc.hirosaki-u.ac.jp
Imai
Atsushi
A
Kudo
Mihoko
M
Hashimoto
Hiroshi
H
Kushikata
Tetsuya
T
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D005745:Gastric Acidity Determination; D006635:Histamine H2 Antagonists / Q000008:administration & dosage*; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control*; D011229:Preanesthetic Medication; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D064750:Rabeprazole; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D006635:Histamine H2 Antagonists; D010880:Piperidines; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D064750:Rabeprazole; C053742:roxatidine acetate