Title: Comparative Study of the Effect of Oral Omeprazole with Oral Ranitidine on pH and Volume of Gastric Aspirate in Patients Undergoing Elective Surgery

Author: Dr GANGA, G MD, DA

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.184

Abstract

Background: The risk of regurgitation and vomiting with subsequent pulmonary aspiration of gastric contents has been recognized as a serious hazard. Various pharmacological agents are being used to minimize the risk of acid aspiration.

The objectives of this present study are to compare the efficacy of omeprazole and ranitidine in reducing the volume of gastric fluid and to compare the efficacy of omeprazole and ranitidine in increasing the pH of gastric fluid in patients undergoing elective surgery.

Material and Methods: After Obtaining institutional approval and individual consent 60 patients were randomly selected into III groups of 20 each in the randomized comparative study.  The   group I as control, group II received 40mg omeprazole and III received 150 mg ranitidine night before and 6am on the day of surgery. All the patients were given premedication of injection phethidine 1mg/kg . General anesthesia is induced and when   a steady state is achieved an 18 FG nasogastric tube well lubricated with ligonocane jelly is passed in to the stomach. Volume of gastric fluid and PH of the aspirate is collected using 20 ml syringe and pH measured by pH paper.

Result: The patients characteristics and demographic data were comparable in the 2 groups. It is proved beyond doubt that both the treatment groups were definitely superior to the control group in increasing the gastric PH and as well as reduce the gastric volume.

Conclusion: The omeprazole group is found to be effective adjuvant to safe anesthesia practice. It should be routinely included in pre anesthetic preparation of all elective surgery patients under  general anesthesia to prevent the dreaded complication  of acid aspiration pneumonitis

Keywords: Omeprazole, Ranitidine, Gastric aspirate

References

  1. Mendelson C.L - The aspiration of stomach contents into the lungs during obstetric anaesthesia. American Journal of Obstetrics and Gynaecology 1946:52:191-205.
  2. TEABEAUT J.R (1952) - Aspiration of gastric contents. An experimental study. American Journal of Pathology 28; 51-56.
  3. COTTON et al (1981): Single and combined effects of atropine andmetoclopramide on the lower oesophageal sphincter pressure. British Journal of Anaesthesia, 53:869-874.
  4. HOLDSWORTH et al (1980): Mixing of antacids with stomach contents- Another approach to the prevention of the acid aspiration (Mendelson's) syndrome. Anaesthesia 1980: 35: 641-650.
  5. Manchikanti L, Culliver J A, Marrero TC, Roush JR. Ranitidine and metoclopromide for prophylaxis of aspiration pneumonitis in elective surgery. Anaesthesia and Analgesia 1984;63;703-910.
  6. BERTACCINI et al (1981) -.Ranitidine increases the lower oesophageal sphincter pressure in man. Italian Journal of Gastroenterology 13; 149-150.
  7. Andrews AD, Buock utne JG, Downing JW. Protection against pulmonary acid aspiration with ranitidine - A new histamine (H2) receptor antagonist Anaesthesia analgesia 1982;61;130-132.
  8. Lind T Cederberg C, Ekenved G, Haglund U, Olbe L - Effect of Omeprazole- a gastric pump inhibitor on pentagastrin stimulated acid secretion in man GUT 1983:24:270-276.
  9. Prichard PJ, Yeomans ND, Mihaly GW, Jones DB, Buckle PJ, Smallwood RA, Louis WJ. Omeprazole - a study of its inhibition of gastric pH and oral pharmacokinetics after morning or evening dosase. Gastroenterology 1985:88:64-69.
  10. Ching MS, Morgan DJ, Mithaly GW, Hardy KJ,Smallwood RA -Placental transfer of omeprazole in maternal and fetal sheep -Developmental pharmacology and therapeutics 1986;9;323-331.

Corresponding Author

Dr GANGA, G MD, DA

Associate Professor, Department of Anaesthesiology

Government Medical College, Kottayam