Effects of preoperative medications on gastric pH, volume, and flora

Aspiration of acid gastric juice poses a potential threat during operations. Many anesthesiologists use a variety of agents aimed at decreasing gastric volume and/or acidity. The effect of three agents on gastric volume, pH, and flora, and the effect of cefazolin on gastric flora in morbidly obese p...

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Bibliographic Details
Published in:Annals of surgery 1986-06, Vol.203 (6), p.614-619
Main Authors: LAWS, H. L, BRYANT, J. W, PALMER, M. D, BOUDREAUX, A. M, DONALD, J. M. JR, SCOTT WHEELER, A
Format: Article
Language:English
Subjects:
Anesthetics. Neuromuscular blocking agents
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Biological and medical sciences
Clinical Trials as Topic
Double-Blind Method
Gastric Juice - analysis
Gastric Juice - drug effects
Gastric Juice - microbiology
Gastrostomy
Humans
Hydrogen-Ion Concentration
Medical sciences
Metoclopramide - therapeutic use
Neuropharmacology
Obesity - surgery
Pharmacology. Drug treatments
Preanesthetic Medication
Prospective Studies
Random Allocation
Ranitidine - therapeutic use
Stomach - microbiology
Stomach - surgery
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Summary:Aspiration of acid gastric juice poses a potential threat during operations. Many anesthesiologists use a variety of agents aimed at decreasing gastric volume and/or acidity. The effect of three agents on gastric volume, pH, and flora, and the effect of cefazolin on gastric flora in morbidly obese patients were studied. Cefazolin did not sterilize the gastric lumen. Almost one-half of patients not treated with an H2 blocker had a pH below 2.5 and a gastric volume of 20 ml or more. Five had both a low pH and significant volume and, thus, the potential for lethal aspiration. Two doses of cimetidine, 300 mgm orally, or of ranitidine, 150 orally, the evening before and the morning of operation decreased gastric volume and raised pH reliably to a level that should be protective from fatal aspiration. However, gastric cultures after these drugs were positive 86% of the time with a larger variety of organisms than in the untreated stomachs. Metoclopramide failed to decrease gastric volume or raise pH. Transoperative cefazolin was used in all patients. Clinical infection was not a problem.
ISSN:0003-4932
1528-1140
DOI:10.1097/00000658-198606000-00005