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Effect of preoperative paracetamol on gastric volumes and pH in children
Insights
Preoperative paracetamol elixir does not affect gastric contents in children undergoing adenotonsillectomy. This study found no significant difference in gastric volume or pH between elixir and suppository administration, supporting preoperative use.
Area of Science:
- Pediatric Anesthesiology
- Pharmacokinetics
- Gastrointestinal Physiology
Background:
- The impact of preoperative oral paracetamol on pediatric gastric contents is not well-established.
- Understanding gastric content changes is crucial for anesthetic safety, particularly regarding aspiration risk.
Purpose of the Study:
- To investigate the effect of preoperative paracetamol elixir administration on gastric volume and pH in children.
- To compare the gastric effects of preoperative paracetamol elixir versus intraoperative paracetamol suppositories.
Main Methods:
- Children undergoing elective adenotonsillectomy were randomized to receive either paracetamol elixir or suppositories.
- Gastric residual volume and pH were measured after anesthetic induction using an orogastric tube.
- Data analysis compared mean residual gastric volume and pH between the two groups.
Main Results:
- No significant difference was observed in mean residual gastric volume (0.083 ml/kg) or pH between the elixir and suppository groups.
- Paracetamol elixir was rapidly absorbed, indicating no significant alteration of gastric contents prior to surgery.
- The study included children with a mean age of 8.5 years and weight of 35 kg.
Conclusions:
- Preoperative administration of paracetamol elixir does not alter gastric contents in pediatric patients.
- Rapid gastrointestinal absorption suggests paracetamol elixir can be safely administered preoperatively for routine procedures.
- This finding supports the use of preoperative paracetamol elixir for analgesia in pediatric surgical patients.
Abstract:
The effect preoperative paracetamol elixir has on gastric contents is unknown. Children presenting for elective adenotonsillectomy were randomized to receive either paracetamol elixir (40 mg x kg(-1)) 90 min before surgery or paracetamol suppositories (40 mg x kg(-1)) intraoperatively. Following induction of anaesthesia a 16 Fr multiple-oriface orogastric tube was passed into the stomach and measure taken of the residual gastric volume and pH. The children had a mean age of 8.5 years (SD 3.2) with a weight of 35 kg (SD 16.5). Children given elixir (n=41) had a mean residual gastric volume of 0.083 ml x kg(-1) (95% CI; 0.006, 1.24) and a pH of 1.83 (95% CI; 0.75, 4.49), while those given suppositories (n=40) had a mean residual gastric volume of 0.083 ml x kg(-1)(95% CI; 0.008, 0.9) and a pH of 2.07 (95% CI; 0.84, 5.12). There was no significant difference between these two groups. Paracetamol elixir is rapidly absorbed in the gastrointestinal system of children and preoperative administration has no effect on gastric contents. Given paracetamol's slow equilibration rate constant from the central to the effect compartment, children may be given this medication preoperatively for routine surgical procedures.