Effects of famotidine on gastric pH and residual volume in pediatric surgery
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J S Jahr1, G Burckart, S S Smith
1Department of Anesthesiology, Children's Hospital of Pittsburgh.
Insights
Preoperative famotidine (histamine2-receptor antagonist) increased gastric pH in pediatric patients, reducing aspiration risk. However, it did not significantly decrease gastric residual volume before surgery.
Area of Science:
- Anesthesiology
- Pharmacology
- Pediatric Medicine
Background:
- Aspiration pneumonitis is a serious risk during anesthesia.
- Histamine2-receptor antagonists are used to manage gastric acidity.
- Famotidine is a newer agent in this class.
Purpose of the Study:
- To evaluate the efficacy of preoperative oral famotidine in pediatric patients.
- To determine if famotidine reduces gastric residual volume and increases gastric pH.
- To assess famotidine's impact on the risk of aspiration pneumonitis.
Main Methods:
- 58 pediatric patients (aged 2-17 years) were randomized into four groups.
- Groups received either famotidine or placebo, with variations in timing (evening before and/or morning of surgery).
- Gastric pH and residual volume were measured; risk for aspiration was assessed.
Main Results:
- Famotidine administered on the morning of surgery significantly increased gastric pH compared to placebo (4.8 vs. 1.3).
- Two doses of famotidine resulted in a higher gastric pH (6.6).
- Famotidine did not significantly reduce gastric residual volume in any treatment group.
Conclusions:
- Preoperative famotidine, particularly when given on the morning of surgery, effectively increases gastric pH in pediatric patients.
- Despite not reducing gastric residual volume, famotidine administration significantly lowered the number of pediatric patients at high risk for aspiration pneumonitis.
- Famotidine shows promise in mitigating aspiration risk in pediatric surgical patients.
Abstract:
Aspiration pneumonitis is a severe complication of anesthesia. The objectives of this study were to determine if preoperative famotidine, a new histamine2-receptor antagonist, given by mouth either the evening before or the morning of elective surgery, reduced gastric residual volume and increased gastric pH in pediatric patients. Either famotidine or placebo (or both) were orally administered to 58 children (aged 2-17 years). The patients were randomly assigned to four groups: Famotidine-Famotidine, Placebo-Placebo, Placebo-Famotidine, and Famotidine-Placebo; subjects in the Famotidine-Famotidine group received two doses of famotidine (0.5 mg.kg-1 per dose), those in the Placebo-Placebo group, two doses of placebo, those in the Placebo-Famotidine and Famotidine-Placebo group, one dose of each by mouth. The Famotidine-Famotidine group received one dose of famotidine at 22:00 the evening before surgery and a second dose 60-90 min before the scheduled time of surgery. The Placebo-Placebo group received two doses of placebo at the same times as the Famotidine-Famotidine group. The Placebo-Famotidine group received a dose of placebo the night before surgery and a dose of famotidine the morning of surgery; the Famotidine-Placebo group received famotidine the night before surgery and placebo the morning of surgery. The administration of famotidine on the morning of surgery significantly increased gastric pH (4.8 vs. 1.3) in comparison with placebo, as did two doses of famotidine (6.6). Famotidine failed to reduce gastric residual volume significantly in any group. The administration of famotidine significantly reduced the number of pediatric patients considered at higher risk for aspiration pneumonitis, despite not decreasing gastric residual volume.