Use of ranitidine in children undergoing cardiopulmonary bypass

Area of Science:

• Pediatric Critical Care Medicine
• Gastroenterology
• Cardiothoracic Surgery

Background:

• Pediatric patients undergoing cardiopulmonary bypass (CPB) are at risk for stress-induced gastric ulceration.
• Maintaining adequate gastric pH is crucial for preventing gastrointestinal complications in critically ill children.

Purpose of the Study:

• To evaluate the efficacy and safety of two ranitidine infusion regimens for prophylaxis against stress-induced gastric ulceration in children.
• To determine the optimal ranitidine dosage for maintaining gastric pH above 3.5 during and after CPB.

Main Methods:

• A comparative study of 60 pediatric patients (6 weeks to 10 years) undergoing CPB for congenital heart defect repair.
• Two ranitidine infusion rates (0.1 mg/kg/h and 0.2 mg/kg/h) were administered from anesthesia induction through 24 hours post-surgery.
• Gastric pH and ranitidine plasma concentrations were monitored.

Main Results:

• Both ranitidine regimens effectively elevated gastric pH to at least 5.3 within 3 hours of CPB cessation.
• The 0.2 mg/kg/h infusion resulted in higher ranitidine plasma concentrations but offered no additional clinical benefit over the 0.1 mg/kg/h dose.
• No adverse events were reported for either treatment group.

Conclusions:

• A ranitidine infusion of 0.1 mg/kg/h is a safe and effective prophylactic treatment for stress-induced gastric ulceration in critically ill pediatric surgical patients.
• The lower ranitidine dose is sufficient for achieving therapeutic gastric pH levels during CPB and the early postoperative period.