Metoclopramide and cimetidine to reduce gastric fluid pH and volume

Eighty female patients undergoing outpatient laparoscopy were divided into four equal groups to investigate the effect of cimetidine and metoclopramide on the gastric fluid volume and pH. Group I patients received two placebo tablets. Group II patients were given metoclopramide, 10 mg, and one placebo tablet. Group III patients received cimetidine, 300 mg, and one placebo tablet. Group IV patients received metoclopramide, 10 mg, and cimetidine, 300 mg. Gastric fluid volume in group I patients was 83.9 +/- 2.3 ml; in group II patients, 11.1 +/- 0.63 ml; in group III patients, 51 +/- 2.33 ml; and in group IV patients, 12.05 +/- 0.79 ml. Gastric fluid pH was 1.38 +/- 0.12, 2.6 +/- 0.21, 4.04 +/- 0.32, and 4.64 +/- 0.28 in groups I through IV, respectively. Gastric fluid volume was significantly less (P less than 0.0001) in groups II and IV than in groups I and III. Gastric fluid pH was significantly higher (P less than 0.0001) in groups III and IV than in groups I and II. It is concluded that administration of metoclopramide and cimetidine two hours prior to induction of anesthesia significantly decreases the gastric fluid volume and increases gastric fluid pH, thereby decreasing both the likelihood of aspiration of gastric contents and the likelihood of severe pulmonary reaction, should aspiration occur.