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Lansoprazole reduces preoperative gastric fluid acidity and volume in children
Insights
Two doses of lansoprazole (a proton pump inhibitor) effectively reduced stomach acidity and volume in children before anesthesia. This regimen improved the gastric environment, enhancing patient safety during surgery.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Gastric aspiration before anesthesia is a critical safety concern in pediatric patients.
- Proton pump inhibitors (PPIs) are used to reduce gastric acid production.
- The efficacy of lansoprazole in pediatric pre-anesthetic management requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of lansoprazole in decreasing gastric aspirate acidity (pH) and volume in children.
- To compare different administration timings of lansoprazole (PPI) before anesthesia.
Main Methods:
- A randomized controlled trial involving 100 healthy children (3-11 years) undergoing elective surgery.
- Four treatment groups received lansoprazole or placebo at bedtime and/or preoperatively.
- Gastric aspirate was analyzed for pH and volume after anesthesia induction.
Main Results:
- Lansoprazole significantly increased gastric fluid pH and decreased fluid volume.
- A two-dose regimen (bedtime and preoperatively) was most effective.
- No patients in the two-dose lansoprazole group had high aspirate volume and low pH.
Conclusions:
- Oral lansoprazole (at least 30 mg) improves the gastric environment for pediatric anesthesia induction.
- A two-dose regimen of lansoprazole is the most effective strategy for reducing gastric acidity and volume.
- Lansoprazole administration before surgery enhances safety in pediatric patients.
Abstract:
The purpose of this study was to explore the efficacy of lansoprazole, a proton pump inhibitor, in reducing the acidity and volume of gastric aspirate in children immediately following the induction of anaesthesia. One hundred healthy in-patients aged 3-11 yr undergoing elective surgery were randomly allocated to four groups (n = 25 each): lansoprazole-lansoprazole, placebo-placebo, placebo-lansoprazole, and lansoprazole-placebo. For each treatment regimen, the first medication was administered at 9:00 pm on the night before surgery and the second at 5:30 am on the morning of the day of surgery (three hours preoperatively). The dose of lansoprazole was 30 mg (approximately 1.4 mg.kg-1 mean). Children were offered 10 ml.kg-1 apple juice three hours before induction of anaesthesia. After induction of anaesthesia and tracheal intubation, gastric fluid was aspirated through a large-bore, multiorifice orogastric tube and analyzed for pH and total fluid volume. Lansoprazole increased gastric fluid pH and decreased gastric fluid volume regardless of whether it was administered before or after placebo. Two consecutive doses of lansoprazole was the most effective means of increasing the pH and reducing the volume of gastric aspirate; in this group, there were no subjects with gastric aspirate volume > 0.4 ml.kg-1 and pH < 2.5. Oral lansoprazole, at least 30 mg, given on the night before surgery or on the morning of surgery will improve the gastric environment at the time of induction of paediatric anaesthesia. The most effective regimen was two doses (at bedtime and on the morning) of lansoprazole.