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Omeprazole reduces preoperative gastric fluid acidity and volume in children
K Nishina1, K Mikawa, N Maekawa
1Department of Anaesthesiology, Kobe University School of Medicine, Japan.
Insights
Two doses of oral omeprazole significantly increase gastric pH in children before surgery, reducing the risk of aspiration. A single dose on the morning of surgery was ineffective.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Pharmacology
Background:
- Preoperative fasting guidelines aim to minimize gastric volume and acidity in children.
- Gastric fluid pH and volume are critical factors in aspiration risk during anesthesia.
Purpose of the Study:
- To evaluate the efficacy of oral omeprazole in altering preoperative gastric fluid pH and volume in pediatric patients.
- To determine optimal dosing regimens for omeprazole administration before elective surgery in children.
Main Methods:
- 104 healthy children (4-9 years) were randomized into four groups receiving omeprazole or placebo.
- Medications were administered either the night before surgery, the morning of surgery, or both.
- Gastric fluid was aspirated post-intubation and analyzed for pH and volume.
Main Results:
- Two doses of omeprazole (bedtime and morning) significantly increased gastric pH compared to placebo (4.8 +/- 1.6 vs 2.0 +/- 0.6, P < 0.05).
- A single bedtime dose also increased gastric pH (3.3 +/- 1.3 vs 2.0 +/- 0.6, P < 0.05).
- Omeprazole administration reduced the incidence of high gastric volume and low pH.
Conclusions:
- Two-dose omeprazole regimen is effective in increasing gastric pH in children undergoing surgery.
- Preoperative omeprazole may reduce the risk of gastric acid aspiration in pediatric patients.
- Single-dose omeprazole on the morning of surgery is insufficient to alter gastric parameters.
Abstract:
To explore the effects of oral omeprazole on preoperative gastric fluid pH and volume in children, 104 healthy in-patients aged 4-9 yr were randomly allocated to four groups (n = 26). Subjects in the Omeprazole-Omeprazole Group received two doses of omeprazole (20 mg per dose), those in the Placebo-Placebo Group, two doses of placebo, those in the Placebo-Omeprazole and Omeprazole-Placebo Groups, one dose each of the two preparations by mouth. For each treatment regimen, the first medication was administered at 9:00 p.m. on the night before surgery and the second at 5:30 a.m. on the morning of the day of surgery (three hours preoperatively). Children undergoing elective surgery were offered 10 ml.kg-1 of 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. The administration of omeprazole at bedtime before surgery increased gastric pH (3.3 +/- 1.3 vs 2.0 +/- 0.6, P < 0.05) in comparison with placebo, as did two doses of omeprazole (pH = 4.8 +/- 1.6, P < 0.05). A single dose of omeprazole administration on the morning of the day of surgery failed to increase gastric pH. There was a reduction in the number of children with a pH < 2.5 and a volume > 0.4 ml.kg-1 in the Omeprazole-Omeprazole and Omeprazole-Placebo Groups, compared with the Placebo-Placebo or Placebo-Omeprazole Groups.(ABSTRACT TRUNCATED AT 250 WORDS)