Gastroprotection in neurosurgery: the practice in Great Britain

The indications for gastroprotection concurrent with corticosteroid use or as prophylaxis for stress ulceration in the neurosurgical intensive care unit remain unclear. The purpose of this study was to determine to what extent gastroprotection is practised in neurosurgical units in the British Isles. Data were obtained by questionnaire circulated at the end of 1988 and 1994. Of 92 surgeons who replied in 1988, 49 routinely used a gastroprotective agent with corticosteroids and 47 in patients at risk of stress ulceration. This compares with 63 out of 89 surgeons using a gastroprotective agent with steroid administration and 60 using prophylaxis for stress ulceration in 1994. The gastroprotective agent of choice in 1988 was an H2 antagonist (76) followed by antacids (36). In 1994, it was again an H2 antagonist (69), but sucralfate (15) was now the second most common agent used. The number of reported peptic ulcer complications among those surgeons who did not routinely use gastroprotective agents was no higher than those who did. Our findings indicate an increase in the administration of gastroprotective agents within neurosurgery. However, the use of H2 antagonists in the intensive care unit and the use of gastroprotective agents with corticosteroids may not be warranted.