Anesth Analg 2005;101:1038-1041
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ane.0000166979.99225.a0
ANESTHETIC PHARMACOLOGY
The Efficacy of Preanesthetic Proton Pump Inhibitor Treatment for Patients on Long-Term H2 Antagonist Therapy
Kazuyoshi Hirota, MD,
Mihoko Kudo, MD,
Hiroshi Hashimoto, MD, and
Tetsuya Kushikata, MD
Department of Anesthesiology, University of Hirosaki School of Medicine, Japan
Address correspondence and reprint requests to Kazuyoshi Hirota, Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki 036-8563, Japan. Address e-mail to hirotak{at}cc.hirosaki-u.ac.jp.
We previously reported that H2-antagonist medication given for longer than 4 wk may produce complete tolerance to preanesthetic H2 antagonist therapy. In this study, we evaluated the efficacy of preanesthetic proton pump inhibitor (PPI; oral rabeprazol) use in patients receiving regular H2-antagonist (oral famotidine) therapy for more than 4 wk. Forty-eight patients with assumed complete tolerance to H2 antagonists undergoing elective surgery were recruited and randomly assigned to receive either a preanesthetic PPI (rabeprazol 20 mg; n = 24) or H2-antagonist (H2 group; roxatidine 75 mg; n = 24) at 9:00 pm on the day before surgery and 2 h before the induction of anesthesia. Volume of gastric contents and pH values were measured after the induction of anesthesia. Gastric pH value in the PPI group (5.38 ± 2.42) was significantly higher than in the H2 group (3.27 ± 1.98; P < 0.01). Gastric volume in the PPI group (8.6 ± 1.5 mL) was significantly smaller than in the H2 group (15.4 ± 2.8 mL; P < 0.05; cf. PPI). Fourteen patients in the H2 group were at risk of acid aspiration pneumonia (gastric pH <2.5 or volume >25 mL), whereas only four patients in the PPI group (P < 0.05) were at risk. These data suggest that in patients receiving H2-antagonist therapy for longer than 4 wk, prophylaxis for acid aspiration pneumonia should include preanesthetic PPI medication.
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