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Recieved from the Departments of Anesthesiology and Pathology, Lourdes Hospital, Paducah, Kentucky.
Abstract
The effects of preanesthetic glycopyrrolate and cimetidine on gastric fluid pH and volume were studied in outpatients. One hundred outpatients scheduled for elective surgery were randomly allocated into four groups with 25 patients in each group. Patients in group I were given neither glycopyrrolate nor cimetidine and served as controls. Group II patients received 4–5 µg/kg of glycopyrrolate intramuscularly 45–90 min before induction of anesthesia. Patients in group III received 300 mg of cimetidine orally with a sip of water 1–4 hr before induction of anesthesia. Group IV patients received cimetidine, as in group III, and glycopyrrolate as in group II. Twenty-five inpatients undergoing elective surgery also were studied for comparison. Patients in group I (control) served as the basis for comparison with inpatients. Patients with gastric pH 
2.5 or volume of gastric contents 
20 ml were defined to be at risk of pulmonary damage in the event of aspiration. Patients in group I had a mean gastric pH of 2.34 ± 0.30 with a mean gastric volume of 25.6 ± 4.1 ml. Seventy-six % of the patients in the control group had gastric contents with a pH 2.5 and 52% had volumes 20 ml. Glycopyrrolate (group II) failed to increase gastric pH or to reduce gastric volume. In contrast, cimetidine in groups III and IV with or without glycopyrrolate significantly reduced the number of patients at risk of aspiration, by increasing the pH and reducing the volume of gastric contents. Cimetidine increased gastric pH to > 2.5 in 84–88% of the patients and reduced the number of patients having a gastric pH < 2.5 and volume > 20 ml to 4–8%. No beneficial effect was seen by administering glycopyrrolate with cimetidine. We recommend that outpatients receiving general anesthesia be given cimetidine preoperatively. Gastric contents in outpatients in group I were comparable to a similar group of inpatients with regard to mean pH and volume and with respect to the proportions of patients with gastric pH 2.5 and volume 20 ml.
Key Words: PHARMACOLOGY—cimetidine, glycopyrrolate • GASTROINTESTINAL TRACT—gastric pH, gastric volume • COMPLICATIONS—aspiration, pneumonitis • ANESTHESIA—outpatient
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