Comparison of Gastric Volume and Acidity between Children and Adults / 대한마취과학회지

BACKGROUND: Aspiration of gastric contents into the lungs is one of the most feared complications during anesthesia. Various factors combine to make pediatric patients more susceptible to regurgitation and aspiration than adults. We compared the risk of incidence of acid aspiration in two groups, after examining the pH, and volume of gastric contents in pediatric and adult patients. METHODS: This study was carried out with inpatients scheduled for elective surgery under general anesthesia. Sixty patients from 1 to 13 years old were included in the pediatric age group, and sixty patients from 18 to 60 years old were included in the adult age group. After induction of anesthesia and stabilization of the condition of the patient, gastric contents were collected via a 10 - 18 French Salem Sump tube. Gastric volume and pH were measured. RESULTS: The mean gastric volume in the pediatric group was significantly higher than those in the adult group, whereas, The mean gastric pH in the adult group was significantly higher than those in the pediatric group. CONCLUSIONS: We concluded that pediatric patients have a lower gastric pH but a higher gastric volume than adult patients.

The Effects of Preanesthetic Low Dose Famotidine on Gastric pH and Volume in Children / 대한마취과학회지

BACKGROUND: Children undergoing general anesthesia are at increased risk of aspiration pneumonia. Cimetidine and ranitidine, specific histamine (H2-receptor) antagonists, markedly reduce the acidity and volume of gastric content when given 2 3h preoperatively. A newer compound, famotidine, is a more specific antagonist that has no inhibitory effect on the drug metabolizing microsomal enzyme systems of the liver (cytochrome P-450), in contrast to cimetidine. An additional clinical advantage is a possible longer duration of action. The aim of this study is to evaluate the lowest effective dose of famotidine on gastric pH and volume in children. METHODS: Fifty-five children, aged 2 to 14 years (ASA physical status I-II) were divided into four groups (Group I:placebo, normal saline 10 ml, Group II:famotidine 0.1 mg/kg, Group III:famotidine 0.15 mg/kg, Group IV:famotidine 0.2 mg/kg.). Doses were administered intravenously 2 or 3 hours before the operation. Following induction with oxygen, enflurane and pentothal sodium, anesthesia was maintained with N2O/O2 and enflurane. A nasogastric tube was passed into the stomach and the gastric contents were aspirated in a uniform manner. Gastric volume was recorded and pH values were measured with pH meter. The incidence of high risk for aspiration pneumonia, defined as gastric pH 0.4 ml/kg of gastric juice, was measured in all groups. RESULTS: In the placebo group, 10 of 13 children (77%) had a pH 0.4 ml/kg. Group II (famotidine 0.1 mg/kg) was not found to produce a significant increase in the gastric pH. Groups III and IV (famotidine 0.15 mg/kg and 0.2 mg/kg) were found to produce a significant increase in the gastric pH. The gastric juice volume was reduced in all famotidine groups, but was not statistically significant compared with the placebo group. The incidences of high risk for aspirationpneumonitis decreased in all famotidine groups. CONCLUSIONS: The results suggest that the preoperative intravenous administration of famotidine 0.15 mg/kg is enough to decrease both gastric juice acidity and volume in this high-risk group.