ABSTRACT
Ascorbic acid is one of the most well-known nutritional supplement and antioxidant found in fruits and vegetables. Calcium ascorbate has been developed to mitigate the gastric irritation caused by the acidity of ascorbic acid. The aim of this study was to compare calcium ascorbate and ascorbic acid, focusing on their antioxidant activity and effects on gastric juice pH, total acid output, and pepsin secretion in an in vivo rat model, as well as pharmacokinetic parameters. Calcium ascorbate and ascorbic acid had similar antioxidant activity. However, the gastric fluid pH was increased by calcium ascorbate, whereas total acid output was increased by ascorbic acid. In the rat pylorus ligation-induced ulcer model, calcium ascorbate increased the gastric fluid pH without changing the total acid output. Administration of calcium ascorbate to rats given a single oral dose of 100 mg/kg as ascorbic acid resulted in higher plasma concentrations than that from ascorbic acid alone. The area under the curve (AUC) values of calcium ascorbate were 1.5-fold higher than those of ascorbic acid, and the C(max) value of calcium ascorbate (91.0 ng/ml) was higher than that of ascorbic acid (74.8 ng/ml). However, their T(max) values were similar. Thus, although calcium ascorbate showed equivalent antioxidant activity to ascorbic acid, it could attenuate the gastric high acidity caused by ascorbic acid, making it suitable for consideration of use to improve the side effects of ascorbic acid. Furthermore, calcium ascorbate could be an appropriate antioxidant substrate, with increased oral bioavailability, for patients with gastrointestinal disorders.
Subject(s)
Animals , Humans , Rats , Ascorbic Acid , Biological Availability , Calcium , Fruit , Gastric Juice , Hydrogen-Ion Concentration , In Vitro Techniques , Models, Animal , Pepsin A , Plasma , Pylorus , Ulcer , VegetablesABSTRACT
Objective To investigate the detecting values of gastric pH for the neonatal asphyxia.Methods: From August 2013 to February 2015 in our hospital, 78 asphyxia were randomly and equally divided into the observation group and control group.All cases were given gastric pH testing, digestion tract bleeding Monitoring, reflux conditions and routine procedure for treatment.The patients in the observation group received Smecta treatment on the basis of conventional therapy.Results The gastric pH values at 72 h and 48 h after treatment in the observation group were significantly higher (P＜0.05) , and showed a rising trend, the gastric pH values at 24 h after treatment had no statistically significant between two groups.The upper gastrointestinal bleeding rates in the observation group during treatment were 5.1％, which was significantly lower than the control group (23.1％) (P＜0.05).The reflux continued ≥5 min frequency and longest reflux time in the observation group were significantly less than the control group, the differences were statistically significant (P＜0.05).Conclusion For neonatal asphyxia, the gastric pH determination can effectively detect gastrointestinal bleeding and gastroesophageal reflux, the early applying of Smecta intervention can increase gastric pH value, improve neonatal outcomes.
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Aims: The anti-ulcerogenic activity of L-arginine and L-citrulline were evaluated in indomethacin-induced gastric ulceration. Degree of ulcerogenesis, gastric pH and microscopic histological evaluation were carried out. Study Design: Six groups of albino rats weighing between 180-280g were pre-treated respectively with distilled water (ulcer control), omeprazole (20mg/kg, reference control 1), cimetidine (100mg/kg reference control 2), L-arginine (experimental control 1), 300mg/kg and 900mg/kg L-citrulline (experimental controls 2 and 3). Place and Duration of Study: Department of Physiology, College of Medicine. University of Ibadan, Nigeria between April 2012 and February 2013. Methodology: Forty-eight albino rats weighing between 180-280g were pre-treated respectively with distilled water (ulcer control), omeprazole (20mg/kg, reference control 1), cimetidine (100mg/kg reference control 2), L-arginine (experimental control 1), 300mg/kg and 900mg/kg L-citrulline (experimental controls 2 and 3) sixty minutes prior to oral administration of indomethacin to generate gastric mucosal injury. ). Ulcer was induced using 40mg/kg BW Indomethacin. Four hours later, rats were sacrificed and gastric contents as well as stomach wall samples were collected. Gastric ulcer score was determined macroscopically as well as gastric pH. Tissue samples were also prepared and examined histologically Results: With gross examination, ulcer control exhibited severe injury to the gastric mucosa and decreased pH of gastric contents, whereas rats pre-treated with L-arginine and L-citrulline showed significant dose-dependent reduction of gastric lesion formation accompanied by significant increase in gastric mucus production and pH of gastric fluid. Gastric protection was more prominent in L-arginine (300mg/kg) and L-citrulline (900mg/kg) groups. Histologically, the ulcer control showed the most severe and deepest gastric mucosal necrotic damage, with oedema of the submucosal layer compared to experimental and reference control groups. Conclusion: The results suggest that a possible explanation for the protective activity of L-arginine and L-citrulline may be due its stimulation of defensive mucin secretion and a consequent increase in pH of gastric contents, which result in less mucosal injury and limited or absent oedema of submucosa.
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The aim of this study was to determine the omeprazol treatment effect on equine gastric fluid pH with food andwithout food administering for the duration of the experiment. To carry this project out, 7 animals were chosenbetween the ages of 3 and 10 (2 males and 5 females) from the Centro de Veterinaria y Zootecnia - CES. In thecontrolled treatment they received 200 ml of physiological saline and were treated using omeprazol pellets whichwere administered in a single dose of 4 mg/kg via a nasogastric insertion, and in two groups with or without foodduring the treatment. Gastric pHs were measured at 0 hour (fasting before treatment) and then at hours 3, 5, 7, 9,11 and 24 after treatment. In animals consuming food, both treatments showed post treatment gastric pH increases,which can be explained by the ad libitumn food management in both treatments, which may increasing post prandialpH. In fasting animals, we observed that in the controlled treatment the pH was maintained at very low levels atall measurement times, while in the omeprazol treatment the pH increased significantly. These results show thattreatment with omeprazol pellets at a dose of 4 mg/kg via nasogastric insertion increased gastric pH in healthyanimals that are not eating food and that this effect was similar to them being administered food.
El objetivo de este estudio fue determinar el efecto del tratamiento con omeprazol sobre el pH del fluido gástrico en equinos, con la administración del alimento y sin ella. Para llevar a cabo este proyecto se eligieron siete animalesentre los 3 y 10 años de edad (2 machos y 5 hembras) del Centro de Veterinaria y Zootecnia CES. El tratamientocon omeprazol se administró en pellets a una dosis única de 4 mg/kg, por vía nasogástrica, para los grupos cono sin alimento. Para el tratamiento control, se administraron 200 ml de solución salina fisiológica. En todos lostratamientos se midieron los pHs gástricos a la hora 0 (ayunas antes del tratamiento) y luego a las horas 3, 5, 7, 9, 11 y 24, postratamiento. Los animales que consumieron alimento con y sin omeprazol presentaron aumentos de pHgástrico postratamiento, lo que se puede explicar por el sumistro de heno ad libitum en ambos tratamientos. En losanimales en ayuno se observó que en el tratamiento control, el pH se mantuvo en niveles muy bajos en todas las horasde medición, mientras que en el tratamiento con omeprazol, el pH aumentó notablemente. Los resultados muestran que el tratamiento con pellets de omeprazol a una dosis de 4 mg/kg vía nasogástrica aumentó el pH gástrico en animales sanos que no están consumiendo alimento y que este efecto fue similar que cuando se administró el mismo.
A resistência é o mecanismo pelo qual a bactéria pode diminuir a ação dos agentes antimicrobianos de formanatural ou adquirida; dentro das causas mais frequentes está a utilização indiscriminada destes agentes em pacienteshumanos e produções pecuárias. Desde 1990 tem identificado novas cepas resistentes de bactérias que originaramdoenças zoonóticas emergentes. Dentro destas a zoonose, a salmonelose é considerada a doença mais difundida anível mundial, a ampla distribuição na natureza entre animais silvestres, domésticos e o meio ambiente, produz umarápida propagação de seus mais de 2500 sorotipos no homem. Contudo, a grande preocupação pela infecção com esteinteiro patógeno é devido aos cada vez mais elevados fracassos nos tratamentos com antimicrobianos convencionais,ocasionados pela alta resistência bacteriana a estes fármacos. O presente artigo é uma revisão sobre a problemáticaque gerou a resistência de Salmonella no homem e os animais, contem também estratégias de prevenção e controledeste fenômeno, que está distante de terminar e permitem o fortalecimento da saúde pública.
Subject(s)
Animals , Hydrogen-Ion Concentration , Food-Drug Interactions , Gastritis/veterinary , Omeprazole/therapeutic use , Animal Diseases/prevention & control , Animal Diseases/therapy , Food , Omeprazole/administration & dosage , Omeprazole/pharmacologyABSTRACT
BACKGROUND: The use of CO2 for pneumoperitoneum during laparoscopic surgery provokes a decrement in the gastric pH. Since the incidence rate of PONV increases after laparoscopic surgery, the possibility of lung aspiration of gastric juice with a low pH during a postanesthetic emergence may increase and this could be fatal for the patient. We conducted this study to determine the effects of esomeprazole premedication on inhibiting the decrement of the gastric pH during laparoscopic surgery. METHODS: 40 adult patients with no underlying diseases were chosen and 20 patients each were grouped as C (the control group) and E (the esomeprazole group). In both group, 0.2 mg glycopyrrolate was given intramuscularly 30 minutes prior to the surgery. In group E, esomeprazole was given orally 2 hours prior to the surgery. The pH, PaCO2, and PETCO2 were measured via pH probe, an ABGA and an capnogram at preinsufflation and 15, 30 and 60 minutes after the CO2 insufflation and right before CO2 exhaustion (predeflation). RESULTS: Comparing the measurements of the gastric pH between group E and group C, all the results showed a significant increase in group E (P < 0.05). The difference of the PaCO2 and PETCO2 in the two groups was not significance. CONCLUSIONS: In contrast to the decrease in the gastric pH as the PaCO2 and PETCO2 increased in group C, the gastric pH in group E remained high until the end of the surgery despite the increase in the PaCO2 and PETCO2. Esomeprazole premedication seem to have an effect for inhibiting the gastric pH decrement regardless of the increase in the PaCO2 and PETCO2 during laparoscopic surgery.
Subject(s)
Adult , Humans , Esomeprazole , Gastric Juice , Glycopyrrolate , Hydrogen-Ion Concentration , Incidence , Insufflation , Laparoscopy , Lung , Pneumoperitoneum , Postoperative Nausea and Vomiting , PremedicationABSTRACT
PURPOSE: The aim of this study was to identify usefulness of simple oral and gastric pH measurement using pH paper on detection of symptomatic gastroesophageal reflux in neonates. METHODS: This prospective study included a total of 66 neonates born at Konyang University Hospital from June 2004 to June 2005. Each neonate's oral and gastric pH levels measured with pH paper at 6 hourly intervals. Suspected gastroesophageal refluex neonates were studied 24-hr lower esophageal pH monitoring or upper GI series and confirmed. We compared oral and gastric pH between symptomatic gastroesophageal reflux (GER) group and asymptomatic (control) group. RESULTS: GER group consist of 12 neonates and control group consist of 54 neonates. Oral and gastric pH were 5.4+/-0.6, 2.9+/-0.5 in GER group, 6.0+/-0.3, 3.9+/-0.9 in control group, the differences between two groups were significant (P<0.05). All neonates of GER group were corfirmed gastroesophageal reflux by 24-hr lower esophageal pH monitoring or upper GI series studies. Our data indicate as a predictor for significantly symptomatic gastroesophageal reflux, at oral pH 5.75, has a sensitivity 92%, specificity 89%, positive predictive value of 65%, and negative predictive value of 98%. The difference between oral and gastric pH (oral pH-gastric pH) was not significant in each group. CONCLUSION: In neonates with symptomatic gastroesophageal reflux oral and gastric pH were significantly lower than asymptomatic neonates. Oral and gastric pH were related with clinically significant symptoms of gastroesophageal reflux. We suggest that pH measurement could be a possible simple screening test of symptomatic gastroesophageal reflux.
Subject(s)
Humans , Infant, Newborn , Esophageal pH Monitoring , Gastroesophageal Reflux , Hydrogen-Ion Concentration , Mass Screening , Prospective Studies , Sensitivity and SpecificityABSTRACT
PURPOSE: The purpose of this study was to measure the oral and gastric pH among preterm and term infants by the simple experimental method using pH paper. METHODS: This prospective study included a total of 60 neonates born at Konyang University Hospital from June 2004 to September 2004. Each neonate's oral and gastric pH levels were measured with pH paper at 6 hourly intervals on the first and the fifth day of life. 15 preterm infants were examined until twenty first day of life. RESULTS: The oral and gastric pH of 60 neonates were 6.3+/-0.5 and 4.1+/-1.0 on the first day and 6.0+/-0.3 and 3.9+/-0.9 on the fifth day, respectively. The preterm infant had lower oral and gastric pH of 6.4+/-0.6 and 4.3+/-1.1 on the first day and 6.0+/-0.2 and 4.2+/-1.0 on the fifth day, respectively in comparison to those of term infant's oral and gastric pH of 6.3+/-0.4, 4.0+/-0.9 on the first day and 6.1+/-0.3 and 3.7+/-0.8 on the fifth day, respectively. The gastric pH's of preterm infant on the first, fifth and twenty first day of life were 4.6+/-1.4, 4.3+/-1.0 and 4.2+/-1.0, respectively. CONCLUSION: This study reports the value of neonates' oral and gastric pH on the first and fifth day of life. The average gastric pH of neonate is higher than that of adult's and preterm infant's gastric pH is higher than term infant's. The gastric pH of preterm infant decreased in time.
Subject(s)
Humans , Infant , Infant, Newborn , Gastroesophageal Reflux , Hydrogen-Ion Concentration , Infant, Premature , Prospective StudiesABSTRACT
Objective To study the different pathogenesis between non-erosive gastroesophageal reflux disease(NERD) and reflux esophagitis(RE).Methods 57 patients with regurgitation or heartburn from 1996 to 2004 were assessed in this study.Patients with esophageal mucosal break by endoscopy were regarded as the RE group,others as the NERD group.The clinical feature and whether complicating with H.pylori infection in both groups were reviewed and all patients underwent esophageal manometry and 24 hours esophageal/gastric pH monitoring.Results No differences of age?sex?smoking?drinking and Hp infection were found between the two groups.The incidence of the atypical reflux symptom (chest pain) in the NERD group was higher than in the RE group.There was pathologic acid reflux in both groups,but the two groups did not differ at reflux degree.Esophageal body peristaltic amplitude of the NERD group was higher than that of the RE group.Average gastric pH of the NERD group in supine was lower compared with the RE group.Conclusion In the NERD patients,the incidence of the atypical reflux symptom is more prevalent.It is the esophageal acid clearance not the reflux degree that plays an important role in the different pathogenesis between NERD and RE.
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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.
Subject(s)
Adolescent , Adult , Child , Humans , Middle Aged , Anesthesia , Anesthesia, General , Hydrogen-Ion Concentration , Incidence , Inpatients , LungABSTRACT
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.
Subject(s)
Child , Humans , Administration, Intravenous , Anesthesia , Anesthesia, General , Cimetidine , Enflurane , Famotidine , Gastric Juice , Histamine , Hydrogen-Ion Concentration , Incidence , Liver , Oxygen , Pneumonia, Aspiration , Ranitidine , Sodium , Stomach , ThiopentalABSTRACT
BACKGROUND: To identify the gastric pH of gastric carcinoma patients after more than 8 hours of fasting and ascertain the antisecretory effects of H2-receptor antagonists, the gastric volume and pH of 41 gastric carcinoma patients was checked immediately after the induction of inhalational general anesthesia (endotracheal intubation). METHODS: The patients were divided randomly into two groups: the control received IV normal saline as a placebo and the famotidine group received IV famotidine as a premedicant 1 to 2 hours before the induction of anesthesia. Immediately after the induction of anesthesia, the gastric contents were aspirated blindly with a 60 ml syringe. Fisher's exact test was used to compare the percentage of patients 'at risk' between the two groups in relation to their pH and volumes. RESULTS: The percentage of patients 'at risk' (volume > 0.4 ml/kg and pH < 2.5) of acid aspiration pneumonitis in the control and famotidine groups was 8.7% and 5.6%, respectively, which was 30 77% lower than for patients with no premedication, as observed in other studies. In the present study, the difference in percentage of patients 'at risk' between the two groups was not statistically significant. CONCLUSIONS: The gastric carcinoma patients exhibited a higher gastric pH when fasting and a lower risk of acid aspiration pneumonitis relative to their gastric contents. The effect of famotidine on lowering gastric acidity and volume in gastric carcinoma patients was rather weak. Accordingly, the routine use of H2-receptor antagonists to decrease gastric secretion in gastric carcinoma patients should be reevaluated.
Subject(s)
Humans , Anesthesia , Anesthesia, General , Famotidine , Fasting , Gastric Acid , Hydrogen-Ion Concentration , Pneumonia , Premedication , SyringesABSTRACT
BACKGROUND: Aspiration of gastric contents is an ever -present risk in the use of general anesthesia, particularly in emergency and obstetric situations, and morbidity and mortality associated with this complication increases with the volume and acidity of the aspirate. Since direct inhibition of acid secretion may be a preferable method, we studied the effectiveness of ranitidine in increasing gastric pH. METHODS: Sixty patients scheduled for elective cesarean section under general anesthesia before midday were randomly divided into three groups. The control group (n=20) did not received preanesthetic ranitidine. Group I (n=20) received a slow intravenous injection of 50 mg ranitidine, one hour before surgery. Group II (n=20) received 150 mg ranitidine orally, both the night before surgery and the morning of surgery. RESULTS: Compared with the control group, the mean gastric pH increased significantly in group I and II (P<0.05). There was no significant difference of gastric pH between group I and II. CONCLUSIONS: The results of this study indicate that ranitidine is a useful agent in increasing the gastric pH in women undergoing elective cesarean section. Ranitidine administered intravenously and orally were equally effective means in increasing the gastric pH.
Subject(s)
Female , Humans , Pregnancy , Anesthesia, General , Cesarean Section , Emergencies , Gastric Acid , Hydrogen-Ion Concentration , Injections, Intravenous , Mortality , RanitidineABSTRACT
Although the "Duodenogastric reflux" was often developed in normal persons, it was more frequently developed in the majority of patients who had a gallstone disease or malfunctioned gallbladder. The "duodenogastric reflux" induced chronic gastritis, peptic ulcer, and esophagitis causing upper abdominal symptoms. After the cholecystectomy was performed, most patients have no further symptoms but a significant minority of patients still have persistent symptoms. Such symptoms was often explained with the "duodenogastric reflux". We examined the degree of duodenogastric reflux in the patients with gallstones and the changes of the degree of the duodenogastric reflux after the laparoscopic cholecystectomy in these patients. The study population consisted of 9 patients with gallstone disease. The clinical symptoms (upper abdominal pain, bloating, early satiety, nausea, vomiting, heartburn, dysphagia, indigestion, fat intolerance) were graded and all subjects had standard esophageal manometry to identify the location of the lower esophgeal sphincter and the 24 hour gastric pH monitoring to ascertain the duodenogastric reflux at before and 3 months after laparoscopic cholecystectomy. On the results of our study, the severity of clinical symptoms was decreased after operation and the time percentage above pH 7, longest time above pH 7, frequency above pH 7 and frequency persistent 5 min above pH 7 in supine and upright position were not significantly different after operation at statistical analysis. It is revealed that the degree of duodenogastric reflux was not changed on 24 hour gastric pH monitoring. We concluded that laparoscopic cholecystectomy did not affect on the duodenogastric reflux in the patients of gall bladder stone.
Subject(s)
Humans , Abdominal Pain , Cholecystectomy , Cholecystectomy, Laparoscopic , Deglutition Disorders , Duodenogastric Reflux , Dyspepsia , Esophagitis , Gallbladder , Gallstones , Gastritis , Heartburn , Hydrogen-Ion Concentration , Manometry , Nausea , Peptic Ulcer , Urinary Bladder Calculi , VomitingABSTRACT
Backgrounds: The purpose of fasting before surgery is to minimize the volume of gastric contents. A short fast after solid food increases gastric volume, but a small drink of clear fluid 2 to 3 hours preoperatively decreases gastric volume. This investigation examined the effects of a small drink of clear fruit juice 2 to 3 hours prior to anesthesia on gastric volume, gastric pH, thirst and hunger. METHODS: Two hundred eighty children whose ages were five to ten years, scheduled for elective surgery were randomly assigned to one of 7 groups. Group 1 continued to fast but in the other 6 groups the children drank 2 ml/kg, 3 ml/kg, or 4 ml/kg of clear fruit juice (orange or grape) 2 to 3 hours preoperatively. The degree of thirsty and hunger was checked. The volume of gastric contents was measured by syringe and the pH by pH meter. RESULTS: The children who drank fruit juice preoperatively had decreased gastric volume. The gastric pH was not significantly different with that of the control group. The degree of thirst and hunger was not significantly different with that of the control group. CONCLUSIONS: We conclude that a small drink of fruit juice 2 to 3 hours preoperatively is more preferable than 8 hours fasting.
Subject(s)
Child , Humans , Anesthesia , Fasting , Fruit , Hunger , Hydrogen-Ion Concentration , Syringes , ThirstABSTRACT
BACKGROUND: Aspiration pneumonia remains a serious result associated with general anesthesia. Therefore, we studied the effectiveness of preanesthetic ranitidine in increasing gastric pH to prevent aspiration pneumonia. METHODS: Eighty patients scheduled for elective surgery were randomly divided into four groups with twenty patients in each group. Patients in control group were not given preanesthetic ranitidine; patients in group I received 300 mg of ranitidine orally at night before surgery, patients in group II received 150 mg of ranitidine orally both the night before surgery and one hour before surgery respecvtively and patients in group III recieved 150mg of ranitidine orally one hour before surgery. RESULTS: Compared with control group, the mean gastric pH of preanesthesia and 1 hour after anesthetic induction increased significantly in the group I, II, III (P<0.0001). There was significant increased gastric pH in the group II compared with group I and III. CONCLUSIONS: These results demonstrate that ranitidine markedly increase the gastric pH. So, we recommend that patients receiving general anesthesia would be taken Hz-antagonist such as ranitidine preoperatively.
Subject(s)
Humans , Anesthesia, General , Hydrogen-Ion Concentration , Pneumonia, Aspiration , Premedication , RanitidineABSTRACT
Aspiratian of gastric contents during anesthesia is the most common cause of maternal anesthetic death. Particularly, the parturient is predisposed to the catastrophe of aspiration for many reasons. So, the effect of cimetidine premedication on gastric pH and volume were studied. 120 ASA Class I patients scheduled for elective obstetric and gynecologic surgery were randomly divided into six groups as follows: Class A(n=80) is pregnant women scheduled for elective cesarean section. In the class A, group 1(n=20)(control group) was received no cimetidine premedication, group 2(n=20) was received cimetidine 300 mg p.o. hs. group 3(n=20) was received cimetidine 300 mg p.o. 2hrs before anesthesia, and group 4(n=20) was received cimetidine 200 mg iv 2hrs before anesthesia. Class B (n=40) is 20-40 aged non-pregnant women scheduled for elective surgery. ln the class B, group 5(n=20)(control group) was received no cimetidine premedication and group 6(n=20) was received cimetidine 200 mg iv 2hrs before anesthesia. Immediately following induction of anesthesia, the gastric fluid was obtained by suction on a nasogastric tube and its volume and pH were measured. The results were as follows: 1) When cimetidine is not premedicated, number of patient with a gastric pH less than 2,5 and gastric volume greater than 25 ml was increased in the group 1 compared with group 5. 2) In the class A, there was significant increased gastric pH and decreased gastric volume in the group 2, 3, and 4 compared with group l. 3) In the class B, there was significant increased gastric pH and decreased gastric volume in the group 6 compared with group 5. In conclusion, it would seem that the risk of aspiration pneumonitis can be increased in the pregnant women compared with nonpregnant women. The authors recommend that the incidence of severe aspiration pneumonia can be decreased by cimetidine premedication before general anesthesia even though there is any gastric aspiration.
Subject(s)
Female , Humans , Pregnancy , Anesthesia , Anesthesia, General , Cesarean Section , Cimetidine , Gynecologic Surgical Procedures , Hydrogen-Ion Concentration , Incidence , Pneumonia , Pneumonia, Aspiration , Pregnant Women , Premedication , SuctionABSTRACT
Nosocomial pneumonia, which can develop in patients with prolonged intubation, may have in fatal consequences. The histamine type 2 blockers used for prevention of stress ulcers, increases gastric pH, and may increase the incidence of nosocomial pneumonia in patients with prolonged intubation by promoting bacterial overgrowth in the stomach and retrograde colonization in the trachea. We assessed the effect of histamine type 2 blockers on the incidence of nosocomial pneumonia in patients with prolonged intubation, who were admitted to the Intensive Care Unit, Young Dong Severance Hospital, Yonsei University College of Medicine from September 1992 to February 1993. The patients were divided into two groups Group 1 was the patients given histamine type 2 blockers and total parenteral nutrition, and Group 2 was the patients not given histamine type 2 blockers and with enteral feeding through the gastric tube. Gastric juice was aspirated for measurement of gastric pH. A culture of isolates was grown from endotracheal secretion and pharyngeal swab for identification of isolate cultured. Chest X-rays were taken for assess of pneumonic infiltrate, The results were as follows ;. 1. There were no difference of age, APACHE II scores at admission to ICU, duration of ICU stay and mortality between the two groups. 2. Gastric pH differed significantly between the two groups. In group 2, there was a significant difference between gastric pH before and after feeding. 3. The incidence of upper gastrointestinal bleeding did not differ between the two groups. 4. Colonization developed more frequently in the patients with enteral feeding. 5. The incidence of retrograde colonization was higher in patients with enteral feeding. 6. The incidence of nosocomial pneumonia were 30 and 40 percent, and there was no significant difference between the two groups. From our study, the incidence of nosocomial pneumonia was not different significantly between the two groups although gastric pH differed significantly.
Subject(s)
Humans , APACHE , Colon , Enteral Nutrition , Gastric Juice , Hemorrhage , Histamine , Hydrogen-Ion Concentration , Incidence , Intensive Care Units , Intubation , Mortality , Parenteral Nutrition, Total , Pneumonia , Stomach , Thorax , Trachea , UlcerABSTRACT
The retrograde microorganismal colonization in the pharynx from stomach may cause the nosocomial pneumonia and that may be more likely when the gastric pH is relatively high. We tried to find out the relationships between the gastric pH and the incidence of nosocomial pneumonia with twenty patients intubated for longer than 48 hours at ICU. We achieved following results: 1) The incidence of the nosocomial pneumonia was twenty percent. 2) All the patients developed nosocomial pneumonia showed the gastric pH above 4.0. 3) In the patients intubated for longer than 5 days, the incidence of nosocomial pneumonia was 33.3% in contrast to 9.0% for less than 5 days. 4) With the sputum culture, the incidence of colonization was higher in the patients with gastric pH above 4.0 than that in the patients with gastric pH below 4.0(84.6% vs 58.1%). 5) With regard to the duration of intubation, the incidence of colonization was higher in the patients intubated for longer than 4 days than that in the patients intubated for less than 4 days(90% vs 50%). 6) The most common pathognomic organisms were astreptoccus and Pseudomonas aeroginosa. It is conculded that the nosocmial pneumonia might develop more frequently in the patients with gastric pH above 4.0 than in the patients with gastric pH below establishment of the relationship between the treatment of the stress ulcer and the nosocomial pneumonia.
Subject(s)
Humans , Colon , Hydrogen-Ion Concentration , Incidence , Intubation , Pharynx , Pneumonia , Pseudomonas , Sputum , Stomach , UlcerABSTRACT
It has been already demonstrated that the gastric acidity of crying pediatric surgical patients were less acidic than that of non-crying patients by Cote CJ and his collegues. Under the postulation that the changes of the gastric acidity and volume of crying patients might not be the same according to the amount of crying(duration or crying), this study was undertaken. 81 ASA physical status 1-2 children ages 1-14 for 1st elective operation except gastrointesti- nal surgery were selected randomly and divided into 2 groups and subdivided into 2 groups as follows: Group 1 (n=39~7, not cried Group 2 (n=42g cried Group A (n=14R cried in RR and OR Group B (n=28); cried in OR Subgoup B-1 (n= 11~7, cried as soon as arrived in OR Subgroup B-2 (n = 17); cried when attached monitoring and/or started IV All patients were premedicated with glycopyrrolate and hydroxyzine. Gastric samples were obtained through nasogastric tube and measured pH values with TOA PH METER MODEL HM-SES immediately after induction. The results were as follows; 1) Gastric pH In the changes of the mean pH values, there were statistical significances between groups 1 and 2(P or = 0.4 ml/kg) between groups 1 and 2, and between subgroups B-1 and B-2, but there were significant differences between groups A and B, and between group A and subgroup B-2 (p <0.05).