efficacy and optimum time of administration of ranitidine [Zantac] HCl on the gastric PH and volume in adult patients undergoing elective surgery

We examined the effect of single oral dose of ranitidine HCl [Zantac] 300 mg, administered 12 or 2 hours before elective surgery, on intragastric pH and volume. One hundred and twenty five adult inpatients of either sex, aged 20-40 years, ASA physical status I and II scheduled for elective surgery with general anesthesia, were randomly enrolled into three groups: Group A [control group] 41 inpatients, group B [oral Ranitidine administered 12 hrs preoperatively] 43 inpatients and group C [oral Ranitidine administered 2 hrs preoperatively] 42 inpatients. There was no statistically significant difference between the three Groups regarding age, sex, ASA physical status, weight, height, and body mass index [BMI]. There was a statistically significant difference between group A vs group B and group A vs group C regarding pH [p <0.0001]. The difference between group B and group C was not significant regarding pH [p > 0.05]. The gastric secretion volume increased in group A more than in group B and C where there were a highly significant difference [p <0.0001] while the difference between group B and C was not significant [p > 0.05]. The proportion of the patients considered [at risk] of significant lung injury should aspiration occur as there was a significant there was a statistically difference between group A vs B [P<0.001], group A vs C [P < 0.05] and no significant difference between group B vs C [p> 0.05]. In conclusion: Oral Ranitidine HCl [Zantac] 300 mg administered twelve or two hours before elective surgery improves condition of gastric secretion at the time of induction of anesthesia, thus reducing the potential risk of pneumonitis, if the aspiration of gastric contents occur following the induction of anesthesia. Our results suggested that the twelve hours dose of ranitidine HCl [Zantac] decreased gastric acidity, secretion volume and numbers of patients at risk of aspiration better than two hours dose but without statistically significant difference

Remifentanil with propofol or thiopental for tracheal intubation without muscle relaxants

This study designed to evaluate the use remifentanil followed by propofol or thiopental without muscle relaxants for endotracheal intubation compared to thiopental followed by succinylcholine as a control group for obtaining clinically acceptable intubation conditions and hemodynamic changes. We studied 90 healthy children [ASA I-II], aged three to nine years presenting for elective ENT-surgery. The children were enrolled into three equal groups: Group A received remifentanil 3 micro g/kg followed by 2.5 mg/kg propofol. Group B received remifentanil 3micro/kg followed by 5 mg/kg thiopental, and Group C as a control group received 5mg thiopental followed by succinylcholine 1.5 mg/kg. The tracheal intubating conditions were considered excellent in 30[100%] of children in Group C, 27[90%] in Groups A and 24 [80%] in Group B. Mask ventilation done easily in all children and complete jaw relaxation in 93.3% of children in Group A, 86.6% in Group B and 100% in Group C [significant difference between Group B and C P<0.05]. All children intubated easily, and slight cord movement in 10% of children in Group A and in 20% in Group B [significant difference between Group A and C P<0.05 and a highly significant difference between Group B and C P<0.001]. 6.66% of children in Group A and 20% in Group B developed slight coughing at intubation [a highly significant difference between Group B and C P<0.001]. As regard the MAP changes after induction and intubation In Group C there was significant difference [P<0.05] between Group C and B and a very highly significant difference [P<0.0001] between group A and C. The heart rate decreased 14% and 2% in the remifentanil groups A and B respectively [P<0.05] arid remained lower than baseline throughout the study. The heart rate increased in group C after induction and intubation and there was significant difference [P<0.05] between Group C and B while the difference in heart rate was very highly significant difference [P<0.0001] between group A and C. In summary, the administration of 2.5 mg/kg propofol or 5mg/kg thiopental and 3.0 microg/kg remifentanil provided clinically acceptable conditions for tracheal intubation and stable hemodynamic in children pretreated with atropine. With this combination of drugs, the return of spontaneous ventilation was as rapid as after thiopental/ succinylcholine with acceptable hemodynamic changes. This technique may be advantageous in children with normal airway anatomy undergoing elective brief surgical procedures or in cases in which neuromuscular block is contraindicated