Comparison of different non-pharmacological preoperative preparations on gastric fluid volume and acidity: a randomized controlled trial

Aspiration of gastric contents is one of the major causes of general anesthesia related morbidity and mortality. This study aimed to compare the effects of using different non-pharmacological preparations preoperatively on gastric fluid volume and pH. This randomized, controlled trial was conducted at a teaching hospital in Shiraz, Southern Iran. Overall, 150 patients were randomly selected from elective surgery candidates, who were 17-95 years old, fulfilled the criteria of American Society of Anesthesiologists [ASA] grade-I or II, and in which tracheal intubation was indicated. The patients were allocated randomly to one of the following five groups: Group A: continuously chewed bicarbonate-containing gum for 2 hours before anesthesia induction until premedication. Group B: continuously chewed standard sugar free gum 2 hours before anesthesia induction until premedication. Group C: sucked lollipop 2 hours before anesthesia induction. Group D: drank pure water 10 ml/kg 2 hours before anesthesia induction. Group E [control group]: without any intervention. The mean volume of gastric fluid was not significantly different among the study groups. In the group who chewed bicarbonate gum, the mean +/- SE gastric fluid pH was significantly higher than in other groups [5 +/- 1 vs. 3 +/- 1 respectively, P<0.001]. Increased gastric fluid pH following the use of bicarbonate gum for pre-operative preparation may have implications for preventing aspiration and enhancing anesthesia care

Benefits of urinalysis.

Objective. In the pilot Iran school screening programme, the minimal cost of screening dipstick urinalysis in 1601 asymptomatic school children was determined. Methods. The cost of screening dipstick urinalysis was calculated by reviewing the literature for the prevalence of asymptomatic proteinuria, hematuria, bacteriuria, and glucosuria determined by an initial dipstick urinalysis.The minimal cost utilizing data of 3 general physicians was calculated. Costs were determined by using current charge for supplies ordered to perform tests, charges for tests performed by a commercial laboratory, and the cost of a final evaluation by a pediatric nephrologist. Results. 4.7% (76/1601) of patients were calculated to have an initial abnormal urinalysis. Upon retesting 1.37% (22/1601) of patients were calculated to have a persistent abnormality. The calculated cost was 167$ to initially screen all 1601pateints with a dipstick urinalysis or 0.092$ per patient. The calculated cost to evaluates the 22 patients with any persistent abnormality on repeat dipstick urinalysis was 0.02$ or 0.001$ per patient. This is the calculated cost for a single screening of 1601 asymptomatic pediatric patients. Conclusion. Multiple screening dipstick urinalysis in asymptomatic pediatric is costly and should be discontinued. We propose that a single screening dipstick urinalysis be obtained at school entry age, between 6 and 7 years, in all asymptomatic children.