Effects of Proton Pump Inhibitors on Gastric Volume and Gastric Ph in Adult Patients Posted for Elective Operative Procedures

Under general anaesthesia even in elective operative procedure, there are chances of aspiration of gastric contents resulting in acid aspiration syndrome. H2 antagonists Ranitidine and Proton Pump Inhibitors were evaluated to compare efficacy of the drugs in decreasing gastric volume and increasing gastric pH when administered orally overnight and early in the morning; 250 patients of ASA grade I and II of either sex were divided in 5 equal Groups of 50 patients each. Group I patients received Tab. Placebo, Group II received Tab. Ranitidine 150 mg, Group III received Tab. Omeprazole 20 mg, Group IV received Tab. Pantoprazole 40 mg and Group V patients received Tab. Esomeprazole 40 mg overnight at 10 pm and 6 am morning. Prior to induction of anaesthesia, gastric contents were aspirated after insertion of nasogastric tube (Ryles tube) with the help of syringe. The volume and pH of aspirated gastric contents was measured in all patients. It was observed that in proton pump inhibitors Groups (III, IV and V) and also in Group II (Ranitidine), the gastric volume was significantly less as compared to control Group I. Mean gastric volume in Group II was 13.383.3 mL, in Group III 10.73.6 mL, in Group IV 10.43.4 mL and in Group V 9.583.2 mL. There was no significant difference in gastric volume amongst Groups III, IV and V. There was significant difference in proton pump inhibi tors Group and ranitidine Group as far as gastric volume was concerned. Mean gastric pH was 5.310.48 in Group II, 4.830.35 in Group III, 4.820.39 in Group IV and 5.170.44 in Group V. There was no significant difference in gastric pH in Group II, III, IV and V. Gastric pH and gastric volume were significantly above and below critical values in study Groups as compared to control Group. It is concluded that proton pump inhibitors, Omeprazole, Pantoprazole and Esomeprazole can be administered orally overnight and early morning to increase gastric pH and decrease gastric volume in patients posted for elective operative procedures under general anaesthesia. Proton pump inhibitors satisfactorily increases gastric pH and reduces gastric volume much above critical values. Esomeprazole was found to be superior to Omeprazole and Pantoprazole in this regards.