ROLE OF ORAL PANTOPRAZOLE AS PRE OPERATIVE PREANAESTHETIC PREMEDICATION FOR THE PROPHYLAXIS OF ACID ASPIRATION IN ELECTIVE ADULT SURGERY

Abstract

Background: The effect of drugs affecting gastric pH and volume has been studied extensively but the effect of duodenogastric reflux on gastric pH and volume at the same time has not been evaluated. Patients and Methods: This prospective, triple blind, randomized and placebo controlled clinical trial was conducted on 108 adult inpatients of American Society of Anaesthesiologist physical status I–II, and aged 15–70 years. The patients in Group C (control) received placebo while Group P (Pantoprazole) orally at 9:00 PM, a night before elective surgery. On the next day, gastric contents were aspirated with a large bore, multi-orifices gastric tube passed through an endotracheal tube placed blindly in oesophagus after tracheal intubation and analysed for pH, volume and the presence of bile salts. Results: Thirty (28.57%) samples out of 105 were contaminated with duodenal contents and 2 with blood. Duodenogastric reflux significantly affected pH and volume of gastric contents in subgroups (C-1 versus C-2:  p-value for pH (0.0009) and volume (0.0236) and P-1 versus P-2:  p-value for pH (0.0348) and volume (0.0003). Pantoprazole, after excluding samples contaminated with duodenogastric refluxate, increased pH (p 0.0118), decreased volume (p 0.0009) and the proportion of the patients (p 0.0324) considered†at risk†compared with Placebo. Conclusion: Preoperative oral administration of Pantoprazole 40 mg reduced residual gastric content volume ≤25 ml and increased pH ≥2.5, possibly reducing the effects of pulmonary aspiration of gastric contents.