Abstract
Effects of pre-operative administration of ranitidine on pH and volume of gastric juicewere evaluated in 54 children (mean age: 5.4±1.0 yr) who underwent elective surgeryunder general anesthesia. Simultaneously, bromazepam suppository was evaluated as a premedicationagent for pediatric patients. Patients were randomly divided into four groups, and premedication agents were given 2 hr prior to induction of anesthesia. Patients ingroup A received diazepam syrup (0.5 mg/kg P. o.) ahd those in group B received bromazepamsuppository (3 mg). Patients in groups C and D received ranitidine (1 mg or2 mg/kg i. m.) together with bromazepam suppository (3 mg). Following induction ofanesthesia, a gastric tube (10 Fr. or 12 Fr.) was passed and stomach contents were collectedand analyzed for volume and pH, which was repeated every hr until the end ofthe operation. The gastric pH at the induction of anesthesia was observed to be 2.5 orless in 70% of the patients of groups A and B, 13% of group C, and O% of group D.The volume of gastric contents was less than 0.4 ml/kg in 87% of ranitidine-treatedpatiehts (groups C and D), in 29% of group A, ahd in 60% of group B. It was thenconcluded that pre-operative administration of ranitidine caused a significant reduction ofboth acidity and volume of gastric contents, which will contribute to preventing or reducingaspiration pneumonitis during general anesthesia. Plasma ranitidine concentrationsmeasured by high-performance liquid chromatography revealed 228±32 ng/ml in group Cand 487±59 ng/ml in group D at the induction.of anesthesia. Sedation at the inductionof anesthesia was evaluated utilizing our original pediatric premedication score, whichconsists of 3 check points: quietness (very good, 3 ; good, 2 ; fair, 1 ; bad, 0); crying (no, 2 ; a little, 1 ; yes, 0); and i. v. root (under local anesthesia, 1 ; following induction ofanesthesia, 0). The averaged scores were 4.5±0.4 in group A, 4.2±1.9 in group B, 4.1±0.6 in group C, and 4.8±0.5 in group D, respectively. There was no significantdifference in the score in 4 groups. A plasma bromazepam level was 414±49 ng/ml at theinduction of anesthesia. Our results showed that bromazepam suppository is as effectiveas diazepam syrup for premedication in children.
