Elsevier

Journal of Clinical Anesthesia

Volume 3, Issue 1, January–February 1991, Pages 40-44
Journal of Clinical Anesthesia

Original contribution
The effects of intravenous cimetidine and metoclopran ide on gastric pH and volume in outpatients

https://doi.org/10.1016/0952-8180(91)90204-ZGet rights and content

Abstract

Study Objective: To evaluate and compare the preinduction effects of intravenously (IV) administered cimetidine alone and combined with metoclopramide on gastric contents and postoperative nausea and vomiting in outpatients undergoing elective surgery. Design: Patients were allocated randomly to 4 groups with 20 patients in each group. Setting: Ambulatory surgery at a university-affiliated city hospital. Patients: Eighty patients undergoing elective gynecologic or orthopedic procedures were studied. Interventions: Outpatients in Group 1 and inpatients in Group 2 served as controls. Outpatients in Group 3 received 300 mg of cimetidine, and outpatients in Group 4 received 300 mg of cimetidine and 10 mg of metoclopramide. All drugs were administered IV as an infusion over a 15-minute period, 30 to 45 minutes prior to induction of anesthesia. Measurements and Main Results: After induction of general anesthesia and endotracheal intubation, stomach contents were retrieved and volume and pH measured. Group 1 outpatients had a large residual gastric volume of 29.2 ± 15.9 ml, with a very low pH of 2.32 ± 1.23 and 15% frequency of postoperative vomiting. These patients are at high risk of developing significant pneumonitis in the event of the aspiration of gastric contents. The combination of cimetidine and metoclopramide in Group 4 provided the optimal, or safest, condition—i.e., high gastric pH [6.15 ± 0.71 (p < 0.005)] and low gastric volume [11.6 ± 7.37 ml (p < 0.001)], with no postoperative vomiting. Conclusions: The combination of cimetidine and metoclopramide given to ambulatory patients during the preinductive phase may prevent severe pulmonary consequences should aspiration occur and is more effective in this regard than cimetidine alone.

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Cited by (11)

  • Systemic metoclopramide to prevent postoperative nausea and vomiting: A meta-analysis without Fujii's studies

    2012, British Journal of Anaesthesia
    Citation Excerpt :

    All 30 studies included reported on nausea and/or vomiting. The aggregated effect of 13 studies (14 comparisons)39–67 examining the effect of 10 mg systemic metoclopramide on the 24 h incidence of nausea and/or vomiting compared with placebo showed a beneficial effect of metoclopramide, OR (95% CI) of 0.58 (0.43–0.78), NNT=7.8. The funnel plot did not demonstrate asymmetry (P=0.38).

  • Clinical practice guideline for appropriate use of gastric acid suppressants in gastrointestinal surgery (2022 edition)

    2022, Chinese Journal of Gastrointestinal Surgery / Zhonghua Wei Chang Wai Ke Za Zhi
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Presented in part at the Annual Meeting of the International Anesthesia Research Society, San Diego, March 1988.

Associate Professor, Mount Sinai School of Medicine

Assistant Professor, City Hospital Center at Elmhurst

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Associate Professor, City Hospital Center at Elmhurst

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