Abstract
Purpose
H2 antagonist premedication is common in surgical patients to control gastric pH and volume. However, several reports suggest that long-term medication may produce tolerance. Therefore, we studied the efficacy of a preanesthetic H2 antagonist (oral roxatidine) in patients on regular H2 antagonist therapy.
Methods
Forty-eight patients undergoing elective surgery were studied and grouped according to medication: those on no medication (control group) and those receiving H2-antagonists for less than two weeks (≤ 2 w group), between two and four weeks (2–4 w group) and for longer than four weeks (≥ 4 w group; n = 12 each). All patients were given oral roxatidine as anesthetic premedication. Gastric volume and pH were measured after induction of anesthesia. Arterial blood was simultaneously collected for measurement of plasma gastrin levels using an enzyme-linked immunosorbent assay.
Results
We observed a significant decrease and increase in, respectively, gastric pH and volume (mL) in the ≤ 2 w group [6.50 ± 0.43 (NS) and 1 1.6 ± 10.3 (NS)], 2–4 w group [4.77 ± 2.1 1 (P < 0.01) and 14.1 ± 10.8 (P < 0.05)], ≥ 4 w group [2.32 ± 1.46 (P < 0.01) and 22.2 ± 14.2 (P < 0.01)] compared to patients in the control group (6.35 ± 1.32 and 4.9 ± 4.7). Plasma gastrin levels were decreased with increasing time on medication with a significant difference (46%) observed after two weeks’ treatment. In addition, there was a significant correlation between gastric pH and plasma gastrin levels (r = 0.43, P < 0.01).
Conclusion
These data suggest that regular H2 antagonist treatment for longer than two weeks may produce tolerance to preanesthetic H2 antagonist administration.
Résumé
Objectif
La prémédication avec un antagoniste H2 est fréquente en chirurgie pour contrôler le pH et le volume gastriques. Mais certains articles montrent que la médication à long terme peut entraîner une tolérance. Nous avons donc vérifié l’efficacité d’un antagoniste H2 préanesthésique (roxatidine orale) chez des patients qui reçoivent un traitement régulier avec un antagoniste H2.
Méthode
Des patients de chirurgie réglée (48) ont été regroupés selon la médication: sans médication (groupe témoin), puis ceux qui reçoivent des antagonistes H2 pour moins de deux semaines (groupe ≤ 2 w), pour deux à quatre semaines (groupe 2–4 w) et pour plus de quatre semaines (groupe ≥ 4w; n = 12 chacun). Tous ont reçu de la roxatidine orale comme prémédication anesthésique. Le volume et le pH gastriques ont été mesurés après l’induction de l’anesthésie. Du sang artériel a été prélevé simultanément pour la mesure de la concentration plasmatique de gastrine par dosage immuno-enzymatique.
Résultats
Nous avons observé une baisse du pH et une hausse du volume gastriques (mL) significatives chez les patients des groupes ≤ 2 w[6,50 ± 0,43 (NS) et 11,6 ± 10,3 (NS)], 2–4 w[4,77 ± 2,11 (P < 0,01) et 14,1 ± 10,8 (P < 0,05)], ≥ 4 w[2,32 ± 1,46 (P < 0,01) et 22,2 ± 14,2 (P < 0,01)] comparés aux patients témoins (6,35 ± 1,32 et 4,9 ± 4,7). Les concentrations plasmatiques de gastrine ont diminué avec le temps de médication et une différence significative (46 %) a été observée après un traitement de deux semaines. De plus, il y avait une corrélation significative entre le pH gastrique et les concentrations plasmatiques de gastrine (r = 0,43, P < 0,01).
Conclusion
Ces données suggèrent qu’un traitement régulier avec un antagoniste H2 pendant plus de deux semaines puisse produire une tolérance à l’administration préanesthésique d’antagoniste H2.
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Hirota, K., Kudo, M., Kushikata, T. et al. Regular use of H2 blockers reduces the efficacy of roxatidine to control gastric pH and volume. Can J Anaesth 52, 166–171 (2005). https://doi.org/10.1007/BF03027723
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DOI: https://doi.org/10.1007/BF03027723