Premedicant Drugs and Gastric Juice pH and Volume in Pediatric Patients

Salem, M. Ramez; Wong, A Y; Mani, M; Bennett, Edward J.; Toyama, T.

doi:10.1097/00000542-197603000-00010

Cited by 74 publications

(15 citation statements)

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“…Therefore, glycopyrrolate was predicted to be a safe drug to pregnant women because of significantly reduced effects on the fetus [15]. Glycopyrrolate has a longer duration of action than atropine [16], and the reduction of gastric juice volume and acidity is more beneficial to pregnant women [17]. Glycopyrrolate is consequently an ideal drug that can compensate CO reduction caused by phenylephrine administration.…”

Section: Discussionmentioning

confidence: 99%

Comparison of hemodynamic changes between phenylephrine and combined phenylephrine and glycopyrrolate groups after spinal anesthesia for cesarean delivery

Yoon

Cho

Jee

et al. 2012

Korean J Anesthesiol

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BackgroundHypotension remains a common clinical problem of spinal anesthesia for cesarean delivery and phenylephrine is used as a vasopressor to address this. However, phenylephrine reduces maternal cardiac output (CO) due to reflex bradycardia. Glycopyrrolate is safe for the fetus, and increases heart rate (HR). Using a noninvasive measure of CO, we compared maternal hemodynamic changes between the phenylephrine only group (group P) and the phenylephrine plus glycopyrrolate group (group PG).MethodsIn this randomized study, 60 women scheduled for elective cesarean delivery were allocated to group P (n = 30) or group PG (n = 30). In both groups, phenylephrine was infused at 50 µg/min. This infusions stopped if systolic blood pressure (SBP) was higher than the baseline value, and phenylephrine 100 µg was injected if SBP was lower than 80% of the baseline value from spinal anesthesia to delivery. In group PG, glycopyrrolate 0.2 mg was injected intravenously after spinal anesthesia. Hemodynamic parameters, such as SBP, heart rate (HR), stroke volume index (SVI), cardiac index (CI) were measured before and until 15 min after spinal anesthesia.ResultsThere were no significant differences in SBP and SVI compared to the baseline value in each group and between the two groups. HR and CI reduced significantly from 8 min to 15 min in group P compared to the baseline value as well as group PG for each time-point. However, HR and CI were maintained in group PG.ConclusionsThe use of glycopyrrolate added to phenylephrine infusion to prevent hypotension by spinal anesthesia for cesarean delivery was effective in maintaining HR and CI.

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Section: Discussionmentioning

confidence: 99%

Comparison of hemodynamic changes between phenylephrine and combined phenylephrine and glycopyrrolate groups after spinal anesthesia for cesarean delivery

Yoon

Cho

Jee

et al. 2012

Korean J Anesthesiol

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“…Glycopyrrolate reduces tone in the LES and thus increases the theoretical risk of reflux 47 [V]. It might, however, reduce the acidity and volume of gastric contents, but less predictably than cimetidine [48][49][50][51] [II and III]. The use of Glycopyrrolate is not recommended by ASA 28 [V].…”

Section: Introductionmentioning

confidence: 99%

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Jensen

Callesen

Hagemo

et al. 2010

Acta Anaesthesiol Scand

115

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Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high‐grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre‐operative gastric emptying is rarely indicated. For pre‐oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre‐oxygenation in the obese patients should be performed in the head‐up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1–1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.

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“…Salem et al (1976) found no difference in gastric contents between elective controls receiving no premedication and children given morphine 0.18 mgkg-' and pentobarbital 2.2 mg-kg-'. Meakin, Dingwall & Addison (1987) investigated the effects of trimeprazine syrup, temazepam syrup and temazepam capsules in children.…”

Section: Sedatives and Premed Ica T Ionmentioning

confidence: 67%

“…Ages ranged from one to 14 yr and only one child refused to take the liquid. Salem et al (1976) found that glycopyrrolate 7.5-10 pgkg-' orally on its own or with other drugs reduced the volume of gastric juice at induction to one-third that of controls. Its effect on pH was not consistent.…”

Section: Aspiration Prophylaxismentioning

confidence: 95%

Perioperative pulmonary aspiration in children: a review

Weaver

1993

Pediatric Anesthesia

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Summary The incidence of significant pulmonary aspiration in children is very low. Factors determining risk include the anaesthetist's experience, the child's ASA status, gastro‐oesophageal disease, obesity, intra‐abdominal obstruction, emergencies, trauma and the occurrence of laryngospasm. The diagnosis of pulmonary aspiration may be confused with post‐obstructive pulmonary oedema. Several approaches to risk reduction can be used and include appropriate pre‐operative fasting, acid aspiration prophylaxis and anaesthetic management. The widespread use of acid aspiration prophylaxis cannot be justified. Less emphasis should be placed on the ‘cut‐off’ values for gastric fluid contents of pH 2.5 and volume 0.4 ml·kg−1 in defining aspiration risk. Clear fluid fasts beyond 2–3 h do not result in reduced gastric fluid volume and if prolonged can be potentially harmful. It seems appropriate to use this interval in fasting guidelines for clear fluids. Recommended guidelines for solids vary from 4 h to no solids on the day of surgery.

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Premedicant Drugs and Gastric Juice pH and Volume in Pediatric Patients

Cited by 74 publications

References 0 publications

Comparison of hemodynamic changes between phenylephrine and combined phenylephrine and glycopyrrolate groups after spinal anesthesia for cesarean delivery

Comparison of hemodynamic changes between phenylephrine and combined phenylephrine and glycopyrrolate groups after spinal anesthesia for cesarean delivery

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Perioperative pulmonary aspiration in children: a review

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