The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta‐analysis of randomised control trials

Abstract

SummaryAspiration of acid into the lungs is an infrequent but potentially devastating complication of general anaesthesia. Routine practice often includes use of pharmacological agents to reduce gastric volume and increase gastric pH. The aim of this study was to compare the net benefit of proton pump inhibitors with histamine 2 blockers in a meta-analysis. Electronic databases were searched for trials that compared ranitidine vs proton pump inhibitors in their effect on volume and pH of gastric fluid aspirates. We identified nine trials of which seven were suitable for meta-analysis. Pooled outcomes suggest that premedication with ranitidine is more effective than proton pump inhibitors in reducing the volume of gastric secretions (by an average of 0.22 ml.kg ; 95% confidence interval 0.04-0.41) and increasing gastric pH (by an average of 0.85 pH units; 95% confidence interval )1.14 to )0.28).

Pre-Anesthetic Medications in Patients Undergoing Exploratory Laparotomy: Results of a Cross-Sectional Study

“…Risk of acid aspiration is another concern in patients undergoing surgery under general anesthesia [16]. Pre-anesthetic medicines are used to reduce gastric acid and volume of gastric secretion, increase gastric pH and reduce the risk of nausea and vomiting [13,16].…”

“…Pre-anesthetic medicines are used to reduce gastric acid and volume of gastric secretion, increase gastric pH and reduce the risk of nausea and vomiting [13,16]. Ranitidine given is more effective than proton pump inhibitors in reducing volume of gastric secretion and increasing gastric pH [16]. Another prospective, randomized, double-blind study showed that intravenous prophylactic ranitidine and metoclopramide is useful to reduce the volume of gastric content and increase gastric pH [11].…”

Drug utilization review of general anaesthetic agents in a tertiary care hospital

“…The finding of the study is in favour of meta-analysis by Clark et al, outcomes suggest that premedication with ranitidine is more effective than proton pump inhibitors in reducing the volume of gastric secretions and increasing gastric Ph. 2 In our study tab. alprazolam 0.25mg and 0.5mg were prescribed to children and adults respectively, was administered 2 hours before surgery to all patients as an anxiolytic medication followed by inj.midazolam with dose range of 0.5-1mg was administered to majority of the patients (96%) before reduction.…”

Treatment Options in Gastrointestinal Cutaneous Fistulas

“…However, different trials examining premedication with either H2 antagonists or PPI before surgery reveal that decrease in gastric volume remnants is more pronounced following H2 antagonists. 28 Studies in other scenarios are lacking, especially those studying long-term reduction of gastric secretions. 29 Thus, whether PPI or H2 blockers are preferable in the long term is unknown.…”