Canadian Journal of Anesthesia, Vol 30, 593-597, Copyright © 1983 by Canadian Anesthesiologists' Society

Cimetidine-Antacid Combination as Premedication for Elective Caesarean Section

¹ Department of Anaesthesia, Maternity Hospital, Kuwait

Address correspondence to: Dr. A.S. Okasha, Anaesthesia Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

The effect of premedication with an oral antacid (magnesium trisilicate), oral cimetidine or a combination of both was studied in 80 patients undergoing elective Caesarean section. Twenty patients served as untreated controls. Seventy per cent of the patients were in the high risk range for acid aspiration pneumonitis (pH < 2.5 plus gastric content volume > 25 ml). Antacid therapy was effective in raising pH but the gastric volume remained high in 50 per cent of the patients. Cimetidine was effective in decreasing gastric volume and raising pH but the pH was still < 2.5 in two patients. None of the patients given the cimetidine-antacid combination were in the high risk range for acid aspiration pneumonitis. The combination of an oral dose of cimetidine 400 mg, three to four hours before the operation followed by 20 ml of magnesium trisilicate one hour preoperatively proved to be the most efficacious regimen for prophylaxsis against Mendelson's syndrome in elective Caesarean section. Recent reports have suggested that non-particulate antacids (e.g., sodium citrate) may be preferable to paniculate antacids such as magnesium trisilicate.

Key Words: PREMEDICATION: cimetidine • COMPLICATIONS: lung acid aspiration, prophylaxsis • ANAESTHESIA: obstetric, Caesarean section