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Regular use of H₂ blockers reduces the efficacy of roxatidine to control gastric pH and volume

[L’usage régulier des H₂bloquants réduit l’efficacité de la roxatidine à contrôler le pH et le volume gastriques]

From the Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki, Japan.

Address correspondence to: Dr. Kazuyoshi Hirota, Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki 036-8563, Japan. Fax: +81-172-39-5112; E-mail: masuika{at}cc.hirosaki-u.ac.jp

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 11.6 ± 10.3 (NS)], 2–4 w group [4.77 ± 2.11 (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 pre-anesthetic H₂ antagonist administration.

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				K. Hirota, M. Kudo, H. Hashimoto, and T. Kushikata The Efficacy of Preanesthetic Proton Pump Inhibitor Treatment for Patients on Long-Term H2 Antagonist Therapy Anesth. Analg., October 1, 2005; 101(4): 1038 - 1041. [Abstract] [Full Text] [PDF]