Pre-Operative Intravenous Co-Administration of Ranitidine and Metoclopramide: Effect on Gastric Content in Laparoscopic Cholecystectomy

Objective: This prospective, randomized, double-blind study was performed to evaluate the effects of intravenous co-administration of metoclopramide and ranitidine on preoperative gastric contents in patients receiving general anesthesia for elective laparoscopic cholecystectomy surgery, a procedure with high risk of aspiration. Material and Methods: Eighty ASA physical status I-II consenting patients were randomly assigned to receive, intravenously 5ml of either saline to control Group C, 50mg ranitidine to Group R, 10mg metoclopramide to Group M and finally combined ranitidine and metoclopramide to Group RM, fifteen minutes before the induction of anesthesia. Each group includes 20 patients. Before surgery and after induction of anesthesia a 14-F multiorifice nasogastric tube was inserted to aspirate the gastric contents of all patients. The volume and pH of collected gastric fluid were estimated. Results: Data revealed that pH, in both ranitidine alone group (R) and in combination with metoclopramide group (MR) were significantly higher than control (C) and metoclopramide (M) groups (p<0.01). Data also revealed that collected gastric fluid volumes were significantly lower in metoclopramide alone and in co-admixture with ranitidine groups (M and RM) (p<0.01) when compared with control and ranitidine groups (C and R), and were also significantly lower in group RM when compared with M (p<0.01). Conclusion: Intravenous prophylactic ranitidine and metoclopramide co-administration, may be an easy and useful method to decrease the volume while increasing the pH of gastric contents, and therefore may reduce the number of patients at risk for aspiration pneumonitis in laparoscopic cholecystectomy procedures.