Introduction

Paediatric general anaesthesia is associated with a higher risk of pulmonary aspiration of gastric contents as compared to adults, predisposing them to risk of developing aspiration pneumonitis. Pharmacological interventions such as histamine 2 receptor antagonists and proton pump inhibitors, have proved successful in reducing the risk of lung damage by decreasing gastric acid secretion in paediatric surgery. Lansoprazole, a potent proton pump inhibitor, has been shown to be effective in the treatment of duodenal and gastric ulcers, reflux esophagitis, and Zollinger-Ellison syndrome. 

In children who are at risk of aspirating gastric contents, the reduction in volume of gastric fluid and the improvement of gastric pH by the drug can reasonably be anticipated to provide protection against the occurrence of pneumonitis, should regurgitation and aspiration of gastric contents occur.

Aim

To evaluate the efficacy of preoperative oral lansoprazole in controlling gastric fluid pH and volume in children immediately following the induction of anaesthesia.

Patient Profile

• 100 healthy children (aged 3-11 years) undergoing elective surgery as in-patients

Method

Study Design

• Prospective, randomized controlled trial
• Children were randomly allocated to four groups: lansoprazole-lansoprazole (received two doses of lansoprazole 30 mg/dose), placebo-placebo (control group, two doses of placebo), placebo-lansoprazole (one dose of each), and lansoprazole-placebo (one dose of each).
• The first dose of medication was administered at 9.00 pm on the night before surgery and the second at 5:30 am in the morning of the day of surgery (three hours preoperatively).

Results

Efficacy

• Lansoprazole 30 mg improved the gastric fluid pH and lowered the gastric fluid volume, regardless of the time of administration (i.e. on the night before surgery or on the morning of surgery).
• Administration of lansoprazole in two consecutive doses (at bedtime and on the morning) effectively increased the pH and reduced the volume of gastric aspirate
• Lansoprazole reduced the number of children with a gastric fluid pH <2.5 and gastric fluid volume >0.4 ml.kg^-1 compared with the control group (Figure 1).
• All the three regimen groups lowered the gastric fluid volume compared with the placebo-placebo (control) group.

Figure 1: Effect of lansoprazole and/or placebo regimens in children undergoing elective surgery

Safety 

• No adverse reactions related to lansoprazole were reported before surgery.

  Conclusion

• A single 30 mg dose of lansoprazole, administered either the night before surgery or on the morning of the day of surgery significantly reduced the acidity and volume of gastric aspirate in children undergoing elective surgery.
• Administration of lansoprazole in two successive doses was more effective in controlling the gastric fluid environment versus a single dose.

Can J Anaesth. 1995; 42(6): 167-72