Cisapride does not alter gastric volume or pH in patients undergoing ambulatory surgery

Abstract

Purpose: To evaluate the efficacy of 20 mg cisapride p0 in reducing residual gastric volume and pH in adult ambulatory surgical patients. Methods: Using a prospective randomised double-blind controlled design, we administered either 20 mg cisapdde p0 or placebo preoperatively to 64 ASA 1-2 ambulatory surgical patients. Following induction of anesthesia we measured volume and pH of residual gastric contents, using blind aspiration through an orogastric tube. Parametric data were analysed using unpaired, one tail Students' t test. Non-parametric data were analysed using Fishers Exact test and Chi square analysis. Statistical significance was accepted at the probability level of < 0.05. Results: Residual gastric volumes were similar in the two groups (19.5-23.8, 23.9 • 24.4 ml), in the cisapride and placebo groups respectively, P=0.24). Data shown are mean (• SD). The proportions of patients with a residual gastric volume exceeding 0.4 ml-kg-I were similar in the two groups (4 of 28, and 8 of 23 patients in the cisapride and placebo groups respectively, P=0.09). The pH of the residual gastric contents were similar in the cisapride and placebo groups (1.6 • 0.5, 1.4 _ 0.5, respectively, P=0.26). The proportions of patients with pH < 2.5 was also similar in the cisapride and placebo groups (21 of 25, and 20 of 21 patients respectively, P=0.2). Conclusions: Preoperative administration of 20 mg cisapride po to patients scheduled for outpatient surgery does not alter either the volume or the pH of gastric contents. Its use in this setting is of no apparent clinical benefit.

Human Gastrointestinal Juices Intended for Use in In Vitro Digestion Models

“…However, no correlation between the production volumes of gastric and duodenal juices was observed. Approximately 24-ml gastric juice is, according to Lydon et al [38], present in the fasting stomach. We measured an average total volume of 87 ml after 2 h aspiration which is in agreement with the reported flow rate of 0.9 ml/min [33]; however, considerable intersubject variation (2 to 355 ml) was observed.…”

Evolution of a detailed physiological model to simulate the gastrointestinal transit and absorption process in humans, Part 1: Oral solutions

“…A typical volume of water coadministered with solid oral dosage forms in a pharmacokinetic (PK) study is about 240 mL (8 fl oz) 67. The resting volume of the stomach ranges between 20 and 50 mL in the fasted state 68–72. It appears that the protein content of fasting gastric fluid is relatively low and only marginal concentrations of lipids and bile salts can be found in fasted gastric fluid,73,74 from which it follows that the gastric juice is made up of about 99.5% water 68,75…”

“…In general, noncaloric liquids and nondissolved particles less than 2 mm in diameter empty relatively quickly from the stomach 93,94. In the model, gastric emptying time is defined as the time at which the remaining volume equals 1/e ≈ 36.8% of the initial volume, which can be assumed to be about 260–290 mL when assuming a mean resting volume of 20–50 mL and a coadministered liquid volume of 240 mL, as recommended for PK studies 67–70,72,95. With reported half‐emptying times of solutions and small pellets ranging between few minutes and 1 h,93,96–99 drugs administered in solution should be available at absorptive sites in the duodenum in as little as 10–15 min if given in the fasted state.…”

Designing a Dynamic Dissolution Method: A Review of Instrumental Options and Corresponding Physiology of Stomach and Small Intestine

“…Table 1 comprises volumes reported for gastric and SI liquid contents, measured in various studies for fasted state, using magnetic resonance imaging or tube aspiration 28–33. For fasted stomach, a starting volume of 30 mL of gastric fluid can be suggested as an average value acceptable for biorelevant dissolutions.…”