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Control of Gastric Acidity by Glycopyrrolate Premedication in the Parturient

ANIS BARAKA, MD^*, MOHAMED SAAB, MD, M. R. SALEM, MD, and A. P. WINNIE, MD

*Professor and Chairman, Department of Anesthesiology, American University of Beirut, Beirut, Lebanon. Assistant Professor, Department of Anesthesiology, American University of Beirut. Associate Chairman, Department of Anesthesiology, Cook County Hospital, and the Hektoen Institute for Medical Research, Chicago, Illinois and Professor of Anesthesiology, Loyola University Stritch School of Medicine, Maywood, Illinois. Professor and Head, Department of Anesthesiology, University of Illinois Medical Center, Chicago, Illinois.

Abstract

The effect of premedication with the anticholinergic quaternary ammonium compound, glycopyrrolate (0.4 mg), on gastric juice pH was investigated in 23 parturients scheduled for elective cesarean section under general anesthesia, and the results were compared to a control group of 15 nonpremedicated obstetric patients and 25 parturients premedicated with atropine (0.6 mg).

In the nonpremedicated control group, the mean gastric juice pH was 2.36 (SE ± 0.23), 66 percent having a pH less than the critical level of 2.5. Premedication with atropine did not significantly increase the gastric pH, while in those premedicated with glycopyrrolate, the mean pH increased to 3.7 (± 0.35), and the incidence of pH less than the critical level dropped to 34 percent. The effect of glycopyrrolate on gastric juice pH was significantly increased when the premedication-induction time was prolonged to 60 to 120 minutes.

It was concluded that glycopyrrolate premedication can be used in the parturient as an additional measure to safeguard against acid-aspiration syndrome.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999