Bicitra (sodium citrate) and metoclopramide in outpatient anesthesia for prophylaxis against aspiration pneumonitis

Abstract

To evaluate the effect of Bicitra (Willen Drug Company, Baltimore, Maryland), a commercial preparation of sodium citrate and metoclopramide, on gastric contents 150 elective outpatients allocated into six groups with 25 patients in each group were studied. Patients in Group 1 served as controls. Patients in Groups 2, 3, 5, and 6 received Bicitra, po, either 15 ml (Groups 2 and 5) or 30 ml (Groups 3 and 6). In addition, patients in Groups 5 and 6 also received metoclopramide 10 mg, iv; Group 4 patients received metoclopramide 10 mg, iv. Eighty-eight per cent of patients in the control group had a gastric pH less than or equal to 2.5, while 36% had a gastric content volume greater than or equal to 25 ml with pH less than or equal to 2.5. Bicitra, 15 ml and 30 ml, po, increased mean gastric pH and decreased the proportion of patients with a gastric pH less than or equal to 2.5 to 32 and 16%, respectively, in Groups 2 and 3. However, Bicitra 15 ml and 30 ml, increased the mean gastric volume in Group 3 and also increased the proportion of patients with a gastric volume greater than or equal to 25 ml to 56% in Group 2 and 84% in Group 3. The addition of metoclopramide 10 mg, iv, to Bicitra reduced the proportion of patients with a gastric volume greater than or equal to 25 ml in Groups 5 and 6 to 28 and 36%, respectively. Metoclopramide (Group 6) independently reduced mean gastric volume (15.6 ml vs. 32.7 ml) and the proportion of patients with a gastric volume greater than or equal to 25 ml (20% vs. 36%). Bicitra and metoclopramide combination significantly reduced the proportion of patients with gastric contents greater than or equal to 25 ml with pH less than or equal to 2.5.