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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sudden death from aspiration pneumonitis during acute catatonia is a generally recognized but poorly understood occurrence. The author describes a case in which a schizophrenic patient died following aspiration of gastric contents. In view of findings that suggest that the acidity of gastric contents is related to morbidity following aspiration, he recommends that liquid antacid medication be given routinely to catatonic patients.
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PMID:Catatonia, gastric hyperacidity, and fatal aspiration: a preventable syndrome. 126 49

Pulmonary aspiration of gastric contents is a significant source of patient morbidity, mortality, and increased healthcare costs. Prevention by identifying patients at risk for aspiration and initiating prophylaxis is the most effective method of reducing complications associated with aspiration pneumonitis. H2-receptor antagonists are among the best prophylactic agents because of their efficacy in reducing gastric acidity and their convenience of administration.
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PMID:Aspiration pneumonitis: risk factors and management of the critically ill patient. 198 Jan 79

Children undergoing general anesthesia are at increased risk of severe aspiration pneumonitis. Cimetidine and ranitidine, specific histamine (H2-receptor) antagonists, when given 1-3 h preoperatively markedly reduce the acidity and volume of gastric content. A newer compound, famotidine, is a more specific antagonist with no inhibitory effect on the drug metabolizing microsomal enzyme systems of the liver (cytochrome P-450), in contrast to cimetidine. An additional clinical advantage is a possible longer duration of action. In order to evaluate these potential advantages we studied the effects of preanesthetic oral famotidine on gastric fluid pH and volume in 4 groups in a random manner. METHODS. With parental consent, 107 infants and children (ASA I status, 4 months to 14 years old, NPO for at least 6 h) received either no famotidine (n = 29) or 0.15 mg/kg (n = 27), 0.3 mg/kg (n = 25) or 0.6 mg/kg (n = 26) famotidine at 7.00 a.m. Following induction by mask with nitrous oxide/oxygen (N2O/O2) and enflurane (E) or i.v. thiopental, intubation was performed in all patients. Anesthesia was maintained with N2O/O2 and E. A orogastric double-lumen tube was passed into the stomach, and the gastric content was aspirated in a uniform manner. Gastric volume was recorded and pH values were measured with pH paper. RESULTS. In the control group, 28 of 29 patients (97%) had a pH less than 2.5, 18/29 (62%) had a gastric volume greater than 0.4 ml/kg and 17/29 (59%) had a pH less than 2.5 and gastric volume greater than 0.4 ml/kg, meaning an increased risk of pneumonitis if the child aspirates the gastric content. Famotidine administration was effective between 1.5 and 6 h after oral administration. Preoperative famotidine application produces pH values of gastric contents higher than 2.5 in all dosage groups (84%, 94%, 75%), and these differences were highly significant (P less than 0.001), whereas the gastric volume reduction with these doses was not significant. The incidence of pH less than 2.5 and volume of gastric contents exceeding 0.4 ml/kg did not vary with the different doses of famotidine. As there were no measurable differences in the effect of famotidine, we recommend that children at high risk of pulmonary aspiration receive 0.15 mg/kg famotidine orally at least 1.5 h but not later than 6 h before induction.
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PMID:[Famotidine dosage in children. The effect of different doses on the pH and volume of the gastric juice]. 228 7

Regurgitation of gastric contents with subsequent aspiration into the lungs contributes significantly to morbidity and mortality in surgical and nonsurgical patients. The consequences of aspiration pneumonitis depend on the volume and the acidity of the aspirate, and the presence of particulate and bacteria in the aspirate. The occurrence of aspiration pneumonitis may be prevented by correction of risk factors, careful monitoring, and appropriate airway management. The goal of aspiration pneumonitis prophylaxis is to minimize pulmonary complications by controlling risk factors for gastric regurgitation, which include gastric pH less than or equal to 2.5, gastric volume greater than 25 mL, lower esophageal sphincter incompetence, and delayed peristalsis. Prophylactic techniques include nasogastric decompression, acid neutralization, acid suppression, and increased gastric peristalsis. The ability of drugs to alter risk factors does not guarantee that aspiration will not occur, but it does reduce the likelihood of secondary respiratory complications. The ideal prophylactic agent should consistently reduce all risk factors, produce a prompt and sustained response, and possess few adverse effects and drug interactions.
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PMID:Reducing the risk of aspiration pneumonitis. 265 99

The effect of Histodil injection on the amount and pH of the gastric juice has been examined in women undergoing caesarean section under intratracheal anaesthesis. According to the results cimetidine decreases the volume and acidity of gastric secretion to a significantly higher extent than the pretreatment with atropine as a single agent. Maximum effect may be expected within 60-90 minutes. With Cimetidine pretreatment the risk of aspiration and pneumonitis may be prevented.
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PMID:Usefulness of acid and gastric juice secretion decreasing action of cimetidine in anaesthesia for the prevention of aspiration. 275 13

One hundred fifty-three critical care patients with documented cimetidine and antacid use were prospectively studied with serial gastric pH determinations and semiquantitative gastric fluid cultures. This study documents the abnormal gastric colonization of patients with therapeutically altered gastric acidity by hospital acquired gram negative rods (GNR). Three hundred twenty-four gastric fluid cultures from 153 patients revealed 152 (47%) positive cultures for GNR, 78 (24%) sterile specimens, and 94 (29%) positive for mixed oropharyngeal flora. One hundred forty (59%) of the 236 cultures at a pH of 4 or greater were positive for GNR. In contrast, only 12 (14%) of the 88 cultures at a pH of less than 4 were positive for GNR (p less than .001). Forty-six (52%) of 88 cultures at a pH of less than 4 were sterile as compared to only 32 (14%) of 236 sterile cultures at a pH of 4 or greater (p less than .001). At low pH, cultures are predominantly sterile and at a pH of 4 or greater the flora dramatically changes to hospital acquired GNR. This artificially maintained reservoir of gram negative rods in the critically ill patient is a potential reservoir of organisms causing nosocomial bacteremia or pneumonia in this high risk population.
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PMID:Alteration of normal gastric flora in critical care patients receiving antacid and cimetidine therapy. 363 41

One hundred inpatients scheduled for elective surgery were studied to determine the age-related risk of pulmonary aspiration as indicated by gastric acidity and volume. Twenty-five patients from 6 months to 12 years old were included in the pediatric age group, 50 patients from 18 to 64 years old were included in the adult age group, and 25 patients older than 65 years old were included in the geriatric group. Mean gastric pH was 1.99, 2.40, and 3.32 in the pediatric, adult, and geriatric age groups, respectively; the differences between the three groups were statistically significant. The proportions of patients with pH less than or equal to 2.50 were also significantly different among three groups: 92%, 76%, and 60% in the pediatric, adult, and geriatric age groups, respectively. Mean gastric volumes were 0.49, 0.37, and 0.24 ml/kg and proportions of patients with volumes greater than or equal to 0.40 ml/kg were 60, 32, and 12% in pediatric, adult, and geriatric patients, respectively. Gastric contents with both pH less than or equal to 2.5 and volume greater than or equal to 0.4 ml/kg were seen in 60, 28, and 12% in the three respective groups. Risk of acid aspiration pneumonitis theoretically is present in all age groups, with children being at greatest risk and geriatric patients with least risk. We have also noted a correlation between age and gastric contents because gastric acidity and volume both decreased as age increased. Increasing length of fasting period increased gastric acidity without significant effect on volume.
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PMID:Assessment of age-related acid aspiration risk factors in pediatric, adult, and geriatric patients. 384 97

In a controlled, randomized, double-blind trial, the value of cimetidine as prophylaxis against acid aspiration pneumonitis was studied. Compared to placebo, cimetidine reduced the volume as well as the acidity of the gastric contents significantly. The patients at risk of developing severe pneumonitis after aspiration (pH less than 2.5 and volume greater than 20 ml) were reduced from 55% in the placebo group to 0 in the group having received cimetidine 400 mg the night before and a further 400 mg on the morning of surgery. Premedication with cimetidine may be useful if rapid intubation cannot be anticipated.
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PMID:Cimetidine in the prevention of acid aspiration during anesthesia. 699 Jun 75

Gastric fluid pH and volume were studied on induction of anesthesia, during maintenance and at the end of the anesthesia in 50 elective surgical patients. All the patients were premedicated with meperidine, 1 mg/kg, and atropine 0.006 mg/kg, administered intramuscularly 45 minutes before induction of anesthesia. Half of the patients had incremental doses of meperidine; the other half had enflurane 1% to 2%; all had 70% nitrous oxide in oxygen during anesthesia maintenance. The incidence of a gastric fluid pH below 2.5 was 68% at the time of induction of anesthesia, 30% after 1 hour anesthesia, and 60% at the end of anesthesia. The incidence of a combination of pH below 2.5 and a volume above 25 ml was 30% on induction and 50% at the end of the anesthetic. There was no difference between the results in the two groups. It was concluded that although there was a decrease of gastric acidity during the anesthetic, the incidence of risk factors for aspiration pneumonitis at the end of the operation is at least as great as that on induction. Emptying the stomach before extubation may decrease this risk.
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PMID:Comparison of the incidence of combined "risk factors" for gastric acid aspiration: influence of two anesthetic techniques. 719 75

Pneumonia, in infants suffering from esophageal atresia with lower esophageal fistula, is usually caused by gastric reflux through the fistula, In order to abolish the acidity of the gastric content, Cimetidine i.v. infusion was used during the first 12--48 hr after diagnosis, while treating the pneumonia. The amount of Cimetidine required to induce achlorhydria was established by serial aspiration of gastric content, in infants and children with gastrostomies performed for various causes.
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PMID:Use of cimetidine in esophageal atresia with lower tracheoesophageal fistula. 722 52


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