Following a thoracotomy, aspiration of gastric contents can lead to pulmonary complications. The actual incidence of gastroesophageal reflux (GER) and tracheal acid aspiration among patients in thoracotomy position is not clearly known.

Ranitidine premedication tends to increase gastric pH, reduce gastric volume, and may even decrease GER.

A randomized, double-blinded, placebo-controlled study was thus conducted among patients undergoing thoracotomy to evaluate the incidence of GER and tracheal acid aspiration as well as to determine the impact of ranitidine premedication on these.

Continuous intraluminal esophageal and tracheal pH monitoring probes were used to evaluate the effect of ranitidine on the incidence of GER and tracheal aspiration. A total of 80 adult patients undergoing thoracotomy were assessed and patients at high risk of GER were excluded.

Findings of the study -

• The incidence of acid GER in the placebo group was 28.2%, compared to 2.5% in the patients receiving ranitidine (P = 0.006).
• Multiple episodes of GER were noted in some patients in the placebo group.
• The total number of GER episodes were 16 in the placebo group vs. 1 in the ranitidine group (P = 0.002).
• The incidence of tracheal acid aspiration was 7.7% and 2.5% in the placebo and ranitidine groups, respectively. This was not significant.

Patients undergoing thoracotomy were found to be at a high risk of acid GER, which can eventually result in tracheal acid aspiration in a considerable proportion of patients. These can be reduced significantly with ranitidine premedication.

Source: Agnew NM, Kendall JB, Akrofi M, et al. Gastroesophageal reflux and tracheal aspiration in the thoracotomy position: should ranitidine premedication be routine? Anesth Analg. 2002 Dec;95(6):1645-9.