Comparison of Intravenous Ranitidine with Pantoprazole in Decreasing Gastric Fluid Acidity in Emergency Cesarean Section

Peri-operative aspiration of gastric contents is a problem that causes certain respiratory problems including ARDS. Prophylaxis against aspiration of gastric contents is performed routinely in elective surgeries, but there is rare evidence on the efficacy of this method in emergency cesarean section. This is a randomized, controlled, double-blinded clinical trial. 60 parturients undergoing emergency cesarean section were randomly assigned into three groups of 20 each. They were allocated into two study and one placebo groups. The study group one and two received intravenous ranitidine (IV) 50 mg or IV pantoprazole 40 mg, half an hour before induction of GA, respectively. The placebo group was administered just 5 ml of isotonic saline half an hour before GA induction. After intubation and confirmation of endotracheal tube insertion, the gastric contents were aspirated through a nasogastric tube for evaluation of acidity and volume. A statistical difference between group one and two with the control group was observed in the acidity of gastric contents, but there was no difference in volume. Also, the PH level of gastric contents in patients receiving pantoprazole was significantly higher than the isotonic saline (p<0.001) and ranitidine groups. The difference in average level of acidity of gastric contents in patients receiving pantoprazole and ranitidine showed a marginal significance (p≤0.036). Our findings revealed that pre-operative administration of H2-blockers and proton pump inhibitors (PPIs) effectively decrease the acidity of gastric contents even in emergency cesarean sections. In addition, if the data had an isotonic distribution, or if there were a large number of cases in different clinical groups, PPIs could possibly be more effective.