EFFECTS OF OMEPRAZOLE, RANITIDINE, FAMOTIDINE AND LACEBO ON GASTRIC SECRETION IN PATIENTS NDERGOING ELECTIVE SURGERY

We have compared the effects of omeprazole, ranitidine, famotidineand placebo on gastric secretion in a double-blind study in110 patients undergoing elective surgery. Three hours beforeoperation, the patients received, orally, omeprazole 40 mg,ranitidine 150 mg, famotidine 40 mg or placebo. Gastric volumeand pH were measured immediately after induction of anaesthesia.Omeprazole, ranitidine and famotidine produced a significantincrease in gastric pH and a significant decrease in gastricvolume compared with placebo. When the effects of omeprazoleon gastric volume were compared with those of ranitidine andfamotidine, no significant difference was found, but omeprazolewas significantly less effective in increasing gastric pH. Thenumber of patients having a pH less than 2.5 and a volume greaterthan 0.4 mlkg^–1 were: none in the ranitidine group, one(3%) in the famotidine group, four (15%) in the omeprazole groupand six (23%) in the placebo group. We conclude that omeprazole40 mg given 2–4 h before surgery does not afford adequateprophylaxis for the acid aspiration syndrome.     

Carotid Artery Percutaneous Transluminal Angioplasty and Stenting: Indications, Technical Approach, and Complications

Carotid percutaneous transluminal angioplasty and stenting are relatively new tools in the field of vascular therapeutics. They are products of the evolution of the techniques used in the therapy of coronary and peripheral vascular disease. Carotid endarterectomy is still the "criterion standard" to which all other carotid interventions are compared. This status has been achieved on the basis of extensive studies on symptomatic and asymptomatic patients. For carotid percutaneous transluminal angioplasty and stenting to become a proven alternative for the therapy of carotid disease, their precise use and role still need to be defined by randomized prospective trials. If performed by experienced operators with meticulous technique, the risk of complications is very low. Outpatient-based 1-day hospitalization, well tolerated, and avoiding anesthesia related complications make their future in the therapy of carotid disease very optimistic.