Antacids Flashcards
What is the principal indications for antacids prior to
surgery?
They are administered to neutralize gastric acid that is present
in the stomach.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 603.
Which are preferred for raising the gastric pH,
particulate antacids or nonparticulate antacids and
why?
Nonparticulate antacids such as sodium citrate are preferred
over particulate antacids such as Maalox or Mylanta because
the particles can cause pulmonary injury if aspirated.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 941.
How effective are antacids at raising the gastric pH?
An antacid dose administered 15-30 minutes prior to induction
is 100% effective at raising the pH of gastric fluid above 2.5.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 603.
How does the administration of antacids affect drug
absorption?
Antacids can slow the absorption of PO digoxin, cimetidine, and
ranitidine, but speed the absorption of phenobarbital.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 281-282.
How do antacids affect gastric emptying time?
Antacids slow gastric emptying and increase gastric volume
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 282.
The administration of antacids obviously increases
the gastric fluid volume. Is this a concern with
regard to increased risk of aspiration?
The risk of aspiration depends upon both the pH of the fluid in
the stomach as well as the volume. The fact that antacids
increase the volume of fluid in the stomach, however, does not
warrant witholding antacids. It has been shown that the
mortality rate of aspiration is increased when small volumes
(0.3 mL/kg) of acidic fluid is aspirated compared to larger
volumes of buffered solution.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 603
Is the administration of an antacid useful in an
emergency setting?
Yes. In fact, because it has an almost immediate and shortlived
peak effect (15-20 minutes), it is more useful as an adjunct
to emergency procedures rather than outpatient procedures
where the time between administration of the antacid and
induction of anesthesia may be prolonged.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 940-941.
What is the pediatric dose of sodium citrate?
0.4 mL/kg of 0.3 M sodium citrate
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 941
What is the adult dose of sodium citrate?
30 mL
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 941.
What are two examples of nonparticulate antacids?
Sodium citrate (Bicitra) and two Alka-Seltzer Gold tablets (which
contains both sodium citrate and potassium citrate) dissolved in
30 mL of water are both options for nonparticulate antacids.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 941.
