Volume Of Gastric Contents Research Articles

Attenuation of Gastric Effects of Famotidine by Preoperative Administration of Intravenous Fluids

Effects of preoperative administration of intravenous crystalloids on the gastric effects of famotidine were studied in 89 patients scheduled for elective surgery in the afternoon. Patients were randomly assigned to one of six groups. Groups P1, P2, and P3 received 2.0 mL of intramuscular saline (placebo) and groups F1, F2, and F3 received 20 mg of intramuscular famotidine 1 h before anesthesia. All patients fasted for 14-18 h before surgery. No fluid was administered to groups P1 and F1 preoperatively, whereas 500 mL of intravenous fluid was given to the other groups over a period of 4-5 h before anesthesia: a maintenance fluid with 10% glucose to groups P2 and F2, and lactated Ringer's solution without glucose to groups P3 and F3. After anesthetic induction, the stomach was aspirated using a nasogastric tube and volume and pH of the contents were measured. The gastric volume was significantly less in F2 (4.2 +/- 1.2 mL, mean +/- SEM) than in P1 (30.7 +/- 5.5 mL) (P less than 0.01) and in F3 (12.7 +/- 2.1 mL) than in P3 (26.8 +/- 4.4 mL) (P less than 0.05). There was no significant difference between P2 (23.4 +/- 4.6 mL) and F2 (17.5 +/- 3.5 mL). Mean pH values were significantly higher in F1 (6.82 +/- 0.48) than in P1 (3.21 +/- 0.72) (P less than 0.01). No significance was observed between P2 (3.65 +/- 0.62) and F2 (4.53 +/- 0.77), or P3 (3.17 +/- 0.81) and F3 (5.03 +/- 0.80).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of preanesthetic rectal famotidine on pH and volume of gastric contents in pediatric outpatients

Effect of preanesthetic rectal famotidine on pH and volume of gastric contents in pediatric outpatients

Effect of preanesthetic intramuscular ranitidine on gastric acidity and volume in children

Study Objective: To evaluate the effects of preanesthetic administration of intramuscular (IM) ranitidine on pH and volume of gastric contents in children. Design: Three randomized treatment groups. Setting: Central operating rooms at a university hospital. Patients: Forty children age 1 to 10 years undergoing a variety of elective surgical procedures requiring general anesthesia with endotracheal intubation. Interventions: IM ranitidine 1 mg/kg (n = 15) or 2 mglkg (n = 15) was administered 2 hours prior to induction of anesthesia. Ten patients without ranitidine served as the control group. An orogastric tube was inserted into each patient. Measurements and Main Results: Gastric fluid pH and volume were measured every hour in the three groups. Plasma ranitidine concentrations were measured in ten patients of the ranitidine-treated groups. The mean volume of gastric fluid at induction of anesthesia was significantly lower in the ranitidine-treated patients (2.4 ml for ranitidine 1 mg/kg, 3.2 ml for ranitidine 2 mglkg) than in the controls (8.6 ml, p < 0.05). The mean pH values at induction of anesthesia were significantly higher in the ranitidine-treated patients (4.6 for 1 mg/kg, 6.7 for 2 mg/kg) than in the controls (2.1; p < 0.05). Dose-dependent plasma ranitidine concentrations were obtained. Conclusions: Preanesthetic IM ranitidine 1 to 2 mglkg resulted in a higher pH and lower volume of gastric fluid at the time of induction and in a higher pH during 3 hours of anesthesia. This therapy may be a useful adjunct to premeditation for children who have a greater than normal risk of pulmonary aspiration during anesthesia.

A critical analysis, with appropriate controls, of gastric acid and pepsin secretion in clinical esophagitis

Because esophagitis is a presumed “acid-peptic” disease, fasting gastric contents (volume and acid and pepsin concentrations) and basal and pentagastrin-stimulated acid and pepsin outputs were studied in 155 patients with endoscopically defined (and graded 1–4) esophagitis and 508 control patients without esophagitis. Basal pepsin and maximal acid and pepsin outputs were lower in the patients with esophagitis than in those without esophagitis. In further analysis, the patients were subdivided into three categories, duodenal ulcer, nonulcer with no disease other than esophagitis, and postgastric surgery, because these categories affect gastric secretion independently of esophageal disease and in the rank order given. Each category was subdivided by sex, because men secreted more than women. Within each category there was no systematic difference in fasting, basal, or maximal gastric acid or pepsin secretion between patients with and patients without esophagitis. Severity of esophagitis was not related to any secretion parameters. Hiatal hernia was present in 50% of patients with esophagitis vs. 15% of controls without the condition (P < 0.01); however, this did not independently influence the gastric secretion findings. Lower esophageal sphincter pressure was also measured in 62 of the patients, 31 with and 31 without esophagitis. Below 10 mm Hg (incompetent sphincter), 9 of 10 patients had esophagitis but accounted for only <30% of the patients with esophagitis, whereas none of 11 patients with basal acid output of <0.1 mEq/h and lower esophageal sphincter pressure of >10 mm Hg had esophagitis. Because neither the composition of gastric juice nor basal or stimulated gastric acid or pepsin output could be correlated to the presence or severity of esophagitis, factors other than amount or composition of gastric juice per se must be responsible for susceptibility to esophagitis.

Dual effects ofN-ethylmaleimide on ethanol-induced gastric lesions in rats

The effects of N-ethylmaleimide (NEM), a sulfhydryl (SH) blocker, on ethanol-induced gastric lesions were investigated in rats by varying the route of administration. Oral administration of acidified ethanol (60% ethanol in 150 mM HCl, 1 ml) produced hemorrhagic bandlike lesions in the gastric mucosa. Pretreatment of the animals with orally administered NEM (0.1-10 mg/kg) dose-dependently inhibited these lesions (the inhibition was over 80% at 1 mg/kg or greater), and the effects were partially reversed by indomethacin (5 mg/kg, subcutaneous). However, when NEM (10 mg/kg) was given subcutaneously, this agent significantly worsened the lesions. Intragastrically applied NEM produced a dose-dependent reduction of the transmucosal potential difference (PD) and the mucosal nonprotein SH levels, an increase of the volume of gastric contents, and an inhibition of gastric motility, while these parameters remained unaltered after subcutaneous administration of the agent. The microvascular permeability in the mucosa was significantly increased by both oral and subcutaneous administration of NEM (10 mg/kg) but remained unchanged in response to lower doses of orally administered (less than 3 mg/kg). These results suggest that NEM given orally is cytoprotective to the stomach against ethanol, probably by acting as a mild irritant and due to dilution of an irritant and inhibition of gastric motility (muscle relaxation), but when given subcutaneously it aggravates the lesions by unknown mechanisms.

Effect of preanesthetic rectal famotidine on pH and volume of gastric contents in pediatric outpatients

Study Objective: To determine the feasibility and effects of preanesthetic rectal famotidine on gastric fluid pH and volume in pediatric patients. Design: Randomized, prospective, double-blind, controlled study. Setting: Operating room at a medical center. Patients: Eighty patients undergoing minor surgery under general anesthesia randomly allocated to one of two groups. Interventions: Thirty-four patients in Group 1 were given 0.5 mg/kg of diazepam rectally 30 to 120 minutes before anesthesia induction. Thirty-eight patients in Group 2 received 1 mglkg of famotidine, a new histamine (H 2) blocker, and 0.5 mg/kg of diazepam through the same route. Six Patients in Group 1 and two patients in Group 2 were excluded from the study due to gastrointestinal (GI) disorders. Measurements and Main Results: Patients with gastric pH less than 2.5 or volume of gastric contents greater than 0.4 mllkg were considered to be at risk for pulmonary aspiration. Thirty-five (92%) of the Group 2 patients had gastric contents with pH greater than 2.5 and gastric volume less than or equal to 0.4 ml/kg. Only 13 (38%) of the patients in Group 1 had similar gastric pH and volume. Rectal administration did not cause the children pain, and no anorectal problems of famotidine were detected. Conclusions: Famotidine 1.0 mglkg administered rectally 30 minutes prior to general anesthesia appears to result in a satisfactory increase in gastric pH.

A Study of Preoperative Fasting in Infants Aged Less than Three Months

The effects of preoperative fasting on plasma glucose and gastric emptying was studied in 62 infants aged less than three months after a feed of either breast milk or an infant milk formula. Prior to induction of anaesthesia no infant was hypoglycaemic, defined as plasma glucose less than 2.2 mmol/l. Five per cent of infants had a significant volume of residual gastric contents. The mean intraoperative plasma glucose levels rose significantly and this was not influenced by the use of intravenous Hartmann's solution or low dose opioids. Infants in this age group tolerate three- to four-hour preoperative fasts well as no infant became hypoglycaemic intraoperatively. They demonstrate a hyperglycaemic response to the stress of anaesthesia and surgery, and may not need routine intraoperative glucose supplements although plasma glucose should still be monitored.

Gastric residual volume in infants and children following a 3-hour fast

The effect of a 3-hour versus a 10-hour preoperative f asting interval on the gastric residual volume and gastric pH o f pediatric patients was evaluated. Forty-four healthy infants, 1 month to 5 years of age, were randomly assigned to one of two groups. The 3-hour nil per os (NPO) group consisted of 19 infants kept NPO for 3 hours following ingestion of up to 4 ounces of 5% dextrose in water (D5W). The control group consisted of 25 infants who remained NPO an average of 10 hours prior to surgery. Gastric residual volume was calculated using the dye-dilution technique. After the dye marker was injected into the stomach, complete aspiration of the stomach (including the volume of dye marker plus residual gastric contents) was attempted as another method to measure gastric residual volume. There were no significant differences in gastric residual volume between the 3-hour and the 10-hour NPO groups using either the dye-dilution or aspiration methods. However, there were significant differences between the two measuring techniques. Gastric residual volume was significantly greater in volume when measured by the dyedilution technique than it was when measured by the aspiration technique in both the 10-hour ( p < 0.009) and the 3-hour ( p < 0.0009) NPO groups. Complete aspiration of a known volume of fluid injected through the orogastric tube was not possible in 23 of the 44 (52.4%) infants. Mean gastric pH was <2.0 in both groups. It is concluded that in healthy infants and children, a 3-hour NPO period following ingestion of clear liquids does not affect gastric residual volume or gastric pH compared to longer fasting intervals.

Occurrence of gastroesophageal reflux on induction of anaesthesia does not correlate with the volume of gastric contents

In an attempt to explain the discrepancy between the high number of patients said to be at risk of aspiration pneumonitis and the low reported incidence of this anaesthetic complication, 100 ASA physical status I-II elective surgical patients were studied. The volume of fluid present in the stomach at the time of induction of anaesthesia was correlated with gastroesophageal reflux (GER) detected by visual inspection of the pharynx and by continuous measurement of upper oesophageal pH. Mean gastric volume was 30 +/- 28 ml (range 0-210 ml). Gastric fluid volume greater than or equal to 0.4 ml.kg-1 at pH less than or equal to 2.5 was present in 46 patients. No GER was detected during induction of anaesthesia in our sample of 100 patients. Furthermore, patient age, duration of preoperative fasting, body mass index, cigarette smoking, alcohol consumption, preoperative anxiety, and a history of preoperative GER were not correlated with significant modifications of gastric volume or pH. We conclude that the low incidence of aspiration pneumonitis in elective surgical patients may be explained in part by the very low risk of GER, despite gastric fluid volumes of more than 0.4 ml.kg-1 in a high proportion of this patient population.

Fasting guidelines for elective surgical patients

The basic physiology of digestion and gastric emptying was described before the discovery of general anaesthesia. Beaumont, in 1833, made direct observations in a man whose gunshot wound to the stomach had healed, leaving a gastric fistula. ~ He recorded that up to five hours were required for solid food to be converted to semifluid chyme and for the chyme to pass through the pylorus; clear liquids were emptied soon after they were received. In 1858, Snow followed physiological principles with his recommendation that an operation should be performed about the time when a patient would be ready for another meal; 2 subsequent authors recommended that clear fluid should be taken two 3 or three hours before surgery. 4 The routine orderNPO after midnight ignores both the difference in rate of gastric emptying between solid food and clear fluids, and the differences in scheduled times for surgery. A consistent finding in recent clinical studies has been that gastric fluid pH and volume are independent of the duration of the fluid fast beyond two hours, provided that only clear fluids are consumed on the day of surgery. 5-8 When more than two hours have elapsed following clear fluid ingestion, endogenous gastric secretion is the principal determinant of the pH and volume of gastric contents. A longer fluid fast does not improve the gastric environment, although timing for administration of preoperative fluids must make some allowance for surgical cancellations or delays. In the absence of pathological factors, ingestion of most liquids increases the rate of gastric emptying. 9 Because of the prolonged and variable time required for gastric emptying of solids, fats, and liquids of high osmotic pressure 1~ it seems prudent that they should not be consumed on the day of surgery; attention has therefore been focussed on the preoperative administration of clear liquids. Those which have been studied are water, carbonated beverages, clear fruit juice, tea and coffee. It

The effect of prophylactic use of famotidine, ranitidine, and sodium citrate in upper abdominal surgery

The effects of famotidine (40 mg), ranitidine (300 mg) and sodium citrate (30 ml) on the gastric pH and volume were tested in 114 patients undergoing upper abdominal surgery. Gastric content was aspirated through a multiorifice tube immediately after intubation, at the end of operation and after a recovery room period of one hour. All three drug regimens significantly increased the mean gastric pH value compared with the control group. Famotidine and ranitidine reduced the volume of gastric content in comparison with sodium citrate and the control group. However, the difference was significant only in the recovery room sample.

Influence of Preoperative Gastric Aspiration on the Volume and pH of Gastric Contents in Obstetric Patients Undergoing Caesarean Section

Aspiration of gastric contents, the most common anaesthetic cause of maternal mortality, is decreased by emptying of the stomach and the use of antacids and H2-receptor antagonists. One hundred and eighty-three mothers presenting for emergency Caesaren section were allocated to three groups. In group 1, the stomach was emptied before operation via an orogastric tube and thereafter 30 ml of sodium citrate 0.3 mol litre−1 was ingested 5–15 min before induction of general anaesthesia (our usual practice). Group 2 received only 30 ml of sodium citrate 0.3 mol litre−1. Group 3 received ranitidine 50 mg i.v. before operation, 5–15 min before induction of anaesthesia, in addition to sodium citrate. Our results show that preoperative gastric emptying with an orogastric tube followed by sodium citrate is preferred if anaesthesia should be induced 15–20 min later. However, the use of ranitidine and sodium citrate is preferred at subsequent times. Although our data show that preoperative gastric emptying decreased the mean intragastric volumes before Caesarean section, the number of patients at risk of acid aspiration was not reduced. In view of these findings and the unpleasantness of orogastric intubation, we suggest that routine preoperative gastric aspiration via an orogastric tube is not justified, although the manoeuvre should still be used following a recent meal.

Human pharmacology of renzapride: a new gastrokinetic benzamide without dopamine antagonist properties

The activity of the substituted benzamide renzapride on the upper gastrointestinal tract has been investigated. It has been shown to enhance stomach emptying in normal subjects; doses of 2 and 5 mg decreasing by 21 and 37% respectively the volume of gastric contents aspirated 80 min after a test meal. Renzapride was found to reduce the oro-caecal transit time as assessed by the lactulose/breath hydrogen method in a dose related manner from 0.2 to 5 mg; the later dose producing a 62% reduction. Finally renzapride was shown not to elevate plasma prolactin at a dose of 5 mg, a finding consistent with lack of dopamine receptor antagonism.

Reflux Esophagitis

The various therapeutic approaches for reflux esophagitis are to increase the competence of the antireflux barrier, to enhance esophageal clearance, to improve gastric emptying and pyloric sphincter competence, to coat damaged tissue, and, especially, to reduce the volume and pH of gastric contents. Of the prokinetic agents, cisapride is the only drug with proven benefit. Single-agent therapy with conventional-dose H2-receptor antagonists or sucralfate results in similar degrees of symptom relief and healing. Post-evening meal (PEM) dosing of H2-receptor antagonists appears to be a rational method of suppressing late evening gastric acidity, but on balance the symptomatic response of twice daily dosing is superior to once daily dosing. More rapid symptom relief and healing are achieved with high-dose H2-receptor antagonists and omeprazole. The significance of sustained a(hypo)chlorhydria remains to be established. To prolong the symptomatic and/or endoscopic remission, the therapy has to be continued long-term with high-dose H2-receptor antagonist, cisapride either alone or in combination with H2-receptor antagonist, or sucralfate with or without H2-receptor antagonist. In the elderly or complicated patient long-term omeprazole may be a justified alternative.

Influence of Preoperative Gastric Aspiration on the Volume and pH of Gastric Contents in Obstetric Patients Undergoing Caesarean Section

At the authors' hospital, patients presenting for emergency cesarean section are prepared, prior to induction into anesthesia, by stomach aspiration with a wide bore nasogastric tube and the subsequent administration of sodium citrate. To assess if this approach was preferable to other techniques for combatting low gastric pH and increased gastric content volume, the authors compared three management modalities.

Gastric retention and delayed absorption of a large dose of butylated hydroxytoluene in the rat

1. After a single oral dose of 800 mg/kg of butylated hydroxytoluene to rats, the plasma concentration of 2,6-di-tert-butyl-4-methylene-2,5-cyclohexadienone (BHT quinone methide), an active metabolite of BHT, reached a maximum 18 h after dosing. 2. The gastrointestinal content of BHT remained constant from 0.5 to 12 h, and began to decline 18 h after dosing. 3. BHT concentrations in epididymal and subcutaneous adipose tissues also attained maxima 18 h after dosing. 4. Volumes and weights of stomachs and contents, and volumes of gastric contents of rats given 800 mg/kg BHT, were 2-3 times larger than those of controls 4-7 h after dosing while there were no significant differences at 24-27 h after dosing. 5. Retention of ingested material in the stomachs was also observed when 18-h starved rats were given 800 mg/kg BHT. 6. Thirty minutes after intraduodenal administration of 800 mg/kg BHT to anaesthetized rats. BHT, but not BHT quinone methide, was 0.4-1.4 micrograms/ml in portal vein plasma. No BHT was detected in plasma from the aorta descendens. BHT and/or BHT radical, and BHT alone, were also found in liver and epididymal adipose tissue at 7-20 and 25-40 micrograms/g wet weight, respectively. 7. These results indicate that delay in attainment of maximum concentration of BHT or its metabolites in internal organs may be due to the long retention in the stomach, caused by high dosage and the inhibitory effect of BHT on gastric function. Moreover, most BHT may not enter lymphatic fluid but it can be absorbed into portal blood.

Prévention de la pneumopathie d'inhalation en anesthésie obstétricale par l'association effervescente cimétidine-citrate de sodium

The effect of an oral effervescent formulation combining 200 mg cimetidine and 1.8 g sodium citrate on gastric pH and volume were studied in patients undergoing caesarean section. Seventy-four patients undergoing elective (group 1) or emergency caesarean section (group 2) were included. Before entering the operating theater (5 to 60 min before intubation), they were given the tablet dissolved in 15 ml of water. Induction and maintenance of anaesthesia were carried out with conventional techniques. The patient's gastric content was aspirated just after endotracheal intubation, and before extubation. Its pH and volume were measured at both times. Mean pH was similar in the two groups after intubation (6.07 ± 1.13 in group 1 ; 5.52 ± 1.14 in group 2) and before extubation (6.32 ± 1.08 vs. 5.85 ± 1.02 respectively). Gastric pH was therefore > 2.5 in all 74 patients at both times. Mean volumes of gastric content after intubation were greater in group 2 (32.7 ± 23.9 ml vs. 21.6 ± 15.8 ml; p < 0.02). However, just before extubation, these were similar (15.0 ± 15.4 ml in group 1, 20.1 ± 14.9 ml in group 2). The percentage of patients in the 2 groups with gastric volumes > 25 ml at the time of intubation were not significantly different (29.7 % vs. 45.9 % respectively). No patient was at risk of developing pneumonitis in case of aspiration (gastric content pH < 2.5 and volume > 25 ml), either during endotracheal intubation or extubation. Effervescent cimetidine with sodium citrate therefore might be very efficient in preventing aspiration pneumonitis in obstetrical anaesthesia; this was especially so in emergency surgery, where the increase in gastric pH lasted until extubation. Moreover, gastric content volumes compared favourably with those found in studies where 30 ml of 0.3 M sodium citrate had been used.

Effect of Oral and Intramuscular Famotidine on pH and Volume of Gastric Contents

Effect of Oral and Intramuscular Famotidine on pH and Volume of Gastric Contents

Ingestion de citrate de sodium avant l'anesthésie générale pour césarienne programmée. Effet sur le pH et le volume du contenu gastrique

A study was carried out to assess the effects of oral sodium citrate on the pH and volume of gastric content in 52 unpremedicated women undergoing elective Caesarcan section under general anaesthesia. The patients were randomly assigned to two groups : group T (n = 26) without antacids and group C (n = 26) receiving orally 30 ml of 0.3 M sodium citrate solution 5 min before induction of anaesthesia. After tracheal intubation, a size 18 double lumen naso-gastric tube was introduced. The gastric content was sampled 10 min (n = 52), 50 min (n = 52) and 80 min (n = 24) later. Before extubation, the stomach was completely emptied and the naso-gastric tube removed. On each sampling time, the pH was measured with a digital pHmeter ; a search for biliary salts (pyloric reflux) was carried out with thin layer chromatography ; the volume of the gastric content was measured using the phenol red dilution method. At 10 min, none patient in group C had a gastric pH < 2,5, in the opposite to 92 % of patients in the control group T. The alkalinizing effect of the citrate lasted throughout the evaluation time. The mean pH was respectively 5.3 ± 1.07, 5.23 ± 1.2 and 5.53 ± 1.3 at 10, 50 and 80 min in group C (controls : 1.9 ± 0.7 ; 2.49 ± 1.3 ; 2.40 ± 0.61). However, the citrate solution increased significantly the volume of the gastric content. It was respectively 51.1 ± 29.9 ml, 79.15 ± 70.9 ml and 91.9 ± 83.9 ml at 10, 50 and 80 min in the study group (controls : 32.9 ± 22.1 ml ; 29.6 ± 28.5 ml ; 26.6 ± 10.9 ml). The number of patients considered to be at risk of aspirating gastric content (pH ⩽ 2.5 and gastric content volume ⩾ 25 ml) was 0/26, 1/26 and 1/14 in group C, and 11/25, 8/25 and 1/10 in group T (1 patient was excluded because of pyloric reflux). Although the correlation between the measured and aspirated volumes was statistically significant, it was rather poor (r = 0.56). It is concluded that giving sodium citrate orally just before anaesthetic induction for elective Caesarean section is a safe, simple and cheap method of preventing aspiration pneumonitis, despite the increased volume of gastric content.

前投薬としてのｒａｎｉｔｉｄｉｎｅおよびｂｒｏｍａｚｅｐａｍ坐薬の小児における評価

Effects of pre-operative administration of ranitidine on pH and volume of gastric juicewere evaluated in 54 children (mean age: 5.4±1.0 yr) who underwent elective surgeryunder general anesthesia. Simultaneously, bromazepam suppository was evaluated as a premedicationagent for pediatric patients. Patients were randomly divided into four groups, and premedication agents were given 2 hr prior to induction of anesthesia. Patients ingroup A received diazepam syrup (0.5 mg/kg P. o.) ahd those in group B received bromazepamsuppository (3 mg). Patients in groups C and D received ranitidine (1 mg or2 mg/kg i. m.) together with bromazepam suppository (3 mg). Following induction ofanesthesia, a gastric tube (10 Fr. or 12 Fr.) was passed and stomach contents were collectedand analyzed for volume and pH, which was repeated every hr until the end ofthe operation. The gastric pH at the induction of anesthesia was observed to be 2.5 orless in 70% of the patients of groups A and B, 13% of group C, and O% of group D.The volume of gastric contents was less than 0.4 ml/kg in 87% of ranitidine-treatedpatiehts (groups C and D), in 29% of group A, ahd in 60% of group B. It was thenconcluded that pre-operative administration of ranitidine caused a significant reduction ofboth acidity and volume of gastric contents, which will contribute to preventing or reducingaspiration pneumonitis during general anesthesia. Plasma ranitidine concentrationsmeasured by high-performance liquid chromatography revealed 228±32 ng/ml in group Cand 487±59 ng/ml in group D at the induction.of anesthesia. Sedation at the inductionof anesthesia was evaluated utilizing our original pediatric premedication score, whichconsists of 3 check points: quietness (very good, 3 ; good, 2 ; fair, 1 ; bad, 0); crying (no, 2 ; a little, 1 ; yes, 0); and i. v. root (under local anesthesia, 1 ; following induction ofanesthesia, 0). The averaged scores were 4.5±0.4 in group A, 4.2±1.9 in group B, 4.1±0.6 in group C, and 4.8±0.5 in group D, respectively. There was no significantdifference in the score in 4 groups. A plasma bromazepam level was 414±49 ng/ml at theinduction of anesthesia. Our results showed that bromazepam suppository is as effectiveas diazepam syrup for premedication in children.