Omeprazole prior to elective surgery

RE: Omeprazole prior to elective surgery

Lucy Fleming — Thu, 18 Feb 2021 09:18:09 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29676/omeprazole-prior-to-elective-surgery/228605#228605"]Why not choose Maropitant (Cerenia), or Metoclopramide (Emeprid, Vomend) though? licenced, effective and safe, and available in injection or oral formulations. [/quote]

Not to say that these shouldn't be used, but the rationale behind the omeprazole is to reduce the acidity of stomach content so that the consequences of any regurgitation (+/- aspiration) are less severe. Maropitant more useful to prevent active vomiting, and metoclopramide useful for regurgitation in terms of increasing lower oesophageal sphincter tone, but still not going to completely prevent passive regurgitation under GA.

I was at a CPD event (pre-pandemic, ah, those were the times) discussing some of these issues and apparently the rate of silent reflux and evidence of damage from aspiration of stomach acid even in brachycephalic dogs that have never had a GA is very high.

RE: Omeprazole prior to elective surgery

Dinu Catilina — Wed, 17 Feb 2021 15:07:16 GMT

We give both maropitant and omeprazole IV on admit. I prefer maropitant over metoclopramide as it's SID and not TID and they can vomit at home as well. Especially if they are starved before surgery. Most brachys we operate on are for some type of BOAS surgery and I believe (no evidence) that the local pain can trigger vomiting as well.

RE: Omeprazole prior to elective surgery

Clive Ansell — Wed, 17 Feb 2021 14:53:01 GMT

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29676/omeprazole-prior-to-elective-surgery/228603#228603"]I'm pretty sure there is no evidence behind using it but I would want to do everything I can to minimise this risk. [/quote]

Good enough.

Why not choose Maropitant (Cerenia), or Metoclopramide (Emeprid, Vomend) though? licenced, effective and safe, and available in injection or oral formulations.

I don't routinely give anti-emetics or antacids for any ops or any particular breeds, but If I am an any way concerned about vomiting or regurgitation, particularly during recover I will use Maropitant pre-op, or get the owners to dose orally the evening before.

One referral centre I occasional deal with, routinely gives Maropitant the night before the op, as standard. I don't know whether there is good evidence to support it or not?

RE: Omeprazole prior to elective surgery

Beats — Wed, 17 Feb 2021 14:44:57 GMT

[quote userid="9239" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29676/omeprazole-prior-to-elective-surgery/228603#228603"]aspiration pneumonia[/quote]

I've seen a bulldog die after routine castration (whether this was indicated at all is another conversation worth having). It got post-GA esophagitis as you sometimes see with any dog, but the subsequent regurg must have led to aspiration pneumonia.

Omeprazole reliably reduces the pH of esophageal reflux occurring under GA (Stanley Marks has some good data to this effect).

Beyond that its just connect the dots that this is likely to reduce the risk of post-GA esphagitis, and that reducing the risk of post-GA esophagitis is likely to save lives, but for the sake of a 10p capsule worthwhile in my opinion with the benefit likely to outweigh the risk (unless forceably tabletting a reluctant brachy shortly before a procedure in which case may be more equivocal).

RE: Omeprazole prior to elective surgery

Dinu Catilina — Wed, 17 Feb 2021 14:04:19 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29676/omeprazole-prior-to-elective-surgery/228599#228599"]What is the rationale for its use? [/quote]

Many brachys have various degrees of gastritis and they have a higher risk of aspiration pneumonia if they vomit during recovery. I'm pretty sure there is no evidence behind using it but I would want to do everything I can to minimise this risk.

RE: Omeprazole prior to elective surgery

Clive Ansell — Tue, 16 Feb 2021 19:46:32 GMT

I've never used it routinely, and not had any problems.

What is the rationale for its use?

Given that it is off licence, is there good and reliable evidence that it is beneficial.

RE: Omeprazole prior to elective surgery

Dinu Catilina — Tue, 16 Feb 2021 17:19:43 GMT

We don't. I will always give cerenia and omperazole IV on admit.

There are too many people involved with booking things in and it's impossible for reception to keep track of everything.

RE: Omeprazole prior to elective surgery

Beats — Tue, 16 Feb 2021 14:11:56 GMT

i get them to give with dinner the night before for morning procedures - no idea if that does any good or not.

if arrive in morning without, i tend to pill them (in butter) and 5ml water and then leave an hour - no idea if that's any good either.

if resistant to pilling, then i don't - have certainly ga'd to find bits of omeprazole capsules stuck round the pharynx following a stubborn attempt at pilling.

[quote userid="10320" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/29676/omeprazole-prior-to-elective-surgery"]And how do you go about ensuring that this happens when owners just ring to book in e.g. a neutering via reception staff without vet input?[/quote]

either train receptionists to do what you like, or send a text to ops booked for you in advance of the big day advising that a medicine to take before the procedure has been dispensed to be collected, or phone owner to discuss in detail if being fancy.