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Gastric volume and pH were studied immediately after induction of anesthesia and endotracheal intubation in 101 elective surgical patients. Of 44 patients not given cimetidine, 82% had a gastric pH less than 2.5 with a mean pH of 1.6; 45% of these patients had a gastric aspirate pH less than 2.5 associated with a volume exceeding 25 ml. In 57 patients premedicated with intravenous cimetidine at variable intervals (15 to 60 minutes) prior to induction of anesthesia, a significant time-dependent increase was noted in gastric pH (p < 0.001) together with a decline in gastric volume (p < 0.0011. Of the patients given intravenous cimetidine (mean 4.5 μg/kg) 45 minutes prior to induction of anesthesia, 90% had a gastric pH greater than 2.5. The increase in gastric pH after cimetidine administration would result in a reduced chemical pulmonary reaction should aspiration occur during induction of anesthesia.