The effects of sedation on gastric emptying and intra-gastric meal distribution in critical illness.
OBJECTIVE
To evaluate the effects of sedation with morphine and midazolam (M&M) versus propofol on gastric emptying in critically ill patients.


METHODS
Descriptive study.


METHODS
Mixed medical and surgical intensive care unit.


METHODS
Thirty-six unselected, mechanically ventilated, critically ill patients.


METHODS
Gastric scintigraphic data were analysed retrospectively according to whether patients were receiving M&M (n=20; 14M, 6F) or propofol (n=16; 7M, 9F). Measurements were performed over 4 h after administration of 100 ml of Ensure, labelled with 20 MBq Tc99m.


RESULTS
Gastric half-emptying time (t1/2) and total and regional (proximal and distal stomach) meal retention (%) were assessed. The median t1/2 of patients receiving M&M (153 (IQR: 72-434) min) was significantly longer than that of patients receiving propofol (58 (34-166) min, p=0.02). Total gastric retention was greater in patients receiving M&M compared to those receiving propofol (p<0.01). Proximal (p=0.02) but not distal (p=0.80) gastric retention was greater in patients who received M&M. Patients who received M&M were more likely to have >or=5% meal retention at 240 min than those treated with propofol (95% (19/20) vs. 56% (9/16); p=0.01). Changes in blood glucose concentrations during the study were similar in the two groups.


CONCLUSIONS
In critical illness, patients receiving M&M for sedation are more likely to have slow gastric emptying, and proximal meal retention than those receiving propofol. The apparent beneficial effects of propofol-based sedation need confirmation by a prospective randomised controlled study.
Nguyen
Nam Q
NQ
Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, SA 5000, Adelaide, Australia. namphoung28@hotmail.com
Chapman
Marianne J
MJ
Fraser
Robert J
RJ
Bryant
Laura K
LK
Burgstad
Carly
C
Ching
Katrina
K
Bellon
Max
M
Holloway
Richard H
RH
D015992:Body Mass Index; D016638:Critical Illness; D019422:Dietary Sucrose / Q000008:administration & dosage; D004750:Enteral Nutrition; D005260:Female; D005526:Food, Formulated; D005746:Gastric Emptying / Q000187:drug effects*; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging / Q000187:drug effects; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000494:pharmacology*; D007362:Intensive Care Units; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000494:pharmacology*; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects / Q000494:pharmacology*; D009294:Narcotics / Q000009:adverse effects / Q000494:pharmacology; D015742:Propofol / Q000009:adverse effects / Q000494:pharmacology*; D011877:Radionuclide Imaging; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging / Q000187:drug effects; D013667:Technetium
D019422:Dietary Sucrose; D006993:Hypnotics and Sedatives; D009294:Narcotics; C082131:Ensure formulated food; D013667:Technetium; D009020:Morphine; D008874:Midazolam; D015742:Propofol