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The effects of sedation on gastric emptying and intra-gastric meal distribution in critical illness

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Abstract

Objective

To evaluate the effects of sedation with morphine and midazolam (M&M) versus propofol on gastric emptying in critically ill patients.

Design

Descriptive study.

Setting

Mixed medical and surgical intensive care unit.

Patients

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

Interventions

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.

Measurements and 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 ≥ 5% meal retention at 240 min than thosetreated 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.

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Acknowledgements

This study was supported by a grant from the National Health & Medical Research Council (NH&MRC) of Australia. Nam Nguyen is a NH&MRC Postgraduate Medical Scholar. The authors would like to thank all ICU nursing and medical staff at the Royal Adelaide Hospital.

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Authors and Affiliations

  1. Departmentof Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, SA 5000, Adelaide, Australia

    Nam Q. Nguyen, Carly Burgstad, Katrina Ching & Richard H. Holloway

  2. University Department of Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Nam Q. Nguyen, Robert J. Fraser & Laura K. Bryant

  3. Investigation and Procedures Unit, Repatriation General Hospital, Daw Park, South Australia, Australia

    Robert J. Fraser

  4. Departmentof Anaesthesia and Intensive Care, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Marianne J. Chapman

  5. Departmentof Nuclear Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Max Bellon

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  1. Nam Q. Nguyen
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  2. Marianne J. Chapman
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  8. Richard H. Holloway
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Correspondence to Nam Q. Nguyen.

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Nguyen, N.Q., Chapman, M.J., Fraser, R.J. et al. The effects of sedation on gastric emptying and intra-gastric meal distribution in critical illness. Intensive Care Med 34, 454–460 (2008). https://doi.org/10.1007/s00134-007-0942-2

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  • DOI: https://doi.org/10.1007/s00134-007-0942-2

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