The effects of sedation on gastric emptying and intra-gastric meal distribution in critical illness
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To evaluate the effects of sedation with morphine and midazolam (M&M) versus propofol on gastric emptying in critically ill patients.
Mixed medical and surgical intensive care unit.
Thirty-six unselected, mechanically ventilated, critically ill patients.
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.
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.
KeywordsMorphine Midazolam Propofol Critical illness Gastric emptying
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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