Skip to main content
Log in

Gastric emptying following brain injury: Effects of choice of sedation and intracranial pressure

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To compare the effects of opioid and nonopioid sedation on gastric emptying.

Design

Prospective, randomized trial.

Setting

University teaching hospital ICU.

Patients

21 brain injured patients requiring sedation, mechanical ventilation and intracranial pressure (ICP) monitoring for >24h.

Interventions

Patients were randomized to receive infusions of either morphine plus midazolam (M), or propofol (P). Gastric emptying was assessed by the paracetamol absorption technique and by residual volumes following a 200 ml test feed.

measuerments and results

Pre-sedation Glasgow Coma Score, mean ICP and the presence of bowel sounds were noted. Plasma concentrations of paracetamol were measured over 3 h following a 1 g gastric dose. There were no differencese in median peak paracetamol concentration (M, 18.5 versus P, 20.8 mg/l), median time to peak concentration (M, 20 versus P, 25 min), median area under the concentration-time curve (AUC), or in the median residual volumes at 1 h (M, 14 versus P, 10.5 ml) and 2 h (M, 5 versus P, 3 ml). In patients with ICP>20 mmHg, paracetamol concentrations were lower (p<0.05), and AUC after 30 min was lower (165 mg·min/l versus 411 mg·min/l,p=0.023). Mean ICP was correlated with AUC (Kendall rankp=0.027). Gastric emptying did not correlate with initial Glasgow Coma Score or presence of bowel sounds.

Conclusions

Gastric emptying is not improved in patients with brain injury by avoiding morphine (1–8 mg/h) in the sedative regimen. Intracranial hypertension is associated with reduced gastric emptying.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Murray MJ, Marsh HM, Wochos DN, Moxness KE, Offord KP, Callaway CW (1988) Nutritional assessment of intensive-care unit patients. Mayo Clin Proc 63:1106–1115

    PubMed  Google Scholar 

  2. Rapp RP, Young B, Twyman D, Bivins BA, Haak D, Tibbs PA, Bean JR (1983) The favorable effect of early parenteral feeding on survival in head-injured patients. J Neurosurg 58:906–912

    PubMed  Google Scholar 

  3. Berger R, Adams L (1989) Nutritional support in the critical care setting (part1). Chest 96:139–150

    PubMed  Google Scholar 

  4. Christman JW, McCain RW (1993) A sensible approach to the nutritional support of mechanically ventilated critically ill patients. Intensive Care Med 19:129–136

    PubMed  Google Scholar 

  5. Berger R, Adams L (1989) Nutritional support in the critical care setting (part 2). Chest 96:372–380

    PubMed  Google Scholar 

  6. Chang RWS, Jacobs S, Lee B (1987) Gastrointestinal dysfunction among intensive care unit patients. Crit Care Med 15:909–914

    PubMed  Google Scholar 

  7. Ott L, Young B, Phillips R, McClain C, Adams L, Dempsey R, Tibbs, P, Ryo Y (1991) Altered gastric emptying in the head-injured patient: relationship to feed intolerance. J Neurosurg 74:738–742

    PubMed  Google Scholar 

  8. Norton JA, Ott LG, McClain C, Adams L, Dempsey RJ, Haak D, Tibbs PA, Young AB (1988) Intolerance to enteral feeding in the brain injured patient. J Neurosurg 68:62–66

    PubMed  Google Scholar 

  9. Bion JF, Ledingham IMcA (1987) Sedation in intensive care—a postal survey. Intensive Care Med 13:215–216

    PubMed  Google Scholar 

  10. Nimmo WS, Heading RC, Wilson J, Tothill P, Prescott LF (1975) Inhibition of gastric emptying and drug absorption by narcotic analgesics. Br J Clin Pharmacol 2:509–513

    PubMed  Google Scholar 

  11. Harris CE, Grounds RM, Murray AM, Lumley J, Royston D, Morgan M (1990) Propofol for long-term sedation in the intensive care unit. A comparison with papaveretum and midazolam. Anaesthesia 45:366–372

    PubMed  Google Scholar 

  12. Heading RC, Nimmo J, Prescott LF, Tothill P (1973) The dependence of paracetamol absorption on the rate of gastric emptying. Br J Pharmacol 47:415–421

    PubMed  Google Scholar 

  13. Gin T, Cho AMW, Lew JKL, Laus GSN, Yuen PM, Critchley JAJH, Oh TE (1991) Gastric emptying in the postpartum period. Anaesth Intensive Care 19:521–524

    PubMed  Google Scholar 

  14. Critchley JAJH, Nimmo GR, Gregson CA, Woolhouse N, Prescott LF (1986) Intersubject and ethnic differences in paracetamol absorption. Br J Clin Pharmacol 22:649–657

    PubMed  Google Scholar 

  15. Gainsborough N, Maskrey VL, Nelson ML, Keating J, Sherwod RA, Jackson SHD, Swift CG (1993) The association of age with gastric emptying. Age and Ageing 22:37–40

    PubMed  Google Scholar 

  16. Divoll M, Ameer B, Darrell RA, Greenblatt DJ (1982) Age does not alter acetaminophen absorption. J Am Geriatr Soc 30:240–244

    PubMed  Google Scholar 

  17. Mushambi MC, Rowbotham DJ, Bailey SM (1992) Gastric emptying after minor gynaecological surgery. The effect of anaesthetic technique. Anaesthesia 47:297–299

    PubMed  Google Scholar 

  18. Power I, Easton JC, Todd JG, Nimmo WS (1989) Gastric empyting after head injury. Anaesthesia 44:563–566

    PubMed  Google Scholar 

  19. Garrick T, Mulvihill S, Buack S, Maeda-Hagiwara M, Tache Y (1988) Intracerebroventricular pressure inhibits gastric antral and duodenal contractility but not acid secretion in conscious rabbits. Gastroenterology 95:26–31

    Google Scholar 

  20. Payne-Jones JJ, Rees RG, Silk DBA (1987) Bowel sounds. Anaesthesia 42:893–894

    PubMed  Google Scholar 

  21. Shelly MP, Church JJ (1987) Bowel sounds during intermittent positive pressure ventilation. Anaesthesia 42:207–209

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

McArthur, C.J., Gin, T., McLaren, I.M. et al. Gastric emptying following brain injury: Effects of choice of sedation and intracranial pressure. Intensive Care Med 21, 573–576 (1995). https://doi.org/10.1007/BF01700162

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01700162

Key words

Navigation