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.
Similar content being viewed by others
References
Christman J, McCain RW (1993) A sensible approach to nutritional support of mechanically ventilated critically ill patients. Intensive Care Med 19:129–136
McMahon M, Farnell M, Murray M (1993) Nutritional support of the critically ill. Mayo Clin Proc 68:911–920
Ritz MA, Fraser R, Edwards N, Di Matteo AC, Chapman M, Butler R, Cmielewski P, Tournadre JP, Davidson G, Dent J (2001) Delayed gastric emptying in ventilated critically ill patients: measurement by 13 C-octanoic acid breath test. Crit Care Med 29:1744–1749
De Beaux I, Chapman M, Fraser R, Finnis M, De Keulenaer B, Liberalli D, Satanek M (2001) Enteral nutrition in the critically ill: a prospective survey in an Australian intensive care unit. Anaesth Int Care 29:619–622
Multu G, Multu E, Factor P (2001) Gastrointestinal complications in patients receiving mechanical ventilation. Chest 119:1222–1241
Dvir D, Cohen J, Singer P (2006) Computerized energy balance and complications in critically ill patients: an observational study. Clin Nutr 25:37–44
Heyland D, Cook DJ, Winder B, Brylowski L, Van deMark H, Guyatt G (1995) Enteral nutrition in the critically ill patient: a prospective survey. Crit Care Med 23:1055–1060
Glatzle J, Leutenegger CM, Mueller MH, Kreis ME, Raybould HE, Zittel TT (2004) Mesenteric lymph collected during peritonitis or sepsis potently inhibits gastric motility in rats. J Gastrointest Surg 8:645–652
Yuan CS, Foss JF, O'Connor M, Roizen MF, Moss J (1998) Effects of low-dose morphine on gastric emptying in healthy volunteers. J Clin Pharmacol 38:1017–1020
Crighton IM, Martin PH, Hobbs GJ, Cobby TF, Fletcher AJ, Stewart PD (1998) A comparison of the effects of intravenous tramadol, codeine, and morphine on gastric emptying in human volunteers Anesth Analg 87:445–449
Mittal R, Frank E, Lange R, McCallum R (1986) Effects of morphine and naloxone on esophageal motility and gastric emptying in man. Dig Dis Sci 31:936–942
Inada T, Asai T, Yamada M, Shingu K (2004) Propofol and midazolam inhibit gastric emptying and gastrointestinal transit in mice. Anesth Analg 99:1102–1106
Hammas B, Hvarfner A, Thorn SE, Wattwil M (1998) Propofol sedation and gastric emptying in volunteers. Acta Anaesth Scand 42:102–105
Chassard D, Lansiaux S, Duflo F, Mion F, Bleyzac N, Debon R, Allaouchiche B (2002) Effects of subhypnotic doses of propofol on gastric emptying in volunteers. Anesthesiology 97:96–101
Bosscha K, Nieuwenhuijs VB, Vos A, Samsom M, Roelofs JM, Akkermans LM (1998) Gastrointestinal motility and gastric tube feeding in mechanically ventilated patients. Crit Care Med 26:1510–1517
McArthur CJ, Gin T, McLaren IM, Critchley JA, Oh TE (1995) Gastric emptying following brain injury: effects of choice of sedation and intracranial pressure. Intensive Care Med 21:573–576
Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G (2001) Upper digestive intolerance during enteral nutrition in critically ill patients: Frequency, risk factors, and complications. Crit Care Med 29:1955–1961
Riker RR, Picard JT, Fraser GL (1999). Prospective evaluation of the Sedation–Agitation Scale for adult critically ill patients. Crit Care Med 27:1325–1329
Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter P. M, Sprung C, Colardyn F, Blecher S (1998). Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 26:1793–1800
Maughan RJ, Leiper JB (1996) Methods for the assessment of gastric emptying in humans: an overview. Diabet Med 13:S6–10
Collins PJ, Horowitz M, Maddox A, Myers JC, Chatterton BE (1996) Effects of increasing solid component size of a mixed solid/liquid meal on solid and liquid gastric emptying. Am J Physiol 271:G549–G554
Nguyen NQ, Fraser R, Chapman M, Bryant L, Holloway RH (2006) Relationship between intra-gastric meal distribution and delayed gastric emptying in critical illness. Neurogastroenterol Motil 18:663
Nguyen NQ, Ng MP, Chapman M, Fraser R, Holloway RH (2007) The impact of admission diagnosis on gastric emptying in critically ill patients. Crit Car 11:R16
Nguyen NQ, Ching K, Fraser R, Holloway RH (2006) Relationship between blood glucose control and feed intolerance in critical illness. Gastroenterology 130:A607
Jellish W, Leonetti J, Murdoch J, Fowles S (1995) Propofol-based anesthesia as compared with standard anesthetic techniques for middle ear surgery. J Clin Anesth 7:292–296
Hammas B, Thorn SE, Wattwil M (2001) Propofol and gastric effects of morphine. Acta Anaesth Scand 45:1023–1027
Nguyen NQ, Fraser RJ, Chapman M, Bryant LK, Holloway RH, Vozzo R, Feinle-Bisset C (2006) Proximal gastric response to small intestinal nutrients is abnormal in mechanically ventilated critically ill patients. World J Gastroenterol 12:4383–4388
Nguyen N, Fraser RJ, Bryan L, Chapman M, Holloway RH (2007) Proximal gastric motility in critically ill patients with type 2 diabetes mellitus. World J Gastroenterol 13:270–275
Chapman M, Fraser R, Vozzo R, Bryant L, Tam W, Nguyen N, Zacharakis B, Butler R, Davidson G, Horowitz M (2005) Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients. Gut 54:1384–1390
Corbett SM, Moore J, Rebuck JA, Rogers FB, Greene CM (2006) Survival of propofol infusion syndrome in a head-injured patient. Crit Care Med 34: 2479–2483
Ernest D, French C (2003). Propofol infusion syndrome–report of an adult fatality. Anaesth Intensive Care 31:316–319
Fass J, Bares R, Hermsdorf V, Schumpelick V (1995) Effects of intravenous ketamine on gastrointestinal motility in the dog. Intensive Care Med 21:584–589
Gehlbach B, Kress J (2002) Sedation in the intensive care unit. Curr Opin Crit Care 8:290–298
Hogarth D, Hall J (2004) Management of sedation in mechanically ventilated patients. Curr Opin Crit Care 10:40–46
Nguyen NQ, Chapman MJ, Fraser RJ, Bryant LK, Holloway RH (2007). Erythromycin is more effective than metoclopramide in the treatment of feed intolerance in critical illness. Crit Care Med 35:483–489
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-007-0942-2