OBJECTIVE: To compare the effects of opioid and non-opioid 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 > 24 h. 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. MEASUREMENTS 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 differences 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 rank p = 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 avoidingmorphine (1-8 mg/h) in the sedative regimen. Intracranial hypertension is associated with reduced gastric emptying.
RCT Entities:
OBJECTIVE: To compare the effects of opioid and non-opioid 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 > 24 h. 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. MEASUREMENTS 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 differences 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 rank p = 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.
Authors: Marc A Ritz; Marianne J Chapman; Robert J Fraser; Mark E Finnis; Ross N Butler; Patricia Cmielewski; Geoffrey P Davidson; Deborah Rea Journal: Intensive Care Med Date: 2005-06-07 Impact factor: 17.440
Authors: Nam Q Nguyen; Marianne J Chapman; Robert J Fraser; Laura K Bryant; Carly Burgstad; Katrina Ching; Max Bellon; Richard H Holloway Journal: Intensive Care Med Date: 2007-12-04 Impact factor: 17.440
Authors: Annika Reintam Blaser; Manu L N G Malbrain; Joel Starkopf; Sonja Fruhwald; Stephan M Jakob; Jan De Waele; Jan-Peter Braun; Martijn Poeze; Claudia Spies Journal: Intensive Care Med Date: 2012-02-07 Impact factor: 17.440