• C J McArthur, T Gin, I M McLaren, J A Critchley, and T E Oh.
• Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
• Intensive Care Med. 1995 Jul 1;21(7):573-6.

ObjectiveTo compare the effects of opioid and non-opioid sedation on gastric emptying.DesignProspective, randomized trial.SettingUniversity teaching hospital ICU.Patients21 brain injured patients requiring sedation, mechanical ventilation and intracranial pressure (ICP) monitoring for > 24 h.InterventionsPatients 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 ResultsPre-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.ConclusionsGastric 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.

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