• Nam Q Nguyen, Marianne J Chapman, Robert J Fraser, Laura K Bryant, Carly Burgstad, Katrina Ching, Max Bellon, and Richard H Holloway.
• Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, SA 5000, Adelaide, Australia. namphoung28@hotmail.com
• Intensive Care Med. 2008 Mar 1;34(3):454-60.

ObjectiveTo evaluate the effects of sedation with morphine and midazolam (M&M) versus propofol on gastric emptying in critically ill patients.DesignDescriptive study.SettingMixed medical and surgical intensive care unit.PatientsThirty-six unselected, mechanically ventilated, critically ill patients.InterventionsGastric 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 ResultsGastric 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 >or=5% meal retention at 240 min than those treated 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.ConclusionsIn 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.

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