Effect of Premedication on Drug Absorption and Gastric Emptying

Todd, J.G.; Nimmo, W.S.

doi:10.1097/00132586-198408000-00023

Cited by 7 publications

(12 citation statements)

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“…Administration of opioid analgetic drugs could be a cause of delayed gastric emptying and drug absorption in the perioperative periods. [36][37][38] Opioids can increase tone and reduce motility in several gut segments, enhance absorption of fluids, and inhibit secretion. 39,40 Delayed gastric emptying could increase the risk of complications like vomiting and pulmonary aspiration.…”

Section: Discussionmentioning

confidence: 99%

Effects of Fentanyl and S(+)-ketamine on Cerebral Hemodynamics, Gastrointestinal Motility, and Need of Vasopressors in Patients With Intracranial Pathologies

Schmittner¹,

Vajkoczy²,

Horn

et al. 2007

Journal of Neurosurgical Anesthesiology

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In neurosurgical patients, opioids are administered to prevent secondary cerebral damage. Complications often related to the administration of opioids are a decrease in blood pressure affording the use of vasopressors and intestinal atonia. One alternative approach to opioids is the application of S(+)-ketamine. However, owing to a suspected elevation of intracranial pressure (ICP), the administration of S(+)-ketamine has questioned for a long time. The aim of the present study was to evaluate ICP, gastrointestinal motility, and catecholamine consumption in neurosurgical patients undergoing 2 different protocols of anesthesia using fentanyl or S(+)-ketamine. Twenty-four patients sustaining traumatic brain injury or aneurysmal subarachnoid hemorrhage received methohexitone plus either fentanyl or S(+)-ketamine to establish a comparable level of sedation. To reach an adequate cerebral perfusion pressure (CPP), the norepinephrine dosage was adapted successively. Enteral nutrition and gastrointestinal stimulation were started directly after admission on the critical care unit. ICP, CPP, and norepinephrine dosage were recorded over 5 days and also the time intervals to full enteral nutrition and first defecation. There was no difference regarding ICP, CPP, and the time period until full enteral nutrition or first defecation between both groups. Patients who underwent analgesia with S(+)-ketamine showed a trend to a lower demand of norepinephrine compared with the fentanyl group. Our results indicate that S(+)-ketamine does not increase ICP and that its use in neurosurgical patients should not be discouraged on the basis of ICP-related concerns.

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Section: Discussionmentioning

confidence: 99%

Effects of Fentanyl and S(+)-ketamine on Cerebral Hemodynamics, Gastrointestinal Motility, and Need of Vasopressors in Patients With Intracranial Pathologies

Schmittner¹,

Vajkoczy²,

Horn

et al. 2007

Journal of Neurosurgical Anesthesiology

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“…58 Ciresi found that metoclopramide at either 10 or 20 mg IV could reliably empty the stomach within 10 to 20 minutes. 133,134 Although pain and anxiety delay gastric emptying through sympathetic stimulation, the administration of an opioid for analgesia can further retard the propulsion of gastric contents into the duodenum. 136 Metoclopramide was also found to reduce the volume of gastric contents in pediatric trauma patients.…”

Section: A Gastroesophageal Motilitymentioning

confidence: 99%

Aspiration Prevention and Prophylaxis

Tasch¹,

Langeron²

2013

Benumof and Hagberg's Airway Management

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Section: Drug Absorptionmentioning

confidence: 99%

“…An indirect estimate of gastric emptying time can be obtained from studies measuring the absorption of paracetamol (acetaminophen) after oral administration, since this drug is not absorbed from the stomach; this technique has been extensively used to investigate the effects of drugs and anaesthesia on gastric emptying during the perioperative period. When paracetamol absorption after oral administration was used as a model of drug absorption and as an indirect estimate of gastric emptying rate, intramuscular diazepam 10mg was shown to have no effect on the model while a similar dose of morphine produced a significant delay (Todd & Nimmo 1983). Narcotic analgesics have been shown to produce a marked delay in paracetamol absorption in women during late labour while, in contrast, epidural analgesia appears to have little effect (Nimmo et al 1975).…”

Section: Drug Absorptionmentioning

confidence: 99%

“…Gastric emptying before elective surgery is normal (Marsh et al 1984;Todd & Nimmo 1983), but premedication with morphine, pethidine (meperidine) and anticholinergics all delay gastric emptying and drug absorption (Clark & Seager 1983;Gamble et al 1976;Nimmo et al 1975;Todd & Nimmo 1983). 1 ± 2.2 mg/L for the patients who I:eceived a saline injection (p < 0.05), and the area under the concentration-time curve for paracetamol for the first 45 min after the dose (AUC(O_45») was 3.6 ± 2.9 mg/L' h for the patients who received morphine compared with 11.3 ± 7.3 mg/L' h for those receiving saline (p < 0.05) [Todd & Nimmo 1983]. When paracetamol absorption after oral administration was used as a model of drug absorption and as an indirect estimate of gastric emptying rate, intramuscular diazepam 10mg was shown to have no effect on the model while a similar dose of morphine produced a significant delay (Todd & Nimmo 1983).…”

Section: Drug Absorptionmentioning

confidence: 99%

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Pharmacokinetic Drug Interactions in Anaesthetic Practice

Wood

1991

Clinical Pharmacokinetics

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Patients receive on average 10 different drugs while in hospital; when fewer than 6 are administered the probability of an adverse drug interaction is about 5%, but when more than 15 are given the probability increases to over 40%. Patients presenting for anaesthesia and surgery are likely to receive multiple preoperative drug therapy and also many perioperative medications as part of their anaesthetic regimen. Thus, there is a considerable potential for interactions to occur in anaesthetic practice. Pharmacokinetic interactions occur when the administration of 1 drug alters the disposition of another, and hence alters the concentration of drug at the receptor site, leading to altered drug response. These changes in drug concentration at the receptor site may be produced by alteration of (a) drug absorption and uptake into the body, (b) drug distribution, (c) drug metabolism and (d) drug elimination or excretion by nonmetabolic routes. Interactions affecting the absorption of orally administered medications are often due to the indirect effect of 1 drug on gastric motility and emptying, which leads to reduced, delayed or variable systemic drug availability. Gastric emptying time before elective surgery is normal, but premedication with morphine, pethidine (meperidine) and anticholinergics all delay gastric emptying and hence drug absorption. Inhalational anaesthesia of short duration does not appear to affect drug absorption, although halothane anaesthetic used for longer periods produces a slight delay in gastric emptying. Volatile anaesthetics have been shown to delay the intramuscular absorption of ketamine. Anaesthetic agents may affect drug distribution, and peak concentrations of propranolol, for example, are 4 times higher during halothane anaesthesia in dogs, accompanied by a marked decrease in volume of distribution. This effect has been noted for other drugs, including thiopental and verapamil. Volatile anaesthetics also affect plasma protein binding, leading to displacement interactions in some cases. Volatile anaesthetics affect the metabolism of concomitantly administered drug (a) by altering the rate of delivery to the organ of clearance (e.g. decreasing hepatic blood flow) and (b) by altering the activity of drug metabolising enzymes. It is now well recognised that all the volatile anaesthetics currently in use inhibit the metabolism of a large variety of drugs, e.g. propranolol, lidocaine (lignocaine), fentanyl and pethidine. Other examples of interactions of clinical importance to anaesthesiologists include those between cimetidine and the local anaesthetics and benzodiazepines; inhibition of plasma cholinesterase by drugs such as ecothiopate; interactions between monoamine oxidase inhibitors and sympathomimetics or pethidine and between monoamine oxidase inhibitors and sympathomimetics or pethidine and between isoniazid and enflurane.(ABSTRACT TRUNCATED AT 400 WORDS)

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Effect of Premedication on Drug Absorption and Gastric Emptying

Cited by 7 publications

References 0 publications

Effects of Fentanyl and S(+)-ketamine on Cerebral Hemodynamics, Gastrointestinal Motility, and Need of Vasopressors in Patients With Intracranial Pathologies

Effects of Fentanyl and S(+)-ketamine on Cerebral Hemodynamics, Gastrointestinal Motility, and Need of Vasopressors in Patients With Intracranial Pathologies

Aspiration Prevention and Prophylaxis

Pharmacokinetic Drug Interactions in Anaesthetic Practice

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