A Prospective Randomized Double-Blind Study to Determine the Effect of Thoracic Epidural Neostigmine on Postoperative Ileus After Abdominal Aortic Surgery

Caliskan, Esra; Türköz, Ayda; Şener, Mesut; Bozdogan, Nesrin; Gülcan, Öner; Türköz, Rıza

doi:10.1213/ane.0b013e318163fbfe

Cited by 28 publications

(42 citation statements)

References 22 publications

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“…It induces smooth muscle contraction that causes an increase in cholinergic activity in the gut wall, which is thus believed to stimulate colonic motility. It was practically used in patients with postoperative ileus, intoxication with drugs which have ileus effect, and colonic pseudo-obstruction (18-19). Application of neostigmine in upper part of gastrointestinal segment like stomach is under investigation.…”

Section: Discussionmentioning

confidence: 99%

A Double-Blind Randomized Clinical Trial Comparing the Effect of Neostigmine and Metoclopramide on Gastric Residual Volume of Mechanically Ventilated ICU Patients

Baradari¹,

Alipour²,

Firouzian³

et al. 2016

Acta Inform Med

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Background:In critically ill patients, enteral feeding through the nasogastric tube is the method of choice for nutritional support. Gastrointestinal feeding intolerance and disturbed gastric emptying are common challenges in these patients. The aim of this study was to compare the effect of Neostigmine and Metoclopramide on gastric residual volume (GRV) in mechanically ventilated ICU patients.Methods:In a double blind, randomized clinical trial, a total of 60 mechanically ventilated ICU patients with GRV >120 mL (3 hours after the last gavage), were randomly assigned into two groups A and B. At baseline and 6 hours later, patients in group A and B received intravenous infusion of neostigmine in a dose of 2.5 mg and metoclopramide in a dose of 10 mg in 100 ml of normal saline, within 30 minutes. Patients’ gastric residual volumes were evaluated before the beginning of the intervention, and 3, 6, 9 and 12 hours after the intervention.Results:After adjusting of other variables (Sex, BMI and ICU stay period) generalized estimating equation (GEE) model revealed that neostigmine treatment increased odds of GRV improvement compare to metoclopramide group (Estimate 1.291, OR= 0.3.64, 95% CI 1.07-12.34). However there is a statistically significant time trend (within-subject differences or time effect) regardless of treatment groups (P<0.001). The median time from intervention to GRV improvement was 6 hours (95% CI 3.75-8.25) and 9 hours (95% CI 7.38-10.17) in neostigmine and metoclopramide groups, respectively. This difference was statistically significant (P<0.05).Conclusion:It seems that neostigmine is more effective than metoclopramide in reducing GRV and improving gastric emptying in mechanically ventilated ICU patients without significant complication and this protocol may be effective on the tolerance of enteral feeding in ICU patients. Further well-designed randomized clinical trials are needed.

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Section: Discussionmentioning

confidence: 99%

A Double-Blind Randomized Clinical Trial Comparing the Effect of Neostigmine and Metoclopramide on Gastric Residual Volume of Mechanically Ventilated ICU Patients

Baradari¹,

Alipour²,

Firouzian³

et al. 2016

Acta Inform Med

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“…Clinically it is used in patients with acute colonic pseudo-obstruction (ACPO or Ogilvie's syndrome, which is a gastrointestinal motility disorder characterized by marked dilatation of the colon in the absence of mechanical obstruction), postoperative ileus, urinary retention, myasthenia gravis, and in anesthesia to reverse the effects of nondepolarizing muscle muscle relaxants [2–5]. Colonic pseudo-obstruction in particular is postulated to occur as an outcome of autonomic imbalance and is usually seen in elderly patients with numerous comorbidities, with an associated high morbidity and mortality [6, 7].…”

Section: Discussionmentioning

confidence: 99%

The Use of Intravenous Neostigmine in Palliation of Severe Ileus

Kasi

2013

Case Reports in Gastrointestinal Medicine

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Neostigmine is a parasympathomimetic drug that acts as a reversible acetylcholinesterase inhibitor. Clinically it is used in patients with acute colonic pseudo-obstruction (ACPO or Ogilvie's syndrome, which is a gastrointestinal motility disorder characterized by marked dilatation of the colon in the absence of mechanical obstruction), postoperative ileus, urinary retention, myasthenia gravis, and in anesthesia to reverse the effects of nondepolarizing muscle relaxants. Both bolus and infusion are noted to be effective and lead to prompt evacuation of flatus or stool with a reduction in abdominal distention on physical examination. Median duration is noted to be 4–30 minutes in some trials. Here we present our experience of using 2 mg of intravenous neostigmine to help relieve the severe abdominal distention and ileus in a patient with severe fecal impaction when all conservative measures had been futile. The most frequent side effect of the drug is abdominal pain/cramping, which was noted in our patient as well. Other complications include bradycardia which is very infrequently symptomatic to require atropine. Overall, the drug is a simple, safe, and effective strategy; and as pointed out in the previous studies, the drug appears to be underused in patients who do not have a true contraindication to its use.

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“…Prokinetic like metclopramide are not effective. Neostigmine increases bowel peristalsis, but may increase the incidence of postoperative nausea and vomiting [308,309].…”

Section: Prevention Of Postoperative Ileusmentioning

confidence: 99%

Anesthetic and Adjunctive Drugs for Fast-Track Surgery

Baldini¹,

Carli²

2009

CDT

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With the changes in health care dictated by economic pressure, there has been a realization that hospital stay could be shortened without compromising quality of care. Advances in surgical technology and anesthetic drugs have made an impact in the way perioperative care is delivered with some emphasis on multidisciplinary approach. From the expansion of ambulatory care, lessons were learnt how to apply same concepts to major surgery with the understanding that interventions to attenuate the surgical stress would facilitate the return to "baseline". Beside minimal invasive approach to surgery, anesthesia interventions are arranged with the intent to decrease the negative effects of surgical stress and pain, to minimize the side effects of drugs and at the same time to facilitate the recuperation which follows after surgery. Fast-track or accelerated care encompasses many aspects of anesthesia care, not only preoperative preparation and prehabilitation, but intraoperative attenuation of surgical stress and postoperative rehabilitation. The anesthesiologist is part of this team with the specific mission to use medications and techniques which have the least side effects on organ functions, provide analgesia which in turn facilitates the intake of food and mobilization out of bed. This chapter has been conceived with the intention to direct the clinician towards procedure-specific protocols where the choice of medications and techniques is based on published evidence. The success of implementing fast-track depends more on dynamic harmony amongst the various participants (surgeons, anesthesiologists, nurses, nutrtionists, physiotherapists) than on reaching an optimum level of excellence at each separate organization level.

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A Prospective Randomized Double-Blind Study to Determine the Effect of Thoracic Epidural Neostigmine on Postoperative Ileus After Abdominal Aortic Surgery

Abstract: Thoracic epidural neostigmine enables faster restoration of bowel sounds and shortens duration of postoperative ileus after abdominal aortic surgery.

Cited by 28 publications

References 22 publications

A Double-Blind Randomized Clinical Trial Comparing the Effect of Neostigmine and Metoclopramide on Gastric Residual Volume of Mechanically Ventilated ICU Patients

A Double-Blind Randomized Clinical Trial Comparing the Effect of Neostigmine and Metoclopramide on Gastric Residual Volume of Mechanically Ventilated ICU Patients

The Use of Intravenous Neostigmine in Palliation of Severe Ileus

Anesthetic and Adjunctive Drugs for Fast-Track Surgery

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