Neostigmine Administered With MoviPrep Improves Bowel Preparation for Elective Colonoscopy in Patients With Spinal Cord Injury

Korsten, Mark A.; Spungen, Ann M.; Radulovic, Miroslav; Rosman, Alan S.; Hunt, Kristel; Galea, Marinella; Kornfeld, Stephen; Lyons, Brian; Yen, Christina; Bauman, William A.

doi:10.1097/mcg.0000000000000284

Cited by 10 publications

(14 citation statements)

References 18 publications

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“…Recent research studies have been conducted on the beneficial aspects of PEG as a tissue-compatible reagent for the prevention of adhesion after laminectomy [ 24 ] and as a carrier of regeneration-prompting molecules in spinal cord injuries [ 25 ]. The oral administration of PEG in patients suffering from spinal injuries has also been noted in the setting of bowel preparation for colonoscopy [ 26 ] and the treatment of neurological bowel dysfunction after spinal cord injuries [ 27 ]. Our results support the administration of PEG for bowel evacuation to decrease the volume of intraoperative bleeding during spinal surgeries and to decrease the need for blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Mechanical Bowel Evacuation Reduces Intraoperative Bleeding and Operation Time in Spinal Surgery

et al. 2018

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Study DesignRandomized clinical trial.PurposeIn this study, we evaluated the effect of mechanical evacuation of the bowels prior to operation on intraoperative bleeding.Overview of LiteratureBleeding is the most significant complication in patients undergoing spinal surgery.MethodsWe randomly divided 108 individuals planned to undergo spinal surgery into two age-, sex-, and co-morbidity (especially preoperative hemoglobin [Hb])-matched groups of 54. The treatment group was administered polyethylene glycol (PEG) before the operation, whereas the control group was not. The exact amount (mL) of bleeding during operation, operative time, and approximate amount of blood transfused were recorded. The volume of bleeding and Hb level were also recorded 24 and 48 hours postoperatively.ResultsT-tests revealed that intraoperative bleeding, the volume of transfusion, and operative time were significantly lower in the treatment group than in the control group. Statistically significant correlations of intraoperative bleeding with age, body mass index (BMI), preoperative Hb levels, operative time, the volume of transfusion, hospitalization time, and 24- and 48-hour postoperative bleeding were observed (p =0.001, all). Repeated measures analysis of covariance after adjusting the covariate variables revealed that the volume of bleeding showed a near-significant trend in the treatment group compared with that in the control group (p =0.056). Diabetic females had the highest bleeding amount between the groups (p =0.03). Bleeding was higher in patients with higher BMI (p =0.02) and was related to operative time (p =0.001) in both the groups.ConclusionsPreoperative gastrointestinal tract evacuation by PEG administration can decrease intraoperative bleeding in spinal surgeries; however, more research is imperative regarding PEG administration in surgical procedures for this purpose.

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Section: Discussionmentioning

confidence: 99%

Preoperative Mechanical Bowel Evacuation Reduces Intraoperative Bleeding and Operation Time in Spinal Surgery

et al. 2018

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“…There are notable strengths with our study. Other centers have studied novel bowel preparation for patients with SCI, including sodium phosphosoda + PEG-ELS [18], pulsed irrigation-enhanced evacuation [20], and addition of neostigmine to a standard preparation [21]. Of these regimens, only the addition of neostigmine to a standard preparation demonstrated a comparable bowel preparatory rating and ADR.…”

Section: Discussionmentioning

confidence: 99%

“…Of these regimens, only the addition of neostigmine to a standard preparation demonstrated a comparable bowel preparatory rating and ADR. However our study had a larger number of subjects with SCI, produced a high rate of adequate preparation, with a higher proportion of procedures performed for screening and polyp surveillance [12,21]. Our protocol may also be more widely available to patients as the usage of neostigmine often requires more intensive monitoring and excludes patients with cardiac or obstructive pulmonary disease due to the risks of the medication.…”

Section: Discussionmentioning

confidence: 99%

Colorectal cancer screening in patients with spinal cord injury yields similar results to the general population with an effective bowel preparation: a retrospective chart audit

et al. 2017

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“…The efficacy of this dual drug combination in improving bowel preparations for elective colonoscopy has also been described by our group [ref. ( 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…To date, intravenous (IV), intramuscular, and subcutaneous administration of NEO/GLY has been reported by our group [ref. ( 3 – 5 )]. Parenteral administration routes for these drugs are impractical for long-term bowel care in the SCI population.…”

Section: Introductionmentioning

confidence: 99%

Delivery of neostigmine and glycopyrrolate by iontophoresis: a nonrandomized study in individuals with spinal cord injury

Korsten

Lyons²,

Radulovic

et al. 2017

Spinal Cord

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STUDY DESIGNPhase I Clinical TrialOBJECTIVESIn this proof-of-principle study, the effectiveness and safety of transdermal administration of neostigmine/glycopyrrolate to elicit a bowel movement was compared to intravenous administration in patients with spinal cord injury.SETTINGJames J. Peters Veterans Affairs Medical Center (Bronx, NY)METHODSIndividuals were screened for responsiveness (Physical Response) to intravenous neostigmine (0.03mg/kg)/glycopyrrolate (0.006mg/kg). Intravenous neostigmine/glycopyrrolate responders (Therapeutic Response) were administered low-dose transdermal neostigmine/glycopyrrolate [(0.05mg/kg)/(0.01mg/kg)] by iontophoresis. Non-responders to low-dose transdermal neostigmine/glycopyrrolate were administered high-dose transdermal neostigmine/glycopyrrolate [(0.07mg/kg)/(0.014mg/kg)] by iontophoresis. Bowel movement, bowel evacuation time, and cholinergic side effects were recorded. Visits were separated by 2 to 14 days.RESULTSEighteen of 25 individuals (72.0%) had a bowel movement (20±22min) after intravenous neostigmine/glycopyrrolate. Of these 18 individuals, 5 individuals experienced a bowel movement with low-dose transdermal neostigmine/glycopyrrolate. Another 5 individuals had a bowel movement after high-dose transdermal neostigmine/glycopyrrolate administration. Fewer side effects were observed in individuals who received neostigmine/glycopyrrolate transdermally compared to those who were administered intravenous neostigmine/glycopyrrolate.CONCLUSIONSTransdermal administration of neostigmine/glycopyrrolate by iontophoresis appears to be a practical, safe, and effective approach to induce bowel evacuation in individuals with spinal cord injury.

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Neostigmine Administered With MoviPrep Improves Bowel Preparation for Elective Colonoscopy in Patients With Spinal Cord Injury

Abstract: The combination of MoviPrep+NG was safe, well tolerated, and an effective approach to prepare the bowel for elective colonoscopy in patients with SCI. The side effects of this preparation were significant compared with the other treatment groups but were considered mild and anticipated.

Cited by 10 publications

References 18 publications

Preoperative Mechanical Bowel Evacuation Reduces Intraoperative Bleeding and Operation Time in Spinal Surgery

Preoperative Mechanical Bowel Evacuation Reduces Intraoperative Bleeding and Operation Time in Spinal Surgery

Colorectal cancer screening in patients with spinal cord injury yields similar results to the general population with an effective bowel preparation: a retrospective chart audit

Delivery of neostigmine and glycopyrrolate by iontophoresis: a nonrandomized study in individuals with spinal cord injury

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