The Use of Intravenous Neostigmine in Palliation of Severe Ileus

Abstract

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.

Acetylcholinesterase Inhibitory Activity of Pigment Echinochrome A from Sea Urchin Scaphechinus mirabilis

“…The activity of AChE was determined by thiocholine formation of DTNB (5,5′-dithiobis-2-nitrobenzoic acid) from the hydrolysis of ACh [ 28 ]. Neostigomine, that is used as a parasympathomimetic drug but has severe side effects such as headache, brow pain, blurred vision [ 29 ] was used as a positive control. As shown in Figure 5 A, EchA showed anti-AChE activity in a dose-dependent manner.…”

Postoperative paresis of the gastrointestinal tract

“…Тем не менее результаты двойного слепого исследования, опубликованные в 1971 г., не подтвердили эффективности неостигмина в разрешении явлений паралитической кишечной непроходимости [59]. P. Kasi [68] на основании анализа единичных случаев пришел к выводу, что применение неостигмина -простая, безопасная и эффективная стратегия; однако указал на необходимость мониторинга побочных эффектов антихолинергических препаратов, таких как брадикардия, что может потребовать введения атропина.…”

“…Большая часть исследований, посвященных использованию неостигмина в лечении пареза ЖКТ, отличается малой выборкой пациентов с несопоставимыми контрольными группами, в них использованы различные дозы и пути введения неостигмина, они не имеют радиологического подтверждения разрешения [14,15]. Таким образом, необходимы крупные рандомизированные иссле-дования с большой выборкой пациентов для лучшего понимания и интерпретации полученных результатов [68].…”

A systematic review and meta-analysis of neostigmine for urinary retention after surgeries

“…Aeschlimann and Reinert first synthesized it in 1931. Neostigmine indirectly stimulates nicotinic and muscarinic receptors by interfering with the decomposition of acetylcholine (5). Studies have reported that neostigmine is a convenient, safe, and effective drug for treating patients with POUR.…”