Ileus, postoperative

Physical/mechanical (e.g., tumor compressing intestinal lumen) Functional (e.g., postoperative ileus)... 

Tsukamoto, K., Mizutani, M., Yamano, M., Suzuki, T., The relationship between gastrointestinal transit and motility in dogs with postoperative ileus, Biol. Pharm. Bull. 1999, 22, 1366-1371. 

Kraft MD. (2007) Emerging pharmacologic options for treating postoperative ileus. Am J Health Syst Pharm 64 S13-S20. 

Uses Minimize paralytic ileus, Rx postop distention Action Cholinergic agent Dose Adults. Relief of gas 2-3 tabs PO tid Prevent postop ileus 250-500 mg IM stat, repeat in 2 h, then q6h PRN Ileus 500 mg IM stat, repeat in 2 h, then q6h, PRN Caution [C, ] Contra Hemophilia, mechanical bowel obst Disp Inj, tabs, cream SE GI cramps EMS May cause bowel obstruction, monitor pt for abd pain and inquire about recent bowel habits OD Sxs unknown symptomatic and supportive... 

L.A. Sorbera, J. Castaner, N.E. Mealy, Lubiprostone. Treatment of constipation, treatment of irritable bowel syndrome, treatment of postoperative ileus, CIC-2 channel activator, Drugs Fut. 29 (2004) 336-342. 

Delaney CP et al Alvimopan for postoperative ileus following bowel resection A pooled analysis of phase III studies. Ann Surg 2007 245 355. [PMID 17435541]... 

In 139 consecutive patients who underwent major gynecological surgery and in whom 32% dextran 70 had been used as an anti-adhesion adjuvant (the mean amount of dextran used was 183 ml), there was an acceptably low rate of complications (34). Adverse effects involved 11 patients and included postoperative ileus (2.9%), pleural effusion (2.2%), allergic reactions (1.4%), wound infection (1.4%), and labial sweUing (0.7%). There was no evidence of an increased infection rate. 

Indications Postoperative ileus Category Opioid antagonist Half-life 10-18 Hours... 

Viscusi ER, Gan TJ, Leslie JB, Foss JF, Talon MD, Du W, Owens G (2009) Peripherally acting p-opioid receptor antagonists and postoperative ileus mechanisms of action and clinical applicability. Anesth Analg 108 1811-1822... 

A 56-year-old man with hypertension suffered a 62% total body surface area burn (day 0) and on day 4 developed atrial fibrillation with a rapid ventricular rate, which was treated with amiodarone and digoxin. After pyloroplasty for a bleeding ulcer on day 20, he developed a postoperative ileus and was given metoclopramide 20 mg intravenously every 6 hours. Beginning on day 54, he started to have episodes of bradycardia and asystole. Some episodes required atropine and others resolved spontaneously. Some converted initially to a junctional rhythm, but all ultimately reverted to sinus tachycardia. Digoxin and metoclopramide were withdrawn and several hours later the bradydysrhythmias stopped. 

Bream-Rouwenhorst HR, Cantrell MA. Alvimopan for postoperative ileus. Am J Health-System Pharm 2009 66 1267-1277. 

Prolonged sympathetic activity, as occurs in a postoperative ileus, results in increased absorption of water, greater energy requirements, and disorganization of some of the normal processes. The stool may become hard and difficult to mobilize. Fissures may develop in the stool and proximal fluids may leak around, creating the impression of loose stools when the opposite is the truth. 

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