Wednesday, February 24, 2016

Treatment of Constipation in Post-operative Ileus

  • Use of prokinetic agents has shown mixed results
Metoclopramide hydrochloride
  • is a prokinetic agent that acts as a cholinergic agonist and a dopamine antagonist
  • No studies had a significant benefit in the treatment of postoperative ileus
  • Some data have shown that the drug may actually worsen ileus
Erythromycin
  • motilin receptor agonist that binds to gastrointestinal smooth-muscle membrane receptors
  • did not resolve postoperative ileus in patients who underwent abdominal surgery
Octreotide
  • analogue of somatostatin that is known to inhibit the secretion of many gastrointestinal hormones
  • octreotide therapy shortens the duration of ileus in the small intestine and colon of dogs. However, clinical studies are needed to prove its efficacy in humans
Laxatives
  • potential therapeutic option for treating POI, but no randomized, controlled trials have assessed their utility
  • found a reduction in time to flatus and first bowel movement, as well as decreased length of hospitalization
  • Laxatives have been used with other therapies after abdominal surgery in multimodal rehabilitation studies, with promising results
Glycerin Enema
  • Osmotic dehydrating agent which increases osmotic pressure; draws fluid into colon and thus stimulates evacuation
  • Cleansing enema is contraindicated in patients with fecal stones, rectal obstruction by tumor or rectal prolapse, active coronary heart disease, and in comatose or noncompliant patients
Fleet
  • use of Fleet Enema (phospho-soda) is forbidden due to the danger of hyperphosphatemia and phosphate nephropathy.
Gum chewing
  • patients chewed gum 3 times a day starting postoperative day 1 until oral intake
  • related to the effects of sham feeding.

References:
  1. http://archsurg.jamanetwork.com/article.aspx?articleid=394327
  2. http://emedicine.medscape.com/article/2242141-medication
  3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3641812/
  4. http://reference.medscape.com/drug/glycerin-342014#5

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.