Postoperative Ileus: Pathophysiology and Treatment

Tropskaya, N. S.; Попова, Т. С.

doi:10.5772/26796

Cited by 3 publications

(3 citation statements)

References 45 publications

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“…In POI, sympathetic (adrenergic) hyperactivity or parasympathetic (cholinergic) hypoactivity occurring at the same time leads to a decrease in gastrointestinal motility (1,27,28). Therefore, cholinergic, antidopaminergic (metoclopramide), motilin agonist (erythromycin), and local anesthetic drugs (lidocaine) can be used in ileus treatment (28). Erythromycin induces phase III of the interdigestive MMC, increases the amplitude of antral contractions, and improves antroduodenal coordination in several species.…”

Section: Discussionmentioning

confidence: 99%

The effects of three different prokinetic drugs on the motility hormones level in lambs with postoperative ileus

Altan¹,

Dönmez²,

Altan³

et al. 2018

Turk J Vet Anim Sci

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The aim of this study was to evaluate the effects of the three different prokinetic agents, namely erythromycin, lidocaine, and metoclopramide in lambs with postoperative ileus (POI) using motilin and ghrelin, which are known as motility markers. Twenty lambs were allocated to 4 groups of 5 lambs each. An enterotomy was performed on the ileum of each lamb. Erythromycin (8.8 mg/ kg), metoclopramide (0.2 mg/kg), and saline (2 mL) were administered as single dose IM before surgery in the ERT, MET, and CNTR groups, respectively. Lidocaine was administered to the LID group, both as a bolus before (1.3 mg/kg IV) and as a continuous rate infusion during surgery (0.05 mg/kg/h IV). Serum motilin and ghrelin concentrations as motility hormones were measured with ELISA. The serum motilin concentration was significantly higher at 0, 1, 3, 5, 10, 24, and 48 h in the ERT group and at 1 and 10 h in the LID group. The serum ghrelin concentration was significantly higher at 0, 1, and 48 h in the ERT group and at 3, 5, 10, 24, and 48 h in the LID group. As a result, erythromycin and lidocaine was thought to be useful in lambs with POI according to the stimulatory effects on the motility hormones.

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Section: Discussionmentioning

confidence: 99%

The effects of three different prokinetic drugs on the motility hormones level in lambs with postoperative ileus

Altan¹,

Dönmez²,

Altan³

et al. 2018

Turk J Vet Anim Sci

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“…Namun demikian, bising usus tidak dapat dipercaya sepenuhnya karena dapat merupakan hasil aktivitas usus halus dan bukan kolon. [6][7][8] Evaluasi terhadap faktor risiko tersebut menemukan bahwa kelompok usia geriatrik (berusia sama dengan atau lebih dari 65 tahun) dan waktu operasi lebih dari 3 jam merupakan faktor risiko terjadinya ileus paralitik patologis pasca operasi dengan nilai relative risk masingmasing adalah 5,96 dan 6,14. Analisis multivariat menunjukkan bahwa kedua variabel tersebut adalah variabel -variabel yang bermakna.…”

Section: Pembahasanunclassified

Faktor risiko kejadian ileus paralitik patologis pasca laparotomi dengan reseksi dan anastomosis pada traktus gastrointestinal

Prawira

Sueta

Golden

2022

Intisari Sains Medis

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Background: Postoperative paralytic ileus is a physiological response of the intestine to surgical stress. However, if this condition lasts more than 3 days, it is pathological. Some factors related to postoperative ileus have been identified, but the results are still confusing. This study aimed to identify risk factors of postoperative ileus following laparotomy for anastomosis and resection of the gastrointestinal tract at Prof. Dr. I.G.N.G. Ngoerah Hospital. Method: This was a retrospective cohort study between January 2019 until July 2020. The subjects were recruited consecutively, which included adult patients who had undergone laparotomic surgery with anastomosis and resection. Data was taken in Prof. Dr. I.G.N.G. Ngoerah Hospital until the needed samples were fulfilled. Data were analyzed using SPSS version 24 for Windows. Result: There were 50 subjects aged from 32 to 74 years old in this study. About 62% of subjects were female. Analysis showed a correlation between postoperative ileus occurrence and Age; it also correlates with the operation duration. Multivariate analysis found that patients aged 65 years and older have a 5.96 greater risk of developing postoperative ileus than younger patients (95% CI 1.55-22.99; p=0.010). This study also found that an operation lasting 180 minutes or more had a 6.14 greater risk of postoperative ileus than a shorter surgery duration (95% CI 1.57-24.05; p=0.009). Conclusion: Age over 65 years old and duration of operation more than 3 hours were associated with postoperative paralytic ileus in adult patients who had undergone laparotomy for anastomosis and resection of the gastrointestinal tract. Latar Belakang: Ileus paralitik pasca operasi merupakan sebuah respon fisiologis usus terhadap stress pembedahan. Namun ketika ileus yang terjadi berlangsung lebih dari 3 hari maka kondisi ini masuk dalam kondisi patologis. Beberapa faktor sudah diidentifikasi untuk memprediksi kejadian ileus post operasi namun hasilnya masih ambigu. Penelitian ini bertujuan mengetahui faktor risiko ileus paralitik patologis pasca operasi pada populasi pasien laparatomi reseksi dengan anastomosis di RSUP Prof. Dr. I.G.N.G. Ngoerah. Metode: Penelitian ini menggunakan pendekatan kohort retrospektif yang berlangsung sejak Januari 2019 hingga Juli 2020. Pengambilan data dilakukan dengan metode konsekutif sampling pada pasien dewasa. Pengambilan data dilakukan di RSUP Prof. Dr. I.G.N.G. Ngoerah sampai jumlah sampel terpenuhi. Data dianalisis dengan SPSS versi 24 untuk Windows. Hasil: Sebanyak 50 subjek diikutsertakan dalam penelitian ini dengan rentang usia 32 hingga 74 tahun. Sebanyak 62% adalah perempuan. Pada analisis ditemukan adanya hubungan usia dan durasi operasi dengan kejadian ileus post operasi. Pada analisis multivariat ditemukan bahwa usia di atas 65 tahun memiliki risiko mengalami ileus post operasi 5,96 kali lebih besar dibanding usia yang lebih muda (95% IK=1,55-22,99; p=0,010). Selain itu juga ditemukan operasi yang berlangsung selama 180 menit atau lebih memiliki risiko 6.14 kali lebih besar mengalami ileus post operasi dibanding durasi operasi yang lebih singkat (95% IK=1,57–24,05; p=0,009). Simpulan: Usia pasien di atas 65 tahun dan durasi operasi lebih dari 3 jam berhubungan dengan kejadian ileus paralitik patologis paska operasi pada pasien yang menjalani operasi laparotomi dengan reseksi dan anastomosis.

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“…It is thought that various mechanisms such as sympathetic neural reflexes, local or systemic inflammatory mediators [cytokines, reactive oxygen species (ROS), acute phase proteins (APP)] and changes in the neural and hormonal transmitter levels play a role occurrence of POI and that recovery occurs by the inhibition of these mediators. It has become clear that inflammatory mediators released by leucocytes within the gut wall also directly impair smooth muscle contractility [3,17,26].…”

Section: Introductionmentioning

confidence: 99%

Determination of the Efficiencies of the Prokinetics in Ruminants with Postoperative Ileus Using Pro-Inflammatory Markers

Altan

Dönmez

Altan

et al. 2018

Acta Scientiae. Vet.

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Background: Recently, the role of inflammation triggered by handling of the intestine various gastrointestinal (GI) surgeries is generally accepted as the key event in postoperative ileus (POI). Because, prokinetics have been increased the smooth muscle contractions and may act by attenuating the inflammatory process in the GI tract, they have been used the treatment of POI in human and animals. There are many in vivo analysis techniques of GI motility. However, there have not yet been studied associated with the evaluation of the inflammatory response. Therefore, it was aimed to evaluate the efficiencies of 3 different prokinetics from inflammatory response during experimentally-induced POI.Materials, Methods & Results: Twenty healthy lambs (30-45 days old) were randomly assigned to four groups. In all groups, enterotomy was performed on the ileum. Erythromycin and metoclopramide were administered to the ERT and MET groups before the surgery, respectively, while lidocaine was administered to the LID group as bolus before and continuous rate infusion during the surgery. Physiological saline was administered to the lambs in control group as placebo before the surgery. Blood samples were collected before surgery (~30-45 min), at the end of surgery (0 h), and at the postoperative 1, 3, 5, 10, 48, 72 and 96 h. The concentrations of serum amyloid A (SAA), haptoglobin (HPT), fibrinogen (FIB) as acute phase proteins (APPs), thiobarbituric acide reactant substrate (TBARs), myeloperoxidase (MPO) as reactive oxygen species, and transforming growth factor-beta (TGF- β) as a cytokine were measured with ELISA reader. In terms of time points, it was found that FIB was statistically higher in ERT group at the 1st h, in MET and LID groups at the 10th h, and in LID group at the 48th and in MET group at the 72 h (P < 0.05). It was found that SAA was higher in MET group at the 1st, 3rd, 5th, 10th, 24th, 48th and 72nd h. HPT was higher in CNTR group until 72th h and MET group at 48th, 72nd and 96th h. TBARs concentrations were statistically higher in MET and LID groups at 0 hour, in ERT and MET groups at the 1st h, in MET group at the 3rd h, in MET and LID groups at the 5th and 10th h, in MET group at the 48th, 72nd and 96th h (P < 0.05). MPO concentrations was higher in LID group at the 3rd, 5th, 10th and 96th h, and in ERT group at the 72nd h (P < 0.05). TGF-β concentrations were particularly high in MET group at the 3rd, 5th, 48th and 72nd h, and in LID group at the 10th, 24th, and 96th h (P < 0.05).Discussion: APPs (HPT, SAA, FIB), which are important regulators of inflammation in cows and sheep, were higher generally in MET and LID groups and inflammation persists in these two groups and, therefore, metoclopramide and lidocaine are less effective in early postoperative POI treatment. Because, significant increase in serum TBARs and MPO concentrations was considered as an important indicator of oxidative stress and inflammatory response MPO concentrations was particularly high until 10th h in LID group, and TBARs concentrations was high both MET and LID groups throughout the study, this was correlated with higher neutrophil infiltration in the postoperative early period than the other groups. It is known that TGF-β, an inflammatory cytokine, is correlated with various smooth muscle disorders in humans. In this study, TGF-β concentration were higher in the MET and LID groups. High concentration of this cytokine might have led to decrease contractions in smooth muscles, thereby slowing down the intestinal transition. In conclusion, based on the presence of pro-inflammatory markers in this study, erythromycin seems to be the most suitable prokinetic drug in lambs. Moreover, lidocaine and metoclopramide are not as successful in small ruminants as reported in other species.

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Postoperative Ileus: Pathophysiology and Treatment

Cited by 3 publications

References 45 publications

The effects of three different prokinetic drugs on the motility hormones level in lambs with postoperative ileus

The effects of three different prokinetic drugs on the motility hormones level in lambs with postoperative ileus

Faktor risiko kejadian ileus paralitik patologis pasca laparotomi dengan reseksi dan anastomosis pada traktus gastrointestinal

Determination of the Efficiencies of the Prokinetics in Ruminants with Postoperative Ileus Using Pro-Inflammatory Markers

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