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The Clinical Application of 5-HT Agonists and Antagonists in Gastrointestinal Disease
Published in T.S. Gaginella, J.J. Galligan, SEROTONIN and GASTROINTESTINAL FUNCTION, 2020
Timothy P. Roarty, Richard W. McCallum
Gastrointestinal postoperative paralytic ileus is a well-known sequelae to intraabdominal surgery and is associated with bowel distension, absence of bowel sounds, and delay of defecation. The pathophysiology of postoperative ileus remains unclear. In monkeys after an abdominal surgery procedure, Woods, et al.86 demonstrated that inhibition of myoelectrical activity was transient in the gastric antrum and shortly delayed in the small bowel — the predominant deficit was in the colon where contractile activity was depressed significantly for 24 hours (in the right colon) to 72 hours (in the sigmoid colon). A follow-up study by the same group found a similar pattern in humans.87 Wilson, et al., in a study of 39 patients, confirmed this association by demonstrating that in operations outside of the abdomen, there is a delay of about 16 hours before colonic activity returns, whereas after abdominal operations the delay is from 40 to 48 hours.88 Interestingly, the length of operation and amount of postoperative analgesia had no significant effect upon the duration of colonic ileus. Although motility is restored postoperatively in a sequential order from stomach to colon, contractile activity does not necessarily correlate with the return of propulsive activity. It does appear, however, that the colon is the rate-limiting factor to the return of normal gastrointestinal activity and the speed with which patients recover from surgery, which makes cisapride, with its unique colonic stimulatory effects, an intriguing option for the treatment of postoperative ileus.
Enteral nutrition
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Enteral nutrition is making in-roads into territory that was hitherto the preserve of TPN. Instrumental oesophageal perforations have been successfully managed by jejunal feeding, sometimes coupled to sump-tube drainage at the site of perforation. Patients with acute pancreatitis can be fed enterally, provided that feed is delivered beyond the duodenum [6]. Early jejunal feeding is also possible after gastrointestinal surgery. The so-called postoperative ‘ileus’ is a phenomenon largely restricted to the stomach and colon; normal peristaltic function in the small intestine returns quickly. The same is often true of post-traumatic ileus in the intensive care unit (ICU), where nasojejunal feeding is increasingly used as an alternative to TPN.
Motility disorders
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
The motility of the gastrointestinal tract is temporarily impaired after surgery. The effect that an abdominal operation has on gastrointestinal motility is referred to as ‘postoperative ileus’, denoting disruption of the normal co-ordinated movement of the gut, and failure of propulsion of intestinal contents. Postoperative ileus involves delay in gastric, small intestinal and large intestinal motility. The cause is multifactorial, and treatments remain far from ideal.
Bioavailability of oxycodone by mouth in coronary artery bypass surgery patients – a randomized trial
Published in Journal of Drug Assessment, 2020
Antti Valtola, James D. Morse, Pawel Florkiewicz, Heidi Hautajärvi, Pasi Lahtinen, Tadeusz Musialowicz, Brian J. Anderson, Veli-Pekka Ranta, Hannu Kokki
Postoperative ileus is common after major surgery. Many surgery- and anesthesia-related factors contribute to delay gastrointestinal transit, and in addition of anesthetics and perioperative opioids, surgical stress and associated inflammatory reaction may contribute.14 Off-pump CAB surgery (OPCAB) is assumed to be associated with less inflammatory reaction by avoiding the use of a conventional extracorporeal circulation (CECC), maintaining pulsatile blood flow and generally having lesser need for fluid resuscitation during the operation.15 In this study our hypothesis was that the surgical trauma to the body is less after OPCAB surgery than after CAB surgery with CECC, and as a result, the gastrointestinal function is less disturbed and the absorption of oxycodone by mouth from a controlled-release tablet formulation is restored earlier after OPCAB surgery compared to CAB surgery with CECC. To test this hypothesis, we conducted the present PK study where the primary outcome measure was the absorption of oxycodone co-administered with naloxone by mouth on the preoperative and first four postoperative days (PODs) in patients scheduled for CAB with CECC or OPCAB surgery.
Factors associated with failure of Enhanced Recovery After Surgery (ERAS) in colorectal and gastric surgery
Published in Scandinavian Journal of Gastroenterology, 2019
Yunpeng Zhang, Yufang Xin, Peng Sun, Daqing Cheng, Ming Xu, Ji Chen, Jue Wang, Jianling Jiang
Several randomized controlled trials (RCT) have demonstrated the benefits and safety of laparoscopic surgery (LAP) for stomach and colorectal neoplastic disease compared with open surgery [29–32]. It results in reduced postoperative pain, fewer postoperative complications, faster recovery and a shorter hospital stay. And few recent studies have shown that a history of abdominal surgery is associated with a significantly higher conversion rate and a greater risk of intraoperative and postoperative adverse events such as intraoperative small bowel injuries, postoperative ileus, and postoperative wound infection, as well as reoperation [33–38]. This might because abdominal operations inevitably result in intra-abdominal adhesions, which is associated with increased technical difficulty and operative time for patients who have undergone previous abdominal surgery [39].
Identifying Patients Eligible for a Short Hospital Stay After Stoma Closure
Published in Journal of Investigative Surgery, 2018
Charles Sabbagh, Cyril Cosse, Lionel Rebibo, Hanane Hariz, Abdennaceur Dhahri, Jean Marc Regimbeau
Complications were defined according to the Clavien classification [10]. Clavien I and II complications were considered to be minor, Clavien III to V complications were considered to be major, and Clavien V complications corresponded to postoperative death. Postoperative complications were defined as those occurring at any time during postoperative hospitalization and up to one month after surgery. Anastomotic leakage was screened for clinically (i.e. the presence of feces or gas leakage in the surgical scar) and on a CT scan (collection around the anastomosis). Postoperative ileus was defined as postoperative nausea or vomiting, the absence of gas transit for at least 24 h and poor tolerance of oral food intake for at least 24 h.