Ileus secondary prevention: Difference between revisions
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==Overview== | ==Overview== | ||
Effective measures for the secondary prevention of ileus include use of local spinal anesthesia via epidural approach and IV ketorolac as a baseline analgesic for postoperative pain seen in patients of ileus. Ileus associated nausea and vomiting should be treated with serotonin receptor antagonist. Other measures include | Effective measures for the [[secondary prevention]] of ileus include use of local [[spinal anesthesia]] via [[epidural]] approach and IV [[ketorolac]] as a baseline [[analgesic]] for postoperative pain seen in patients of ileus. Ileus associated [[nausea and vomiting]] should be treated with [[serotonin receptor]] antagonist. Other measures include early mobilization and ambulation, removal of [[urinary catheter]] within 24 to 48 hours of surgery with avoidance of [[Nasogastric tube|nasogastric tubes]] and [[abdominal]] drains. | ||
==Secondary Prevention== | ==Secondary Prevention== | ||
Effective measures for the secondary prevention of ileus include:<ref name="Lassen2009">{{cite journal|last1=Lassen|first1=Kristoffer|title=Consensus Review of Optimal Perioperative Care in Colorectal Surgery|journal=Archives of Surgery|volume=144|issue=10|year=2009|pages=961|issn=0004-0010|doi=10.1001/archsurg.2009.170}}</ref><ref name="Kehlet2008">{{cite journal|last1=Kehlet|first1=Henrik|title=Postoperative ileus—an update on preventive techniques|journal=Nature Clinical Practice Gastroenterology & Hepatology|volume=5|issue=10|year=2008|pages=552–558|issn=1743-4378|doi=10.1038/ncpgasthep1230}}</ref><ref name="Bundgaard-NielsenHolte2007">{{cite journal|last1=Bundgaard-Nielsen|first1=M.|last2=Holte|first2=K.|last3=Secher|first3=N. H.|last4=Kehlet|first4=H.|title=Monitoring of peri-operative fluid administration by individualized goal-directed therapy|journal=Acta Anaesthesiologica Scandinavica|volume=51|issue=3|year=2007|pages=331–340|issn=0001-5172|doi=10.1111/j.1399-6576.2006.01221.x}}</ref><ref name="PatelPanchagnula2012">{{cite journal|last1=Patel|first1=Santosh|last2=Panchagnula|first2=Umakanth|last3=Lutz|first3=JanM|last4=Bansal|first4=Sujesh|title=Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1)|journal=Journal of Anaesthesiology Clinical Pharmacology|volume=28|issue=2|year=2012|pages=162|issn=0970-9185|doi=10.4103/0970-9185.94831}}</ref><ref name="AdaminaKehlet2011">{{cite journal|last1=Adamina|first1=Michel|last2=Kehlet|first2=Henrik|last3=Tomlinson|first3=George A.|last4=Senagore|first4=Anthony J.|last5=Delaney|first5=Conor P.|title=Enhanced recovery pathways optimize health outcomes and resource utilization: A meta-analysis of randomized controlled trials in colorectal surgery|journal=Surgery|volume=149|issue=6|year=2011|pages=830–840|issn=00396060|doi=10.1016/j.surg.2010.11.003}}</ref> | Effective measures for the [[secondary prevention]] of ileus include:<ref name="Lassen2009">{{cite journal|last1=Lassen|first1=Kristoffer|title=Consensus Review of Optimal Perioperative Care in Colorectal Surgery|journal=Archives of Surgery|volume=144|issue=10|year=2009|pages=961|issn=0004-0010|doi=10.1001/archsurg.2009.170}}</ref><ref name="Kehlet2008">{{cite journal|last1=Kehlet|first1=Henrik|title=Postoperative ileus—an update on preventive techniques|journal=Nature Clinical Practice Gastroenterology & Hepatology|volume=5|issue=10|year=2008|pages=552–558|issn=1743-4378|doi=10.1038/ncpgasthep1230}}</ref><ref name="Bundgaard-NielsenHolte2007">{{cite journal|last1=Bundgaard-Nielsen|first1=M.|last2=Holte|first2=K.|last3=Secher|first3=N. H.|last4=Kehlet|first4=H.|title=Monitoring of peri-operative fluid administration by individualized goal-directed therapy|journal=Acta Anaesthesiologica Scandinavica|volume=51|issue=3|year=2007|pages=331–340|issn=0001-5172|doi=10.1111/j.1399-6576.2006.01221.x}}</ref><ref name="PatelPanchagnula2012">{{cite journal|last1=Patel|first1=Santosh|last2=Panchagnula|first2=Umakanth|last3=Lutz|first3=JanM|last4=Bansal|first4=Sujesh|title=Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1)|journal=Journal of Anaesthesiology Clinical Pharmacology|volume=28|issue=2|year=2012|pages=162|issn=0970-9185|doi=10.4103/0970-9185.94831}}</ref><ref name="AdaminaKehlet2011">{{cite journal|last1=Adamina|first1=Michel|last2=Kehlet|first2=Henrik|last3=Tomlinson|first3=George A.|last4=Senagore|first4=Anthony J.|last5=Delaney|first5=Conor P.|title=Enhanced recovery pathways optimize health outcomes and resource utilization: A meta-analysis of randomized controlled trials in colorectal surgery|journal=Surgery|volume=149|issue=6|year=2011|pages=830–840|issn=00396060|doi=10.1016/j.surg.2010.11.003}}</ref> | ||
*The choice of analgesia and anesthesia for post surgical pain may reduce the morbidity and mortality associated with postoperative ileus. | *The choice of [[analgesia]] and [[anesthesia]] for post surgical pain may reduce the [[Morbidity & Mortality|morbidity and mortality]] associated with postoperative ileus. | ||
**In patients with severe pain, local spinal anesthesia via epidural approach has been observed with increased colonic blood flow and early return of GI function. | **In patients with severe pain, local [[spinal anesthesia]] via [[epidural]] approach has been observed with increased colonic blood flow and early return of [[Gastrointestinal tract|GI]] function. | ||
**Use of NSAIDs (such as IV ketorolac) as a baseline analgesic with avoidance of opioid anesthesia and analgesia has also been proved to be beneficial for patients with postoperative ileus. | **Use of [[Non-steroidal anti-inflammatory drug|NSAIDs]] (such as IV [[ketorolac]]) as a baseline [[analgesic]] with avoidance of [[opioid]] [[anesthesia]] and [[Analgesic|analgesia]] has also been proved to be beneficial for patients with postoperative ileus. | ||
*Postoperative nausea and vomiting is a common complication of abdominal surgeries and may be prevented with the use of medications such as serotonin receptor antagonist and dexamethasone at induction. | *Postoperative [[nausea and vomiting]] is a common complication of [[abdominal]] surgeries and may be prevented with the use of [[medications]] such as [[serotonin receptor]] antagonist and [[dexamethasone]] at induction. | ||
*Early mobilization and ambulation with removal of urinary within 24 to 48 hours of surgery with avoidance of nasogastric tubes and abdominal drains. | *Early mobilization and ambulation with removal of [[urinary catheter]] within 24 to 48 hours of surgery with avoidance of [[Nasogastric tube|nasogastric tubes]] and [[abdominal]] drains. | ||
*Recent studies have shown that patients of postoperative ileus who chew gum have an increased activation of neuro-hormonal mechanisms leading to increased fluid secretion and early return of GI motility. | *Recent studies have shown that patients of postoperative ileus who chew gum have an increased activation of neuro-hormonal mechanisms leading to increased [[fluid]] secretion and early return of [[GI]] [[motility]]. | ||
*Use of osmotic and stimulant laxatives (such as bisacodyl suppository) may also lead to early reversal of postoperative ileus. | *Use of [[Osmotic diuresis|osmotic]] and [[stimulant laxatives]] (such as [[bisacodyl]] suppository) may also lead to early reversal of postoperative ileus. | ||
*Patients who require a second surgery should be approached via minimal invasive techniques. Surgical procedures done via | *Patients who require a second surgery should be approached via minimal invasive techniques. Surgical procedures done via [[laparoscopy]] are associated with early return of [[GI]] function whereas, [[laparotomy]] is associated with increased severity and [[incidence]] of paralytic ileus. | ||
==References== | ==References== | ||
Revision as of 17:07, 5 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
Effective measures for the secondary prevention of ileus include use of local spinal anesthesia via epidural approach and IV ketorolac as a baseline analgesic for postoperative pain seen in patients of ileus. Ileus associated nausea and vomiting should be treated with serotonin receptor antagonist. Other measures include early mobilization and ambulation, removal of urinary catheter within 24 to 48 hours of surgery with avoidance of nasogastric tubes and abdominal drains.
Secondary Prevention
Effective measures for the secondary prevention of ileus include:[1][2][3][4][5]
- The choice of analgesia and anesthesia for post surgical pain may reduce the morbidity and mortality associated with postoperative ileus.
- In patients with severe pain, local spinal anesthesia via epidural approach has been observed with increased colonic blood flow and early return of GI function.
- Use of NSAIDs (such as IV ketorolac) as a baseline analgesic with avoidance of opioid anesthesia and analgesia has also been proved to be beneficial for patients with postoperative ileus.
- Postoperative nausea and vomiting is a common complication of abdominal surgeries and may be prevented with the use of medications such as serotonin receptor antagonist and dexamethasone at induction.
- Early mobilization and ambulation with removal of urinary catheter within 24 to 48 hours of surgery with avoidance of nasogastric tubes and abdominal drains.
- Recent studies have shown that patients of postoperative ileus who chew gum have an increased activation of neuro-hormonal mechanisms leading to increased fluid secretion and early return of GI motility.
- Use of osmotic and stimulant laxatives (such as bisacodyl suppository) may also lead to early reversal of postoperative ileus.
- Patients who require a second surgery should be approached via minimal invasive techniques. Surgical procedures done via laparoscopy are associated with early return of GI function whereas, laparotomy is associated with increased severity and incidence of paralytic ileus.
References
- ↑ Lassen, Kristoffer (2009). "Consensus Review of Optimal Perioperative Care in Colorectal Surgery". Archives of Surgery. 144 (10): 961. doi:10.1001/archsurg.2009.170. ISSN 0004-0010.
- ↑ Kehlet, Henrik (2008). "Postoperative ileus—an update on preventive techniques". Nature Clinical Practice Gastroenterology & Hepatology. 5 (10): 552–558. doi:10.1038/ncpgasthep1230. ISSN 1743-4378.
- ↑ Bundgaard-Nielsen, M.; Holte, K.; Secher, N. H.; Kehlet, H. (2007). "Monitoring of peri-operative fluid administration by individualized goal-directed therapy". Acta Anaesthesiologica Scandinavica. 51 (3): 331–340. doi:10.1111/j.1399-6576.2006.01221.x. ISSN 0001-5172.
- ↑ Patel, Santosh; Panchagnula, Umakanth; Lutz, JanM; Bansal, Sujesh (2012). "Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1)". Journal of Anaesthesiology Clinical Pharmacology. 28 (2): 162. doi:10.4103/0970-9185.94831. ISSN 0970-9185.
- ↑ Adamina, Michel; Kehlet, Henrik; Tomlinson, George A.; Senagore, Anthony J.; Delaney, Conor P. (2011). "Enhanced recovery pathways optimize health outcomes and resource utilization: A meta-analysis of randomized controlled trials in colorectal surgery". Surgery. 149 (6): 830–840. doi:10.1016/j.surg.2010.11.003. ISSN 0039-6060.