You are on page 1of 11

PHARMACOLOGYCAL ASPECT OF PARALYTIC ILEUS

dr H M Bakhriansyah, M.Kes., M.Med.Ed Department of pharmacology

Treatments

Medical care
Intravenous

hydration NGT (if necessary) for relief the symptoms not proven scientifically

Integrated med Digestive

Correcting

the sepsis and electrolyte abnormality: hypoK, hypoNa, hypoMg Diminishing of narcotic usage Discontinue the drug such as opiate

Integrated med Digestive

Diet
Delaying

oral feeding until ileus resolves clinically Chewing gum increasing early recovery scientifically proven (3:6)

Integrated med Digestive

Activity

The ambulation stimulates bowel function (conventional) scientifically non proven (day 1 and day 4) Effective to prevent atelectasis, deep vein thrombosis, and pneumonia

Integrated med Digestive

Thoracic epidural administration bupivacain alone or and in combination with opioids

Integrated med Digestive

Suppositories and enemas no clinical benefit Erytromycin (a motilin receptor agonist) no clinical benefit

Rectal cisaprite (a serotonin agonist) moderate beneficial banned by FDA cardiac dysarithmia Metoclopramide (a dopaminergic agonist) worsen the ileus

Integrated med Digestive

Premedication drug in preventing paralytic ileus

Methylnaltrexone and ADL 8-2698 (alvimopan)


Inhibiting

peripheral mu-opioid receptors Abolishing the adverse gastrointestinal effects of opioids without impairing the analgesic effects of such drugs.

Integrated med Digestive

Indicated

to prevent postoperative ileus following bowel resection. A study;


2 days earlier in first bowel movement 1.3 days earlier resumed a solid diet 1.4 days earlier returned home

Integrated med Digestive

Alvimopan
Dose:

12 mg po 0.5-5 hrs (single dose) pre operative and 12 mg/day after surgery (7 days) Pediatric dose: not established Contraindication : hypersensitivity Pregnancy : fetal risk in some study in animals

Integrated med Digestive

Reference: Mukherje, S and Otah, E. 2008. Ileus. Downloaded at emedicine.com September 2008

Integrated med Digestive

You might also like