A Retrospective Study on Use of Neostigmine for Management of Non Mechanical Bowel Obstruction

Abstract

Introduction In this study we study the role of neostigmine in nonmechanical bowel obstruction either it may be due to post operative ileus or may be due to some severe illness like pancreatitis and liver abcess. In post operative ileus normal bowel function can be affected by three main mechanism: neurogenic, inflammatory mediators and gastrointestinal hormones. In GI system parasympathetic system increase gut motility while sympathetic system inhibit gut motility.. After major surgeries sympathetic nervous system tends to be more active than parasympathetic one which causes ileus. Method All patients  receive 2.5 mg of neostigmine IV (diluted in 10 ml normal salie) over a period of five minutes. All patients were monitored by electrocardiography; atropine and glycopyrolate was kept ready on bedside and 1.0 mg was given intravenously in case of symptomatic bradycardia. Results In our study we retrospectively analyzed 45 patients. Out which 28 were male and 17 patients were female. Male to female ratio was 1.65: 1. The patient ranged from 18 years to 70 years. 27 patients showed improvement in clinical symptoms(passed flatus and faeces) after 3 to 5 minutes, 12 patients showed improvement in 5 to 10 minutes and 4 patients showed improvement in more than 10 minutes. 2 patients was not improved till one hour after injecting neostigmine. Symptomatic bradycardia was seen in 3 (∼7%) patient. In two patient pulse rate was decreased upto 36. Abdominal pain was the most commen side effect noticed in 23 (∼51%) of patients, excessive salivation(∼30%) and vomiting(∼20%) were second and third most commen side effect respectively. Conclusion On the basis of our findings we can suggest that it is feasible to use neostigmine in non mechanical bowel obstruction.