An obstruction not to forget: Pseudo-obstruction (Ogilvie syndrome): Single center experience

Purpose:

Colonic pseudo obstruction disease commonly seen in the elderly, immobile patient group can cause serious mortality and morbidity. Our objective in this retrospective study is to share our clinical experience by evaluating patients with Ogilvie syndrome who were followed and treated in our clinic.

Methods:

Eleven cases with the diagnosis of Ogilvie syndrome followed up and treated between September 2010 and April 2013 were evaluated retrospectively. All the patients that had no symptoms of acute abdominal pain were initiated conservative treatment. Colonoscopic decompression was attempted for patients whose clinical pictures were not recovered. Patients underwent operation if they developed peritoneal irritation symptoms during these procedures and of their number of white blood cells seriously increased during the follow-up period.

Results:

A total of 11 patients were treated for Ogilvie syndrome. 6 of the patients underwent surgical treatment, and 5 were treated medically. Mortality developed in two patients. The main cause of mortality was a delay in diagnosis and additional severe underlying diseases. Seven patients were given Neostigmine. Of these, 2 patients required surgery and 3 patients responded to Neostigmine.

Conclusion:

Ogilvie syndrome is a rare cause of ileus of the colon. It is more common particularly in old patients with additional problems. If the disease is suspected and diagnosed early, unnecessary surgical interventions can be prevented with medical treatment choices.     

Factors predicting atracurium reversal time

BACKGROUND: To identify individual factors and combination of factors predictive of reversal time (defined as time from neostigmine administration to train-of-four (TOF) ratio 0.70) from atracurium-induced neuromuscular block, the present study tested the following variables as possible predictors of reversal time: 1) degree of block at the time of antagonism as quantified by first response to TOF or double-burst stimulation (DBS); 2) time from last supplemental dose of atracurium to administration of neostigmine (pre-reversal time); and 3) time from administration of initial atracurium dose to T1 (the magnitude of the first twitch in TOF) recovered to 10% (duration of action of the initial dose of atracurium). METHODS: The study population comprised 83 female patients, ASA physical status 1 or 2, anaesthetized with fentanyl, thiopental, halothane and nitrous oxide. Initial and supplemental doses of atracurium were 0.5 mg x kg(-1) and 0.15 mg x kg(-1), respectively. Evoked responses to TOF or DBS were recorded mechanomyographically. Neuromuscular block was antagonized with neostigmine, 0.07 mg x kg(-1), at varying time intervals (6-50 min) after the final atracurium dose. RESULTS: Multiple linear regression analyses testing T1, D1 (the magnitude of the first twitch in DBS), pre-reversal time and duration of action of the initial dose of atracurium, demonstrated that with superficial block, T1 >15%, T1 is the only significant predictor for reversal time. With moderate block, 0< T1 < or =15%, both T1 and duration of action of the initial atracurium dose are significant predictors for reversal time. With profound block, T1=0, duration of action of the initial dose and pre-reversal time are significant predictors for reversal time. CONCLUSION: 1) T1 is a more important predictor for reversal time from atracurium-induced neuromuscular block than D1; 2) predictors differ with the degree of block: with T1 > 15%, T1 is the only significant predictor; with 0< T1 < or =15%, the duration of action of the initial dose and T1 are predictors for reversal time; with T1=0, the duration of action of the initial dose and pre-reversal time predict reversal time.     

中医康抚护理对腹腔镜术后腹胀及疼痛的影响

目的:观察中医康抚护理对腹腔镜术后患者腹胀及疼痛的影响。方法:将80例患者随机分为2组,每组40例,对照组实施常规护理,观察组在此基础上给予中医康抚护理,比较2组干预过程中VAS评分及肛门排气、排便时间和肠鸣音恢复时间、腹胀缓解时间。结果:VAS评分干预24小时后2组即开始降低,与干预前比较差异有统计学意义(P0.05);干预后相同时间2组比较,差异也有统计学意义(P0.05)。肠鸣音恢复时间、肛门排气时间、经肛门排便时间及腹胀缓解时间2组比较,差异有统计学意义(P0.05)。腹胀缓解率观察组为90.0%,对照组为67.5%,2组比较差异均有统计学意义(P0.05)。结论:中医康抚护理能有效的缓解腹腔镜术后患者腹胀不适,促进术后胃肠功能早期恢复,加速经肛门排气排便时间。     

甲硫酸新斯的明注射液在剖宫产术后胃肠功能恢复的应用研究

目的研究甲硫酸新斯的明注射液在剖宫产术后胃肠功能恢复的应用效果。方法选择2019年2月至2020年8月在保定市第一医院进行剖宫产的产妇360例,随机分为对照组、实验1组及实验2组,每组120例。对照组剖宫产术后进行常规处理,实验1组术后即刻肌肉注射1mg甲硫酸新斯的明,实验2组即刻肛塞1mg卡前列甲酯栓。对比三组产妇术后肠鸣音恢复时间、首次排气时间和排便时间,术后腹胀、乳汁分泌情况及肠梗阻发生情况。结果实验1组术后肠鸣音恢复时间、首次排气时间和排便时间少于对照组和实验2组(实验1组vs.对照组:t值分别为9.313、10.995、10.357;实验1组vs.实验2组:t值分别为4.925、6.207、3.599,均P<0.05),实验2组术后肠鸣音恢复时间、首次排气时间和排便时间少于对照组(t值分别为4.448、4.651、6.758,均P<0.05)。实验1组术后腹胀发生率低于对照组和实验2组(χ²值分别为31.493、12.227,均P<0.05),实验2组术后腹胀发生率低于对照组(χ²=16.345,P<0.05)。实验1组24h初泌乳率高于对照组和实验2组(χ²值分别为36.983、8.531,均P<0.05),实验2组24h初泌乳率高于对照组(χ²=11.309,P<0.05)。实验1组和实验2组无肠梗阻发生,对照组有2例肠梗阻发生,组间比较差异无统计学意义(P>0.05)。结论甲硫酸新斯的明注射液能够促进剖宫产术后胃肠功能恢复,缩短剖宫产术后肛门排气时间,降低腹胀发生率,并可促进早泌乳。     

Confirmatory in vivo Electrodiagnostic and Electromyographic Studies for Neuromuscular Junctional Blocking Action of Cleistanthus collinus Leaf Extract in Rat

Detailed electromyographic and electrodiagnostic studies were made on sciatic nerve–anterior tibialis muscle preparations in rat in vivo for the first time to confirm the neuromuscular junctional (NMJ) blocking action of Cleistanthus collinus leaf extract (CCLE) and the transient reversal of NMJ blockade by neostigmine. A sublethal dose of 175 mg dry leaf powder/kg body weight of rat caused NMJ blockade confirmed by a decremental response in nerve evoked compound muscle action potentials (NCMAPs). The study suggests the action of the toxic plant extract on acetylcholine (ACh) receptor sites. Muscle evoked compound muscle action potentials (MCMAPs) showed negligible decremental response suggesting the action at the NMJ level only and not on muscle excitation and contractility. The CCLE poisoning revealed a specific diagnostic EMG pattern which might be of help to clinicians in diagnosing Cleistanthus poisoning. The studies confirm that the leaf extract contains a proven and promising new NMJ blocker.     

Profound atracurium induced neuromuscular blockade

Speed of reversal of profound atracurium induced neuromuscular blockade following edrophonium (0.5 or 1.0 mg/kg) or neostigmine (0.04 or 0.08 mg/kg) was measured using the train-of-four pattern of nerve stimulation. In all patients adequate clinical reversal was present when the ratio of the strength of the fourth to the first twitch (T4 ratio) was 0.5. Both doses of edrophonium were associated with a significantly faster speed of reversal than the smaller dose of neostigmine (p less than 0.05 in both cases). However, the larger dose of neostigmine was associated with a reversal time approaching that of edrophonium. Possible explanations for these findings are discussed in terms of contemporary theories of neuromuscular pharmacology.     

Cholinesterase inhibitors lack therapeutic effect in amyotrophic lateral sclerosis. A controlled study of physostigmine versus neostigmine

Seven patients with amyotrophic lateral sclerosis participated in a double-blind cross-over trial of oral physostigmine and neostigmine (10 and 45 mg/day, respectively, for 3 days). Six of the patients were also given intravenous injections (1 and 1.5 mg, respectively) of the drugs in an open trial. No significant effects on muscle strength or neurophysiological parameters were observed.     

Comparison of the effects of neostigmine and edrophonium on the duration of action of suxamethonium

Rapid sequence induction of anaesthesia necessitating the use of suxamethonium may occasionally be needed soon after antagonism of neuromuscular block with anticholinesterase agents. The onset and duration of action of 1 mg kg^-1 of suxamethonium was recorded in groups of 10 patients each, 5 or 10 min after the administration of edrophonium 1 mg kg^-1 or neostigmine 40 μg kg^-1 given for the antagonism of atracurium-induced neuromuscular block. Plasma cholinesterase activity was measured before, and 5 and 10 min after the administration of the anticholinesterases. A further 10 patients received suxamethonium 1 mg kg^-1 without prior atracurium or anticholinesterase administration to serve as controls. The onset of action of suxamethonium was significantly prolonged when administered 5 min after both anticholinesterases, compared to the control group ( P <0.01). Recovery of suxamethonium block was delayed significantly after neostigmine, compared to both the edrophonium and the control groups ( P <0.05–0.001). Plasma cholinesterase activity was significantly reduced with the use of neostigmine but not with edrophonium ( P <0.001).