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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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PERIOPERATIVE MEDICINE  SMART 2002 Milan, May 29-31, 2002

Minerva Anestesiologica 2002 April;68(4):152-6

language: English

Prevention of postoperative ileus

Holte K., Kehlet H.

From the Department of Surgical Gastroenterology Hvidovre University Hospital, Denmark


Post­op­er­a­tive ile­us (PI) is a ­major con­trib­u­tor to post­op­er­a­tive mor­bid­ity and pro­longed con­va­les­cence ­after ­major sur­gi­cal pro­ce­dures. The pathoph­y­sio­lo­gy of PI is mul­ti­fac­to­ri­al, includ­ing acti­va­tion of the ­stress ­response to sur­gery, ­with inhib­i­to­ry sym­pa­thet­ic vis­cer­al reflex­es and inflam­ma­to­ry medi­a­tors. We ­update evi­dence on the advanc­es in the pre­ven­tion and treat­ment on PI. As sin­gle inter­ven­tions, con­tin­u­ous tho­rac­ic epi­du­ral anal­ge­sia ­with ­local anes­thet­ics and min­i­mal­ly inva­sive sur­gery are the ­most effi­cient inter­ven­tions in the reduc­tion of PI. The ­effects of phar­mac­o­log­i­cal ­agents ­have gen­er­al­ly ­been dis­ap­point­ing ­with the excep­tion of cis­a­pride and the intro­duc­tion of the new selec­tive periph­er­al­ly act­ing µ-opi­oid antag­o­nists. Pres­ent­ly, intro­duc­tion of a mul­ti-­modal reha­bil­i­ta­tion pro­gramme (includ­ing con­tin­u­ous epi­du­ral anal­ge­sia ­with ­local anes­thet­ics, ear­ly ­oral feed­ing and ­enforced mobil­iza­tion) is the ­most effec­tive tech­nique to ­reduce PI in abdom­i­nal pro­ce­dures.

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