Postoperative ileus is a condition that has recently come to prominence in our clinical care for patients. For many years, patients undergoing abdominal surgery were known to take 4 or 5 days to recover gastrointestinal function and to be able to maintain adequate hydration and nutrition.
This was accepted as a normal part of recovery after intestinal surgery. Approximately 10% of patients are known to develop a more signifi cant form of ileus, often requiring prolonged nasogastric intubation and intravenous nutrition. Increasing pressure on provision of care, with reduced reimbursement and reduced nursing resources, has increased the emphasis on providing care effi ciently. Over the past decade, perioperative care has improved and patients now stay 4 to 7 days after open abdominal surgery, instead of the 7 to 12 days that used to be required. These new benchmarks have been further accelerated by laparoscopic intestinal surgery, and in some institutions patients now return home within 1 or 2 days of surgery. Thus, as care has evolved, clinicians have realized that while a period of postoperative ileus is mandatory, a shorter ileus is not harmful and simply accelerates recovery.
In this book, Dr. Gan reviews all of the salient points related to postoperative ileus. Defi nitions, clinical features, and the magnitude of the clinical problem are reviewed. Precipitating factors and pathophysiology are described. Protocols to optimize perioperative care and minimize ileus are reviewed, and fi nally pharmacologic management and prevention are discussed in detail. In short, this handbook briefl y reviews all the points that the clinical practitioner needs to know about the management and prevention of postoperative ileus.
This book will be a useful tool for those looking after patients at risk of, and who have developed, this troubling and common condition.
Contents
About the Author
T.J. Gan is Professor and Vice Chairman of the Department of Anesthesiology at Duke University Medical Center.
This was accepted as a normal part of recovery after intestinal surgery. Approximately 10% of patients are known to develop a more signifi cant form of ileus, often requiring prolonged nasogastric intubation and intravenous nutrition. Increasing pressure on provision of care, with reduced reimbursement and reduced nursing resources, has increased the emphasis on providing care effi ciently. Over the past decade, perioperative care has improved and patients now stay 4 to 7 days after open abdominal surgery, instead of the 7 to 12 days that used to be required. These new benchmarks have been further accelerated by laparoscopic intestinal surgery, and in some institutions patients now return home within 1 or 2 days of surgery. Thus, as care has evolved, clinicians have realized that while a period of postoperative ileus is mandatory, a shorter ileus is not harmful and simply accelerates recovery.
In this book, Dr. Gan reviews all of the salient points related to postoperative ileus. Defi nitions, clinical features, and the magnitude of the clinical problem are reviewed. Precipitating factors and pathophysiology are described. Protocols to optimize perioperative care and minimize ileus are reviewed, and fi nally pharmacologic management and prevention are discussed in detail. In short, this handbook briefl y reviews all the points that the clinical practitioner needs to know about the management and prevention of postoperative ileus.
This book will be a useful tool for those looking after patients at risk of, and who have developed, this troubling and common condition.
Contents
- Introduction
- Definitions
- Prevalence
- Economic burden in the hospital setting
- Risk factors
- Causes and pathophysiology
- Diagnosis and clinical features
- Diagnostic tests and imaging
- Diff erential diagnosis
- Prevention
- Nasogastric intubation
- Fluid administration
- Surgical technique
- Anesthetic techniques
- Psychological factors
- Current pharmacological options for treatment and management
- Nonsteroidal anti-inflammatories and other anti-inflammatory agents
- Symptom relief with hydration and nasogastric tube
- Prokinetic agents
- Chewing gum
- Anticholinergic or cholinergic drugs
- Laxatives
- ??-opioid antagonists
- Other drugs
- Nonpharmacological therapies
- Early feeding
- Fast-track recovery protocol
- Emerging pharmacotherapies
- Peripherally acting ยต-opioid antagonists
- Conclusions
About the Author
T.J. Gan is Professor and Vice Chairman of the Department of Anesthesiology at Duke University Medical Center.
Product Details
- Spiral-bound: 32 pages
- Publisher: Oxford University Press, USA; Spi edition (January 8, 2009)
- Language: English
- ISBN-10: 0195384466
- ISBN-13: 978-0195384468