Abstracts
1998 Digestive Disease Week

#991

EFFECT OF NEOSTIGMINE ON POSTOPERATIVE COLONIC MOTILITY. COMBINED MANOMETRY/BAROSTAT RECORDINGS. M. E. Kreis, A. Huge, T. T. Zittel, M. Kasparek, G. Thiers, M. J. Starlinger, H. D. Becker, E. C. Jehle. Univ. Hospital, Dep. of Surgery, Tübingen, FRG.

Introduction: The colon has been suggested to limit the resolution of postoperative ileus. In order to improve this condition cholinergic drugs are frequently administered. We aimed to evaluate the effect of i.v. Neostigmine on postoperative colonic motility and tone. Methods: 9 patients were studied (3m, 6f, median age 62 years, range 51-70) who underwent anterior rectal resection (n=4), resection of the sigmoid colon (n=4) or reanastomosis after a Hartmann procedure (n=1). A combined manometry/barostat catheter was placed intraoperatively with the tip in the splenic flexure. Motility recordings were performed daily from the 1st to the 3rd postoperative day at corresponding time points. After 20 min baseline recording 0.05, 0.5 and 5 µgkg-1 Neostigmine were given i.v. Each dose was administered over 10 minutes followed by a 10 minute period without perfusion. Manometry recordings were analyzed using dedicated software which allowed characterisation of long duration contractions (LDC). Barostat recordings were analyzed manually. In one patient, only barostat recordings were possible for technical reasons. In 2 patients the recording on day 3 could not be performed due to catheter displacement. Results:

*p<0.05 vs. baseline; one way repeated measures ANOVA.

LDC duration did not change throughout the study (19.4 ± 1.0 sec; mean ± SEM). LDC frequency increased on day 3 after 0.5 and 5 µgkg-1 Neostigmine (both p < 0.05). The mean amplitude of LDCs was increased on day 3 after 5 µgkg-1 versus baseline (p < 0.05). Conclusions: Neostigmine stimulated postoperative colonic motility. The decrease in barostat volumes indicated a dose-dependant increase in colonic tone following Neostigmine. Neostigmine should be effective in the treatment of postoperative colonic ileus.

Supported by the Deutsche Forschungsgemeinschaft (Kr 1816 1-1).

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.