From the Research
The recommended dose of neostigmine for colonic decompression is 2 mg given as a slow intravenous injection, as demonstrated in the study by 1. This dose is typically administered as a single injection. If there is no response within 3 hours, a second dose may be given. However, the total dose should not exceed 5 mg in 24 hours. Before administration, ensure the patient is on continuous cardiac monitoring, as neostigmine can cause bradycardia, as noted in the study by 1. Have atropine (0.5-1 mg) readily available to counteract potential cholinergic side effects. Neostigmine is effective for colonic decompression because it is a cholinesterase inhibitor that increases acetylcholine levels in the gut, stimulating peristalsis and promoting bowel motility. This action helps to relieve acute colonic pseudo-obstruction (Ogilvie's syndrome) by promoting the passage of flatus and stool. Some key points to consider when using neostigmine for colonic decompression include:
- Contraindications: mechanical obstruction, peritonitis, and recent bowel surgery
- Use with caution in patients with bradycardia, asthma, or renal impairment
- Monitor for side effects, such as abdominal pain, excess salivation, and vomiting, as reported in the study by 1
- Consider the factors that predict successful outcome following neostigmine therapy, as identified in the study by 2, such as postoperative patients and those without electrolyte imbalance or antimotility agents.