simethicone and Postoperative-Complications

To examine the effect of simethicone on reducing operative difficulty associated with bowel interference during minilaparotomy for postpartum modified Pomeroy partial salpingectomy.. We enrolled 20-45-year-old women planning the procedure from March 2018 to February 2019. We randomized participants to chew simethicone 160 mg with water 50 mL 2-8 h before surgery or no treatment. The participants were not blinded; however, surgeons, care providers, and outcome assessors were blinded to the study allocation. We measured surgeon-rated operative difficulty using a 10-cm visual analog scale that represented the difficulty perceived to be resulting from bowel interference. Secondary outcomes included operative time and intraoperative and postoperative complications.. We enrolled 60 women in each group; baseline characteristics and procedural profiles were comparable. Women in the intervention group used simethicone a median of 157 min (interquartile range 127-192) before the procedure. Surgeons rated the procedure difficulty score as 4.8 in the simethicone group and 4.5 in the control group (p = 0.57). Operative time in the two groups were 26 and 24 min, respectively (p = 0.14). We found no difference in intraoperative adverse events including blood loss and mesosalpinx tear, postoperative morbidities, hospital stay, and patient-rated satisfaction scores.. Preprocedural simethicone has no demonstrable benefit in reducing operative difficulty caused by bowel interference during minilaparotomy for postpartum tubal sterilization.. Preprocedural simethicone as given in this study did not result in reduced bowel interference and improved procedure difficulty. Further research examining simethicone in this setting would not be worthwhile as clinically meaningful benefit is unlikely.

Topics: Adult; Antifoaming Agents; Female; Gastrointestinal Motility; Humans; Laparotomy; Middle Aged; Operative Time; Patient Satisfaction; Postoperative Complications; Postoperative Period; Salpingectomy; Simethicone; Single-Blind Method; Sterilization, Tubal; Young Adult

Postoperative ileus is a poorly understood multifactorial outcome following colorectal surgery that presents significant clinical challenges and contributes to increased morbidity, length of stay, and healthcare cost. To date, there are few pharmacological interventions that shorten the duration of postoperative ileus.. This study is the first to evaluate the efficacy of simethicone in treating postoperative ileus symptoms in patients undergoing colorectal surgery.. A multicenter, double-blinded, placebo controlled randomized controlled trial.. This trial was conducted at two academic tertiary care centres in Ontario, Canada.. 118 patients undergoing colorectal surgery.. Patients were randomized to receive either a five-day course of oral simethicone (n = 58) or a placebo (n = 60).. The primary outcome was time to first passage of flatus. Secondary outcomes included time to first bowel movement, postoperative length of stay, and postoperative pain. Statistical analyses were performed on an intention-to-treat basis. Statistical significance set at p = 0.05.. The median time to first passage of flatus in simethicone arm was 25.2 h and 26.7 h in controls (P = 0.98). There were no significant differences in the median time to first bowel movement (simethicone = 41.1 h vs. control = 42.9 h, P = 0.91) or median length of hospital stay (simethicone = 4.5 days vs. control = 4.0 days, P = 0.63).. This study failed to show a difference in return of gastrointestinal motility in patients receiving simethicone following colorectal surgery. Postoperative ileus remains a significant clinical and economic burden to the healthcare system and further research is needed to identify a reliable and effective method of treatment.

Topics: Aged; Antifoaming Agents; Canada; Colon; Defecation; Digestive System Surgical Procedures; Double-Blind Method; Female; Gastrointestinal Motility; Humans; Ileus; Length of Stay; Male; Middle Aged; Pain, Postoperative; Postoperative Complications; Postoperative Period; Rectum; Simethicone; Treatment Outcome

To determine the comparative efficacy of several histamine (H2)-receptor antagonists (cimetidine, famotidine, and ranitidine) and the antacid Mylanta-II (Stuart Pharmaceuticals, Wilmington, DE) in gastric pH control and the prevention of postoperative stress ulceration, a prospective, randomized study was performed in a homogeneous population of patients with elective coronary artery bypass. None of the 57 patients in the study population had a documented history of ulcer disease. There were four treatment groups, each with similar demographics (age and sex). Cimetidine-treated group consisted of 15, famotidine-treated group of 18, ranitidine-treated group of 19, and antacid-treated group of 5 patients. There was no hemodynamically significant postoperative gastrointestinal bleeding in any of the patients. When the agents were compared for efficacy of gastric pH control, statistically better pH control was found in the famotidine- and ranitidine-treated groups (P less than 0.003) than in the cimetidine-treated group (pH less than or equal to 4.0) during the 20-hour observation period. Side effects (hematologic and neurological) were noted only in the cimetidine-treated group. The results of this study indicate that in patients in postoperative intensive care, better gastric pH control, and thus prevention of gastric stress ulcers, is achieved with either famotidine or ranitidine rather than cimetidine or antacid.

Topics: Aged; Aluminum Hydroxide; Antacids; Cimetidine; Coronary Artery Bypass; Drug Combinations; Famotidine; Female; Humans; Magnesium Hydroxide; Male; Middle Aged; Peptic Ulcer; Postoperative Complications; Prospective Studies; Ranitidine; Simethicone; Stress, Physiological

We carried out a randomized, controlled trial of sucralfate vs antacid as prophylaxis against upper gastrointestinal tract bleeding in 50 patients who had undergone abdominal aortic surgery. The groups were similar in age, sex, duration of prophylaxis, and number of risk factors per patient. No patient in the antacid group had upper gastrointestinal tract bleeding. One patient in the sucralfate group had frank bleeding from the nasogastric tube; however, she also had a coagulopathy and thrombocytopenia. The bleeding stopped when these conditions were corrected. No complications occurred in the sucralfate group; five patients in the antacid group had minor complications. Sucralfate was as effective as antacid in this trial, and it resulted in a considerable saving in nursing time.

Topics: Aged; Aluminum; Aluminum Hydroxide; Antacids; Anti-Ulcer Agents; Aorta, Abdominal; Clinical Trials as Topic; Drug Combinations; Female; Gastrointestinal Hemorrhage; Humans; Intubation, Gastrointestinal; Magnesium Hydroxide; Male; Postoperative Complications; Prospective Studies; Random Allocation; Risk; Simethicone; Sucralfate

A prospective, randomized trial was designed to compare the relative efficacy of 15 (R)-15-methyl prostaglandin E2 with antacid (usually Mylanta II) in 46 patients admitted to a respiratory-surgical intensive care unit. Bleeding was assessed by a modification of the Hemoccult slide test. Three of 22 patients in the antacid group bled, and 12 of 24 patients in the prostaglandin group bled, for a highly significant difference (p = 0.008). Patients in whom prophylaxis failed tended to have a greater number of risk factors. Other prostaglandin analogues that do not require conversion from an inactive to an active form, may be more useful than the agent we studied. Based on currently available data, the hourly titration of the gastric juice to a pH of greater than 3.5 remains the preferred method of prophylaxis for acute bleeding from the stomach in seriously ill patients.

Topics: Aged; Aluminum Hydroxide; Antacids; Arbaprostil; Clinical Trials as Topic; Drug Combinations; Female; Gastric Acid; Gastric Acidity Determination; Gastrointestinal Hemorrhage; Humans; Magnesium Hydroxide; Male; Postoperative Complications; Prospective Studies; Prostaglandins E, Synthetic; Random Allocation; Risk; Simethicone

One hundred twenty-six parturients for elective cesarean section under general anesthesia were allocated to either a cimetidine or an antacid group in a randomized, double-blind, multicenter trial. The cimetidine-treated group received 300 mg cimetidine orally the evening before the operation and 300 mg intramuscularly between 1 and 3 h preoperatively. The antacid-treated group received 30 ml of Mylanta-II orally on both occasions. Gastric volume, 30 min after induction of anesthesia and 30 min before response to oral commands, was less in the cimetidine-treated group. Gastric pH 30 min after induction was greater in the cimetidine-treated group. The maternal serum level of cimetidine at birth was 1.31 +/- 0.12 micrograms/ml and the umbilical venous level was 0.78 +/- 0.05 micrograms/ml. The neonatal gastric acidity, Apgar scores, and Early Neonatal Neurobehavioral Scale (ENNS) scores were similar in both groups. No maternal or neonatal complication was attributed to treatment.

Topics: Adolescent; Adult; Aluminum Hydroxide; Anesthesia, General; Anesthesia, Obstetrical; Antacids; Cesarean Section; Cimetidine; Double-Blind Method; Drug Combinations; Drug Evaluation; Female; Gastric Acid; Guanidines; Humans; Magnesium; Magnesium Hydroxide; Pneumonia, Aspiration; Postoperative Complications; Pregnancy; Premedication; Silicones; Simethicone

Over a 15-month period, 75 critically ill patients at risk of acute gastrointestinal bleeding were randomized into two groups: one group (38 patients) received the H2-blocker cimetidine intravenously at an initial dosage of 300 mg every six hours, and the other group (37 patients) received antacid (Mylanta II) through a nasogastric tube at an intial dosage of 30 ml every hour. Gastric pH was measured hourly and titrated above 3.5. Upper-gastrointestinal-tract bleeding occurred in seven of 38 cimetidine-treated patients but in none of 37 antacid-treated patients (P less than 0.01). When antacid titration was added to the cimetidine regimen in four of seven patients with bleeding, all four stopped bleeding. Renal failure, sepsis, peritonitis, hypotension, respiratory failure, jaundice, multiple trauma, and major operative procedures were associated with an increased incidence of bleeding. Cimetidine does not adequately protect seriously ill patients from acute upper-gastrointestinal-tract bleeding. Antacid is better for this purpose.

Topics: Acute Disease; Aluminum Hydroxide; Antacids; Cimetidine; Clinical Trials as Topic; Critical Care; Drug Combinations; Female; Gastrointestinal Hemorrhage; Guanidines; Humans; Intubation, Gastrointestinal; Magnesium Hydroxide; Male; Middle Aged; Postoperative Care; Postoperative Complications; Random Allocation; Risk; Simethicone

Topics: Air; Body Fluids; Chemical Phenomena; Chemistry, Physical; Chest Tubes; Ethanol; Humans; Pleura; Pneumonectomy; Postoperative Complications; Proteins; Simethicone; Suction; Surface Tension

Topics: Air; Body Fluids; Chest Tubes; Humans; Pneumonectomy; Postoperative Complications; Simethicone; Suction; Surface Tension

In the study, 27 dogs were divided into three groups: A, B and C. Then all of the dogs had their lumbar intervertebral disks removed. Into the wounded cavity of group A, 1 ml of dimethicone was dropped and gelatin sponge was applied on the surface of the nerve root of group B. Group C was served as the control. The dogs were killed and the operation area was removed respectively 2 weeks, 4 weeks, and 12 weeks after the operation for macroscopical observation, nerve root motility measurement and histological examination. The result of the experiment proved that dimethicone was fairly effective in the prevention from secondary nerve root adhesion. While gelatin sponge in the process of its absorption induced the formation of quite a few scar tissues, thus aggrevating nerve root adhesion.

Topics: Animals; Dogs; Emollients; Intervertebral Disc; Male; Peripheral Nervous System Diseases; Postoperative Complications; Simethicone; Spinal Nerve Roots; Tissue Adhesions

Various biologic and non-biologic materials may be embolized to the brain after the use of cardiopulmonary bypass (CPB) pumps during open heart surgery but their relative frequency and importance are uncertain. Among the nonbiologic materials, Antifoam A, which contains organosilicates and silicon, continues to be employed as an additive to prevent frothing. Recent improvements in filtration and oxygenation techniques have clearly reduced the incidence of large emboli and complications like stroke but other neurologic sequelae following open heart surgery are common and in many cases poorly explained. A recently developed histochemical technique for the demonstration of the endothelial alkaline phosphatase (AP) was employed in a post-mortem study of brains from 8 patients and 6 dogs dying within a few days after open heart surgery employing cardiopulmonary bypass perfusion. Brains from 38 patients and 6 dogs who were not subjected to heart surgery were studied as controls with the same technique. The AP-stained slides are suitable for both light microscopic examination of the thick celloidin sections as well as a subsequent processing for high-resolution microradiography. Small capillary and arteriolar dilatations (SCADs) were seen in the test subjects/animals but not controls. SCADs were seen in all parts of the brain. Approximately 50% of the SCADs showed birefringence when examined with polarized light. SCADs are putative embolic phenomena and the exact nature and source of the embolic material is under investigation. A glycolipid component is indicated by preliminary studies. SCADs are difficult to find in routine paraffin sections and most if not all of the offending material seems to be dissolved during processing.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Alkaline Phosphatase; Animals; Antifoaming Agents; Arterioles; Biomarkers; Brain; Capillaries; Cardiopulmonary Bypass; Cerebrovascular Disorders; Dilatation, Pathologic; Dogs; Endothelium, Vascular; Humans; Intracranial Embolism and Thrombosis; Postoperative Complications; Prospective Studies; Retrospective Studies; Simethicone

Topics: Aluminum Hydroxide; Antacids; Cimetidine; Drug Combinations; Famotidine; Humans; Magnesium Hydroxide; Peptic Ulcer; Postoperative Complications; Ranitidine; Simethicone; Stress, Physiological

The effects of aspiration of (a) 2 ml of Mylanta (a particulate antacid) mixed with 2 ml of hydrochloric acid (pH 1.5), (b) 2 ml of half-strength Bicitra (a soluble antacid) mixed with 2 ml of hydrochloric acid (pH 1.5), (c) 4 ml of hydrochloric acid (pH 1.5), and (d) 4 ml of normal saline (pH 6.5) on arterial blood gas tensions and lung pathology were compared in anesthetized rabbits. PaO2 decreased similarly in all animals 15 minutes after aspiration, but recovered to normal levels 4 hours after aspiration of saline and 48 hours after aspiration of Bicitra. PaO2 remained depressed after aspiration of Mylanta and HCl. Gross and microscopic evidence of lung injury was most severe in animals that aspirated Mylanta. One animal died 8 hours after aspiration of Mylanta.

Topics: Aluminum Hydroxide; Animals; Antacids; Citrates; Citric Acid; Drug Combinations; Magnesium; Magnesium Hydroxide; Male; Oxygen; Partial Pressure; Pneumonia, Aspiration; Postoperative Complications; Preoperative Care; Rabbits; Silicones; Simethicone