Paralytic Ileus and Prophylactic Gastrointestinal Motility Medication after Spinal Operation

PURPOSE: To investigate the prevalence of paralytic ileus after spinal operation in the supine or prone operative position and to determine the efficacy of prophylactic gastrointestinal motility medications in preventing symptomatic paralytic ileus after a spinal operation. MATERIALS AND METHODS: All patients received spinal surgery in the supine or prone operative position. The study period was divided into two phases: first, to analyze the prevalence of radiographic and symptomatic paralytic ileus after a spinal operation, and second, to determine the therapeutic effects of prophylactic gastrointestinal motility medications (postoperative intravenous injection of scopolamine butylbromide and metoclopramide hydrochloride) on symptomatic paralytic ileus after a spinal operation. RESULTS: Basic demographic data were not different. In the first phase of this study, 27 patients (32.9%) with radiographic paralytic ileus and 11 patients (13.4%) with symptomatic paralytic ileus were observed. Radiographic paralytic ileus was more often noted in patients who underwent an operation in the prone position (p=0.044); whereas the occurrence of symptomatic paralytic ileus was not different between the supine and prone positioned patients (p=0.385). In the second phase, prophylactic medications were shown to be ineffective in preventing symptomatic paralytic ileus after spinal surgery [symptomatic paralytic ileus was observed in 11.1% (4/36) with prophylactic medication and 16.7% (5/30) with a placebo, p=0.513]. CONCLUSION: Spinal surgery in the prone position was shown to increase the likelihood of radiographic paralytic ileus occurrence, but not symptomatic paralytic ileus. Unfortunately, the prophylactic medications to prevent symptomatic paralytic ileus after spine surgery were shown to be ineffective.

Air sickness in pilot trainees

Motion sickness is a common and debilitating response to provocative motion environment, to which a person is unfamiliar and hence unadapted. It poses a particular problem to aircrew in training, degrades performance in the air, and wastes training time. This paper discusses the incidence, attrition rate and to evaluate the therapeutic role of transderm scopolamine system in motion sickness during flight training in the Royal Jordanian Air Force. Three hundred and forty one flight trainees were included. Designed form elaborating symptoms, correlating factors and response to therapeutic transderm scopolamine system was prepared, a case definition of motion sickness was developed. Data collected from the medical and squadron records were analyzed to evaluate the incidence of motion sickness and the efficacy of therapeutic transderm scopolamine system in reducing the attrition rate. One hundred and six trineesout of 341 [31%] developed motion sickness. A total of 11 [3%] trainees were eliminated from flight training due to that reason, therapeutic transderm scopolamine system was effective in 87% of cases. Familial mediterranean fever and self medication with Retin A [Tretinoin] cream were discovered in two unresolving cases. Motion sickness continues to present difficulties to flight trainees. Clinical assessment is mandatory to exclude secondary causes of motion sickness. Therapeutic transderm scopolamine system can be an effective drug in reducing the susceptibility to conditioned motion sickness with few and tolerable side effects. Further studies to elaborate on other means like desensitization particularly in qualified pilots is encouraged