Background: The sympathetic nervous hyperactivity present in response to surgical stress has been implicated as an important component of the postoperative paralytic ileus. A randomized and prospective study was conducted, evaluating the effects of the preoperative beta-adrenergic blockade with propranolol in schistosomotic patients during the period of postoperative ileus. Methods: The study compared schistosomotic patients submitted, or not, to beta-adrenergic blockade. Basal cardiac frequency was determined and propranolol was used in a dose of 40 mg twice a day. The dose was adjusted weekly until a minimum decrease of 20% in cardiac frequency was achieved. Three coupled bipolar electrodes were placed in the left colon in both groups, and registration of myoelectric activity of the left colon was made twice a day during the period of postoperative ileus using a system of data collection (DATA Q Series 200). The electric signals were previously amplified, filtered and separated into Electric Control Activity (ECA) and Electric Response Activity (ERA). Results: The dose of propranolol varied from 80 to 160 mg/day. The proportional decrease in basal heart frequency varied from 20 to 33%, with an average of 25.4 ± 3.9% in the propranolol group, maintaining a mean of 24.3 ± 3.6% decrease in the postoperative period. Differences on clinical recovery of the postoperative ileus were not found. Significant differences on electromyographic patterns were not observed between the groups, except for the presence of a greater number of short-duration contractions in the second postoperative day in the beta-blocked group. Conclusion: The authors suggest that the preoperative beta-adrenergic blockade with propranolol does not determine myoelectric activity changes that could contribute to an earlier resolution of postoperative ileus.

Keywords:
Colonic motility, Postoperative ileus, Beta-adrenergic blockage, Propranolol, Electromyography
1.
Condon RE, Cowles VE, Ferraz AAB, Carilli S, Carlson ME, Ludwig K, Ulualp K, Ezberci F, Shoji I, Isherwood P, Frantzides CT, Schulte, WJ: Human colonic smooth muscle electrical activity during and recovery from postoperative ileus. Am J Physiol 1995;193:408–417.
2.
Ferraz AAB: Myoelectric Activity of the colon: Experimental and clinical Evaluation of Ketoralac tromethamine, during and after the recovery of postoperative ileus. Master Thesis Center of Health Sciences of the Federal University of Pernambuco. Recife, 1994.
3.
Graber JN, Schulte WJ, Condon RE, Cowles VE: Duration of postoperative ileus related to extent and site of operative dissection. Surg Forum 1978;31:141–144.
4.
Mota CVA: Atividade mioelétrica do colon esquerdo durante o período de recuperação do íleo paralítico pos-operatório em pacientes esquistossomóticos. Master Thesis Center of Health Sciences of the Federal University of Pernambuco. Recife, 1997.
5.
Salaymeh B, Condon RE: Postoperative ileus. Surgery 1990;1:270–283.
6.
Santos MA Jr: Estudo do padrão mioelétrico do cólon esquerdo em pacientes portadores de esquistossomose mansônica na forma hepatoesplênica. Master Thesis Center of Health Sciences of the Federal University of Pernambuco. Recife, 1995.
7.
Silveira RK: Efeito da Morfina epidural na atividade eletromiográfica do cólon esquerdo durante a a recuperação do íleo paralítico pós-operatório. Master Thesis Center of Health Sciences of the Federal University of Pernambuco. Recife, 1997.
8.
Woods JH, Erickson LW, Condon RE, Schulte WJ, Sillin LF: Postoperative ileus: The colonic problem? Surgery 1978;84:527–533.
9.
Condon RE, Cowles VE, Ekbon GA, Schulte WJ: Effects of halothane, enflurane and nitrous oxide on colon motility. Surgery 1987;101:81–85.
10.
Ferraz AAB, Cowles VE, Condon RE, Carilli S, Ezberci F, Frantzides CT, Schulte WJ: Nonopioid analgesics shorten the duration of postoperative ileus. Am Surg 1995;61:1079–1083.
11.
Esser MJ, Mahoney JL, Robinson JC, Cowles VE, Condon RE: Effects of adrenergic agents on colonic motility. Surgery 1987;102:416–426.
12.
Heimbach DV, Crout JR: Treatment of paralytic ileus with adrenergic neuronal blocking drugs. Surgery 1971;69:582–587.
13.
Perry LB, van Dyker A, Theye RA: Sympathoadrenal and hemodinamic effect of isoflurane, halothane and cyclopropane in dogs. Anaesthesiol 1974;40:465–470.
14.
Smith J, Kelly KA, Weinshelboum RM: Pathophysiology of postoperative ileus. Arch Surg 1977;112:203.
15.
Tarnoky K, Szenohradszky J, Petri G: Plasma catecholamine levels in the postoperative period in complication free and ‘paralytic’ ileus patients. Acta Chir Hung 1987;28:287–298.
16.
Carlson MA, Ludwig KA, Cowles VE, Frantzides CT, Condon RE: Effect of propranolol on human colonic myoeletric activity. Surg Forum 1992, pp 155–157.
17.
Hallerback B, Ander S, Glise H: Effect of combined blockade of beta-adrenoceptors and acetylcolinesterase in the treatment of postoperative ileus after cholecystectomy. Scand J Gastroenterol 1987;22:420–424.
18.
Sjoqvist A, Hallerback B, Glise H: Adrenergic reflex of colonic motility in rat caused by nociceptive stimuli of peritoneum in alpha 2-adrenoceptor-mediate response. Dig Dis Sci 1985;30:749–754.
19.
Varilek GW, Weinstoek JW, Williams TH, Jew J: Alterations of the intestinal innervation in mice infected with Schistosoma Mansoni. Paras J 1991;77:472–478.
20.
Burroughs AK, McCormick PA: Pharmacologic long-term therapy of portal hypertension. Surg Clin North Am 1990;2:327–349.
21.
Mies S, Pereira MB, Orlando CD, Sette ME, Raia S: Propranolol na prevenção da recidiva de hemorragia digestiva em pacientes com esquistossomose hepatoesplênica. Rev Ass Med Brasil 1988;34:24–26.
22.
Sarna SK: Myoeletric correlate of colonic motor complexes and contratile activity. Am J Physiol 1986;250:G213–G220.
23.
Sarna SK: Cyclic motor activity: Migrating motor complex. Gastroenterology 1985;89:832–844.
24.
Sarna SK: In live myoelectrical activity: Methods, analysis and interpretation; in Schultz SG, Wood JD (eds): Handbook of Physiology, Gastrointestinal Motility and Circulation. Bethesda, Am Physiol Soc, 1989, vol 1, pp 817–863.
25.
Sarna SK: Physiology and pathophysiology of colonic motor activity. Part one of two. Dig Dis Sci 1991;36:827–862.
26.
Sarna SK: Physiology and pathophysiology of colonic motor activity. Part two of two. Dig Dis Sci 1991;36:998–1018.
27.
Sarna SK: Atividade Motora Colônica. Clin Cir Am Norte 1993;6:1251–1275.
28.
Cowles VE, Condon RE, Ferraz AAB, Carilli S, Frantzides CT: Computer analysis of human colonic electrical activity. Gastroenterology 1994;107:a1233.
29.
Ferraz AAB, Bacelar TS, Santos MA Jr, Vasconcelos HG, Figueiredo FL, Vaeiredo FL, Vasconcelos HMC, Ferraz EM: Myoelectric activity of the colon: Description of the methodology. Rev Bras Colo-Proct 1995;15:114–121.
30.
Krevsky B, Malmud LS, of Ercole F, Maurer AH, Fisher RS: Colonic transit scintigraphy: A physiologic approach to the quantitative measurement of colonic transit in humans. Gastroenterology 1986;91:1102–1112.
31.
Ferraz AAB, Cowles VE, Schulte RE, Condon RE: Intraluminal perfusion catheter vesus serosal transducer for recording colonic contractile activity. Gastroenterology 1994;106:A498.
32.
Ferraz AAB, Cowles VE, Schulte RE, Condon RE: Comparasion of opioid and non-opioid analgesics on colonic motor activity. Gastroenterology 1994;106:A498.
33.
Elsayed SS, Shiha G, Hamid M, Farag FM, Azzam F, Awad M: Sclerotherapy versus sclerotherapy and propranolol in the prevention of rebleeding from esophageal varices. A randomised study. Gut 1996;38:770–774.
34.
Lebrec D, Novel A, Corbic M: Propranolol: A medical treatment for portal hypertension. Lancet 1980;2:180–182.
35.
Lebrec D, Poynard T, Bernuau J: The randomised controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis. A final report. Hepatology 1984;4:355–358.
36.
Hoffman BB, Lefkowitz RJ: Antagonistic of adrenergic receivers; in Goodman LS, Gilman AG (eds): Terapêutica. Rio de Janeiro, Guanabara Koogan’s Bases Farmacológicas 1990;11:145–160.
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2001
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