••• CHAPTER 35^ Postoperative Care of the Gynecologic Patient^353
(3) Use of perioperative opioids is the most common pharmacologic mechanism.
(4) All three mechanisms result in activation of the mu-opioid gastrointestinal receptors that inhibit the release
of acetylcholine from the mesenteric plexus. This disrupts peristalsis by causing uncoordinated nonpropulsive
contractions.❍ True or False: There is no difference in the rates of aspiration pneumonia, wound dehiscence, or intestinal
leakage with early versus delayed postoperative feeding.
True. Early feeding does not appear to increase the rate of postoperative complications and can reduce the
occurrence of postoperative ileus and length of hospital stay.
❍ Name five methods shown to reduce postoperative ileus.
(1) Early feeding.
(2) Gum chewing.
(3) Bowel stimulation (with magnesium hydroxide, sodium phosphate, or bisacodyl suppositories).
(4) Use of Alvimopan, a mu-opioid receptor antagonist.
(5) Pain control with ketorolac—reduces total opioid use and may decrease the gastrointestinal inflammatory
response.
❍ What is the most common cause of small bowel obstruction following surgery?
Adhesions to the operative site.
❍ What findings indicate the need for immediate surgery for small bowel obstruction?
Worsening symptoms, leukocytosis, acidosis, and fever that may indicate bowel ischemia.
❍ What is the most common cause of postoperative colonic obstruction in gynecological patients?
Pelvic malignancy, most likely due to advanced ovarian cancer.
❍ What is the most common gynecological process associated with both bowel ileus and obstruction?
Severe pelvic inflammatory disease.
❍ Which parts of the gastrointestinal tract recover first after intraperitoneal surgery?
The small intestine recovers after several hours, the stomach after 24 to 48 hours, and the large intestine after 48 to
72 hours.
❍ When are the symptoms of postoperative small bowel obstruction most likely to present?
5 to 7 days postoperatively.
❍ Where do most pulmonary emboli arise?
The deep venous system of the legs.
❍ When do the majority of deep venous thromboses develop relative to surgery?
Within the first 24 hours of surgery.