Introduction

Abstract

DEAR NURSING COLLEAGUE: Postoperative ileus (POI) has emerged as a significant determining factor in the quality of the overall perioperative experience, from proper and adequate pain management to the optimization of recovery and discharge protocols. Although the transient cessation of normal gastrointestinal (GI) function after major surgery (ie, POI) has long been recognized, only recently have deeper insights into its pathophysiology and the true nature of its negative clinical impact been more fully appreciated. Perianesthesia nursing personnel, and many of their nursing colleagues, have an equivalent long history of dealing with the clinical consequences of major surgery, being forced to rely on unproven or anecdotal methods to help decrease the discomfort and other adverse effects associated with POI. This “standard of practice” has persisted for decades, but the development of new surgical and anesthesia strategies, as well as a new class of drugs, peripherally acting mu-opioid-receptor antagonists, have contributed to a renewed interest in learning how to overcome the challenges associated with POI. Some degree of POI will likely remain an inevitable response to surgery, but the long-held notion that we are essentially powerless to diminish its severity and duration is rapidly giving way to new paradigms of prevention and improved management. Combined with ongoing evaluations of alternative surgical, anesthesia, and supportive approaches, peripherally acting mu-opioid-receptor antagonists (methylnaltrexone, and in particular, alvimopan) have helped spark the design of innovative protocols to improve the perioperative experience and clinical outcomes. Nursing personnel, always on the forefront of patient management, will play key roles in the planning and implementation of these new multimodal strategies, and will help redefine the surgical team’s management of POI through heightened communication and ongoing education among themselves and their colleagues. Developed from a symposium, Redefining the Surgical Team’s Management of Postoperative Ileus, ⁎This commercially supported symposium was independent of ASPAN’s educational conference activities, although it was accredited for continuing education credit by the American Society of PeriAnesthesia Nurses. which took place during the 24th National Conference of the American Society of PeriAnesthesia Nurses in Chicago, the articles that follow will discuss the variety of approaches that have been used to manage POI and attempt to put into context the rationale for these, their potential benefit, if any, and furthermore, delineate management concerns regarding POI from the perspective of individual surgical team members: a surgeon, an anesthesiologist, and two key nursing personnel, involved in preoperative/preanesthesia and postanesthetic roles, on specific POI management points and issues. I hope you find the information and the recommendations within this supplement valuable and helpful to your nursing practice. Sincerely, Susan Carter, BSN, RN, CPAN, CAPA Guest Editor This commercially supported symposium was independent of ASPAN’s educational conference activities, although it was accredited for continuing education credit by the American Society of PeriAnesthesia Nurses. Susan Carter, BSN, RN, CPAN, CAPA, is a Staff Nurse CNIII, University of California San Diego Medical Center–Thornton Hospital, La Jolla, CA.