Neostigmine drip and Critical illness induced intestinal Pseudo-obstruction

IV Neostigmine has been used successfully in acute colonic pseudo-obstruction with quick colonic decompression after a bolus infusion. But it carries significant risk of adverse effects of cholinesterase inhibitors include bronchospasm, salivation, vomiting, life threatening bradycardia and hypotension. Atropine should be at bedside during the administration of neostigmine.

To counter act this life threatening bradycardia a slow infusion may be use which may carry a lower risk of bradycardia. This could also be extremely useful in patients with critical illness-related intestinal ileus unresponsive to other standard measures. The recommended dose of neostigmine for continuous infusion is 0.4-0.8 mg/h over 24 hours.