Q: All of the following are contraindications for use of neostigmine in acute colonic pseudo-obstruction (Ogilvie's syndrome) except ?

A) Severe coronary artery disease (CAD)
B) cecal diameter more than 12 cm
C) Seizure
D) Therapy with beta-blockers
E) Peritonitis


Answer: B

Neostigmine may induce bradycardia and hypotension and should be avoided in patients with compromised cardiac function or on therapy with B-Blocker with lower heart rate. Also it decreases the threshold for seizures. Other risk factors are restlessness, bronchoconstriction, nausea, vomiting, increase salivation, diarrhea and sweating.

Neostigmine is indicated in patients who fails conservative therapy and are risk for perforation with cecal diameter more than 12 cm.