The extensive literature on the treatment of paralytic ileus and the constantly increasing number of methods for inducing intestinal motility indicate the lack of a satisfactory therapy for intestinal atonia. Recent attention has been directed toward acetylcholine and its probable function as the chemical mediator of parasympathetic nerve impulses. As such, it has been considered as an agent initiating gastro-intestinal motility, and attempts have been made to treat both experimental and clinical paralytic ileus with this preparation. It has been shown, however, that acetylcholine has an extremely evanescent action and that it is rapidly destroyed in the body by a specific ferment (esterase) which splits the ester into acetic acid and relatively inactive choline.
Physostigmine salicylate in extremely high dilutions has been found to inhibit the action of the esterase and greatly to augment and prolong the action of acetylcholine. These facts have not been applied clinically in the use
ZIMMERMAN LM, FRANK R, NECHELES H. EFFECT OF ACETYLCHOLINE AND OF PHYSOSTIGMINE ON GASTRO-INTESTINAL MOTILITY: OBSERVATIONS OF NORMAL ANIMALS AND OF ANIMALS WITH EXPERIMENTAL PERITONITIS. Arch Surg. 1936;33(2):187–196. doi:10.1001/archsurg.1936.01190020003001
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