Jungle Juice: Knowledge and Usage Among Kenyan Surgical Teams

Background: Lidocaine Adrenaline combination (LAC) in saline (jungle juice) is used to provide peri-operative analgesia, blood conservation and separation of tissue planes. It comprises 20mls of 2% Lidocaine, 80mls of sterile saline and 0.5mls of 1:1000 Adrenaline solution, +/- hyaluronidase. This survey aimed to evaluate knowledge and safe usage of jungle juice on patients in Kenyan public hospitals.Objectives: To establish formulation, extent of usage, patterns and safety measures employed during use of jungle juice among surgical teams in Kenya. Methods: A cross sectional descriptive survey among 344 surgeons.and.66 anesthesiologists.Results: Majority (95.2%) of the respondents could not constitute the recommended jungle juice solution. Most (66.3%) had learnt about jungle juice from medical school and workmates (28.9%). About half of the anesthesiologists and 13.6% of surgeons were aware of the maximum dose of lidocaine with adrenaline. Regarding the specific antidote for severe local anesthetic toxicity and its dosage, 3.2% of surgeons and 18.2% of anesthesiologists had good awareness. Intralipid Emulsion was available in operating theaters to 3.9% of surgeons and 18.2% of anesthesiologists.Conclusions: Most of the Kenyan surgical teams had poor knowledge on the preparation and safe use of jungle juice.Keywords: Lidocaine Adrenaline Combination, Jungle Juice, Intralipid Emulsio

Restoration of Anal Sphincter Tone by Graciloplasty: A Report of Five Cases

Stool incontinence can be as a result of congenital or acquired anal sphincter problems. It is a devastating state for a patient not to be able to control stools resulting into continued feacal soiling. It reduces an individual to a dejected and depressed person who becomes a social misfit. Hence any procedure that can alleviate this state is normally highly appreciated. Various techniques have been quoted in literature and use of gracilis muscle to form a neosphincter is one of them. Dynamic graciloplasty, is a technique whereby electrodes have been implanted into gracilis muscle and is connected to an implantable pulse generator which provides progressive levels of stimulation to convert the fast twitch, fatigue prone muscle fibres to a slow twitch, fatigue resistant firbres over eight week training period (1,2,3). This has shown improved efficacy over the static graciloplasty (3). In this case report, five patients with stool incontinence from different aetiologies are presented, all having been managed by static graciloplasty and intense physiotherapy with good outcomes reported

Neonatal surgical emergencies at Moi Teaching and Referral Hospital in Eldoret -Kenya

Background: Success in the management of neonatal surgical emergencies depends on prompt diagnosis, adequate resuscitation, good nursing care, safe anaesthesia and competent surgery. Considering that centres for paediatric surgery are few in the developing world, an added requirement is application of the principles of neonatal transport, when neonates are transported to these centres from wherever they are born. These are the challenges that Moi Teaching & Referral Hospital (MTRH) faces in the provision of emergency service to neonates. The hospital serves the Western Kenya region with a population of about 15 million. This study was aimed at determining the pattern and the outcome of neonatal emergency surgery at MTRH.Methods: This was a retrospective descriptive study done at The Moi Teaching & Referral Hospital, Eldoret-Kenya. The study population included all neonates with emergencies managed by the paediatric surgical service between July 2003 and July 2006. Data was obtained from the theatre register and patients’ files.Results: Sixty nine neonates were operated between July 2003 and July 2006 but only 56 files were completed for analysis. Of the 56 neonates, 35 were male and 21 female (M: F ratio of 1.7:1). The median age of presentation was 3 days with a range of 1 – 22 days. Referrals represented 32 (60%). The leading three diagnoses were anorectal malformation 19 (34%) intestinal atresia 8 (14%) and anterior abdominal wall defects 7 (13%). 14 (25%) of the neonates had low birth weight. Application of principles of neonatal transport was poor. Inadequacy of fluid therapy was noted in 26 (45%) of the neonates. Challenges of providing parental nutrition were encountered in 11 (20%). Sepsis was the leading complication and major cause of mortality. Overall mortality was 18 (24%) but was 14 (44%) among the referrals.Conclusion: Morbidity and mortality was high in the management of neonates with surgical emergencies. Reversing the trend will require: early referral and presentation; overcoming the challenges of providing infrastructure that will enable good nursing care, and improving neonatal transport in the region

Cns lignocaine toxicity in an infant following vp shunt and spina bifida repair: a case report

A 3.7kg one-month-old male infant with Spina Bifida Cystica with Hydrocephalus had Ventriculo-Peritoneal (VP) Shunting and repair of the Spina Bifida Cystica done. Lignocaine with Adrenaline 1:100,000 was infiltrated intra-operatively to reduce blood loss. Overenthusiastic infiltration, an oversight, led to Lignocaine toxicity. In Pediatrics, prior calculation of maximum dosage, based on child’s weight, and use of dilute solutions for multiple sites could have prevented this