Does omphalocele major undergo spontaneous closure?

The early surgical management of omphalocele major in Africa predisposes neonates to surgical complications which are often worsened by the presence of associated anomalies. Conservative management using available escharotics results in early skin cover by secondary wound healing. This delays the need for fascial closure and avoids neonatal surgical risks thus improving survival. We present a case of omphalocele major that underwent spontaneous closure during conservative management with honey dressing without surgical intervention.

Safety profile of parenteral ketamine and lignocaine infiltration in pediatric operations.

OBJECTIVE: To study the safety and benefits of parenteral ketamine and lignocaine infiltration among pediatric surgical patients with co-morbidities that would preclude the use of general anesthesia requiring endotracheal intubation/face mask in a developing country. METHODS: This prospective study was undertaken at the Leadeks Medical Centre, Benin City Edo State, Nigeria between January 2002 and December 2006. Patients requiring surgery were safely operated even in the presence of co-morbidity. RESULTS: A total of 416 children were recruited and they were aged 6 days to 16 years (mean 12 -/+ 2.04 years) with a male/female ratio of 1:1.1. Appendectomy (33.2%), herniotomy (20.2%) and suturing of laceration (15.9%) were the most common indications for surgery. Anemia, upper respiratory tract infections, malnutrition, malaria fever, typhoid fever, and retroviral infections were co-morbidities. Ambulatory surgery was carried out in 48.6% patients. Overall, only 23.3% experienced postoperative pain, which was statistically significant in those that had laparotomy and appendectomy (p<0.0001), and analgesics such as paracetamol were enough to relieve the pain. Complications recorded such as postoperative vomiting, emergence reaction, wound infection, post operative fever, and apnea occurring after ketamine injections were tolerated and no mortality was recorded. CONCLUSION: The satisfactory anesthesia and analgesia recorded with this combination, and the low complications observed in the presence of co-morbidity showed that these agents have much to offer in a developing country.