Experts have said caution should be exercised when administering the anaesthetic lignocaine, particularly in consulting rooms, and that although it is a safe, commonly used medication when properly used, incorrect dosing and not following procedures after an overdose could be fatal.
This comes after a 13-year-old boy died and another was admitted to hospital after visiting a private GP in Bronkhorstspruit for routine circumcisions, and mistakenly being overdosed with lignocaine, reports New24.
The Health Professions Council of South Africa (HPCSA) has confirmed an unprofessional conduct investigation is under way, while police were also investigating the circumstances that led to Siyabonga Mbonani’s death.
The South African Society of Anaesthesiologists (SASA) says lignocaine is a commonly used local anaesthetic that is safe when used correctly.
Mbonani and another 14-year-old had both visited Dr Nimrod Machebe’s private practice outside Gauteng for routine circumcisions – however, the doctor allegedly later admitted to giving the boys 10mg of lignocaine instead of 2mg, although he told the concerned parents of both boys that he was “reversing it”.
According to the father of the second boy, who was admitted to a hospital and has since been discharged, instead of calling paramedics, the doctor allegedly called a towing company, which brought in first responders.
Siyabonga’s mother Nthabiseng Mbonani said her boy was declared dead some six hours later.
While officials are investigating the circumstances, SASA president and executive head of Anaesthesiology and Critical Care at Stellenbosch University, Professor Sean Chetty, said lignocaine was widely acknowledged as a safe and effective local anaesthetic when administered correctly.
Commonly used to numb specific areas of the body, lignocaine temporarily blocks nerve signals, enabling minor surgeries, dental procedures, and diagnostic tests without affecting the patient’s consciousness.
When used for circumcision, it is typically administered via injection around the base of the penis.
“This technique is known as a penile ring block, and the method provides a safe and effective form of anaesthetic,” he said.
The safety and success of applying lignocaine for such regional anaesthetic techniques depend on proper dosing and precise execution.
“This type of block should only be done by a trained healthcare professional,” he said, adding that the dosage is primarily determined by the patient’s weight. For children aged 13 to 14, the recommended maximum dose without adrenaline is 3mg-5mg per kilogram of body weight.
“Dosages must be carefully calculated and adjusted by the healthcare provider, taking into account factors like liver function, other medications, and the area being anaesthetised,” he said.
Risks of overdose
Chetty said an overdose of local anaesthetic typically has cardiovascular and nervous system effects.
“A fivefold overdose (for example) is a medical emergency and can be fatal if not rapidly managed.”
Such scenarios demanded immediate, specialised medical intervention, the first step being to halt administration and focus on securing the patient’s airway and breathing.
“Advanced life support may become necessary. A specific treatment called intravenous lipid emulsion (a fat-based solution) is used to bind the lignocaine and mitigate its toxic effects,” he explained.
“The one commonly used in South Africa is called Intralipid, which is typically available in hospital operating theatres where regional anaesthesia is often administered.”
Chetty stressed the importance of having all essential medications and equipment on hand for resuscitation in cases of local anaesthetic overdose, particularly for procedures undertaken in consulting rooms.
“This includes having Intralipid readily available. Resuscitation must be conducted by a qualified doctor or an appropriately trained nurse,” he added.
In cases where an overdose is suspected, an emergency must be declared, and help summoned immediately.
While awaiting medical assistance, it was critical to ensure the patient’s airway remained open, and to monitor their breathing and pulse, and initiate CPR if necessary.
“Advanced resuscitation care requires trained healthcare professionals. Once stabilised, the patient would need to be transferred to a high-care hospital environment.”
Despite multiple attempts to contact Machebe, no response has been received by News24.
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