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Biomedical subjects

A Mackersie

Publications and source records attributed to A Mackersie.

8 recordsLinked to original sources

A comparison of the induction characteristics of sevoflurane and halothane in children.

The induction characteristics of sevoflurane and halothane were compared in 81 children aged 6 months to 6 years. The mean time taken to achieve loss of eyelash reflex was significantly shorter with sevoflurane than with halothane (sevoflurane, mean time (SD) 1 min 41 s (35 s), halothane, mean time (SD) 2 min 17 s (43 s), t = 4.11, p = < 0.01). The mean time taken to complete induction (to achieve steady spontaneous ventilation and small pupils with central gaze) was also shorter in children induced with sevoflurane (sevoflurane, mean time (SD) 3 min 58 s (1 min 8 s), halothane, mean time (SD) 4 min 50 s, (1 min 27 s), t = 2.29, p = 0.027). Effects on heart rate, blood pressure and oxygen saturation during induction were similar for both agents. There were no major complications during induction with either halothane or sevoflurane.

Anesthesia, Inhalation

A comparison of the recovery characteristics of sevoflurane and halothane in children.

The recovery characteristics of sevoflurane and halothane anaesthesia were compared in 40 children aged 6 months to 6 years undergoing day case surgery. The mean time taken to open eyes after surgery had ended was appreciably and significantly shorter after sevoflurane than after halothane (sevoflurane, mean time (SD) 7 min 52 s (5 min 46 s), halothane, mean time (SD) 15 min 50 s (9 min 2 s), t = 3.32, p = 0.002). The time taken to be ready for discharge from the recovery unit to the ward was also significantly shorter after sevoflurane than after halothane (sevoflurane, mean time (SD) 12 min 46 s (4 min 11 s), halothane, mean time (SD) 19 min 13 s (9 min 48 s), t = 2.7, p < 0.01). However, more children were in pain and given analgesia after sevoflurane (p < 0.01) and the mean time to reach the criteria for discharge home was similar in both groups (sevoflurane, mean time (SD) 2 h 9 min (17 min), halothane, mean time (SD) 2 h 4 min (8 min)). There were no major complications in either group.

Ambulatory Surgical Procedures

Cardiac arrest and resuscitation of a 6-month old achondroplastic baby undergoing neurosurgery in the prone position.

We describe the case of a 6-month-old achondroplastic baby who underwent foramen magnum decompression to relieve congenital cervical cord compression. During the procedure, acute hypotension occurred secondary to cord compression, and following attempts to alleviate this, torrential haemorrhage ensued and air was entrained into the circulation through large venous channels in the surgical field. This resulted in an asystolic cardiac arrest from which the baby was resuscitated whilst remaining in the prone position. Haemorrhage remained difficult to control and a second episode of air embolism occurred 5 min later leading to a profound bradycardia and hypotension again requiring full cardiorespiratory resuscitation in the prone position. In total, 11 min elapsed before an adequate spontaneous cardiac output was re-established. The procedure was abandoned and the patient transferred to the intensive care unit for postoperative management. An electroencephalogram performed after 24 h was reported as normal, and clinically the child made a full neurological recovery.

Achondroplasia

Recent results of treatment of infantile hypertrophic pyloric stenosis.

During the five year period December 1980 to November 1985, 106 infants with hypertrophic pyloric stenosis were treated. There were no operative deaths, but two late deaths occurred from associated abnormalities. The combination of preoperative rehydration, skilled anaesthesia, and the use of the Fredet-Ramstedt operation (pyloromyotomy) have virtually eliminated mortality from uncomplicated infantile hypertrophic pyloric stenosis. The most common complications were gastro-oesophageal reflux in 11 (11%), perforation of the duodenal fornix in nine (8%), and wound infection in five (5%); no wound dehisced.

Duodenum

Esophageal replacement with whole stomach in infants and children.

This is a report of ten patients in whom the esophagus is replaced by the whole stomach brought through the chest. It was used for children with long gap or previously failed esophageal atresia repair. It documents complications (anastomotic leak and stricture) and morbidity, and highlights precautions that must be taken.

Child