British journal of anaesthesia
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In order to determine if the Adult Respiratory Distress Syndrome (ARDS) is associated with a shortage of pulmonary surfactant, we have examined a series of 155 undiluted tracheal aspirates obtained from 23 patients with ARDS and from 30 patients without ARDS, all 53 needing ventilatory support. The unfixed and unstained specimens were examined by polarized light microscopy for the presence of pulmonary surfactant. Free surfactant particles were present in the aspirates of 50 patients (95%). ⋯ Fibrinogen/fibrin was found in the aspirates from 20 of 21 patients with ARDS and in only five of 30 patients without ARDS; these five had bronchopneumonia. The method has a sensitivity of 0.95 and a specificity of 0.83. The role of plasma proteins and of neutrophil leucocytes in causing ARDS is discussed.
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Flow-volume and pressure-volume loops were measured with continuous spirometry in 49 patients in whom the trachea was intubated "blindly" with a double-lumen endobronchial tube for thoracic surgery. Nineteen endobronchial tubes were malpositioned by fibreoptic bronchoscopic criteria; 63% of these were suspected because of the configuration of the spirometric loops. ⋯ The secondary displacements were identified by abnormal loop configurations and confirmed with fibreoptic bronchoscopy. Continuous spirometric monitoring is helpful in detecting endobronchial tube displacement during intubation and surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
The pressor response to venous cannulation: attenuation by prior infiltration with local anaesthetic.
We have compared the cardiovascular response to insertion of an 18-gauge venous cannula in 40 healthy patients. In 20 of the patients, cannulation was preceded by infiltration of local anaesthetic. ⋯ We conclude that there is a significant pressor response to venous cannulation which is obtunded by prior infiltration with local anaesthetic. We recommend, therefore, that s.c. injection of lignocaine should be considered before insertion of an i.v. cannula, especially in the high risk patient.