I-Gel: A Rescue Intubation Device in Unanticipated Difficult Intubation for Emergency Laparotomy

The “i-gel” is a newer, non-inflatable supraglottic airway device for clinical use and also for resuscitation purposes. It has also been found to be a useful ventilation and intubation device in anticipated simulated difficult airway situations. However, its use in unanticipated difficult airway situations in emergency set up has not been explored. We describe a case of 24 year male posted for emergency laparotomy that turned out to have an unanticipated difficult airway. Attempts to intubation and ProSeal Laryngeal Mask Airway insertion failed. However, “i-gel” proved to be a very handy intubating conduit in this critical situation.

Undiagnosed Abdominal Paraganglioma: An Anaesthetic Challenge

Paragangliomas are tumours which arise in extra adrenal autonomic paraganglia and have the ability to secrete catecholamines. Their anaesthetic management is the same as that of a case of pheochromocytoma, but in an undiagnosed case like our patient, unexpected eventful encounter in the operating theatre may lead to life threatening complications during surgical resection warranting immediate management and thus posing a real challenge to the skill of an anaesthesiologist.

Antioxidative and anti-endotoxin effects of propofol on endothelial cells

Objective To investigate the antioxidant and anti-endotoxin effects of propofol on endothelial cells and the possible mechanisms.Methods Cultured endothelial cells were treated with hydrogen peroxide (H 2O 2), propofol + H 2O 2, lipopolysaccharide (LPS) and propofol + LPS, respectively. Endothelial cell damage was monitored for possible lactic dehydrogenase (LDH) release. The transcription and the protein expression levels of endothelial nitric oxide synthase (eNOS) were measured.Results LDH release was higher in groups treated with H 2O 2 or LPS than in the control group. After pretreatment with propofol, the effects induced by H 2O 2 were attenuated, but propofol did not decrease the LDH release induced by LPS. Both H 2O 2 and LPS significantly increased the eNOS transcript levels and the increases were significantly attenuated after pretreatment with propofol. Both H 2O 2 and LPS significantly increased the eNOS protein expression and the increase was attenuated after pretreatment with propofol. Conclusion Propofol could protect endothelial cells against oxidative stress by inhibiting eNOS transcription and protein expression, but could not antagonise endotoxin induced cell injuries.

连续心排血量监测仪测量心排血量趋势能力的研究综述

目前有很多种可提供连续读数而非间断读数的心排血量（cardiac output，CO）监测仪。与旧标准相比，Bland－Altman法已成为验证其性能的标准方法。然而，Bland－Altman法只能评价仪器精确度，而不能评价仪器检测心排血量连续变化的能力（趋势能力）。目前对如何进行趋势能力或趋势分析评价尚未达成一致意见。因此，我们进行了文献综述，对1997—2009年之间发表的关于比较连续CO测量方法的文献实施筛选，入选的文献根据测量技术和统计学方法进行分组。我们对分析趋势能力的文献进行了回顾以期寻找一种令人满意的统计学方法。入选的文献共有202篇。最常用的方法是脉搏波形法（69篇）、多普勒法（54篇）、生物阻抗法（38篇）以及经肺或连续热稀释法（27篇）。有41篇文献涉及到CO趋势变化，其中仅23篇提供了深入分析。有几种常用的统计方法：时间曲线图、回归分析、使用CO变化（ACO）的Bland-Altman法以及使用△CO的变化方向来确定一致性的四象限曲线图。该曲线图可通过排除小值数据而进一步精简，采用受试者操作特征曲线来定义排除范围。在动物实验中经常选用可靠的参照标准如主动脉流量探头，并可用回归分析或时间曲线图来显示变化趋势。临床研究中由于数据采集点较少（每个受试者8－10个点）而会存在更多的问题，一致意见是采用有排除范围的四象限曲线图，并应用一致性分析。使用15％排除范围时一致率〉92％表明良好的变化趋势。有人提出一种在极坐标图上显示数据变化趋势（△CO）的新方法，通过与水平轴线所成的角度表示一致性，到中心的距离表示△CO，与Bland-Altman法类似，能够用数据的垂直界限来评价变化趋势。