RESUMO
INTRODUCTION The endotrachealtube is the gold standard for controlling the airway. Laparoscopic procedures mark the new era. However, with various advantages they have their complications. Endotracheal intubation evokes significant hemodynamic changes. We have used I-gel, to find a suitable alternative. The study was conducted to compare haemodynamic changes, efficacy of ventilation, and complications laparoscopic cholecystectomy. MATERIALS AND METHODS: After ethical approval the study was completed with 100 ASA PS I or II patients undergoing elective laparoscopic cholecystectomy. They were randomly allocated into either: Group-I (I-gel) or Group-E (ETT). Ease of insertion of device, haemodynamic and ventilatory parameters and perioperative complications were recorded. RESULTS: Ease of insertion was difficult in Group E compared to Group I. HR variation and MAP variation was highly significant between the groups. Leak Pressures were high throughout in GroupE. Mean Peak Airway Pressure was though higher in I-gel but was less than leak pressure and was clinically acceptable. CONCLUSION: I-gel may be an alternative to endotracheal intubation for laparoscopic cholecystectomy under general anaesthesia for its design, less haemodynamic perturbations and similar efficacy in maintaining oxygenation and ventilation.
RESUMO
The monocytic lineage cells in brain, generally speaking brain macrophage and/or microglia show some dissimilar distribution patterns and disagreement regarding their origin and onset in brain. Here, we investigated its onset and distribution/colonization pattern in normal brain with development. Primarily, early and late embryonic stages, neonate and adult brains were sectioned for routine H/E staining; a modified silver-gold staining was used for discriminating monocytic lineage cells in brain; and TEM to deliver ultramicroscopic details of these cells in brain. Immunofluorescence study with CD11b marker revealed the distribution of active microglia/macrophage like cells. Overall, in early embryonic day 12, the band of densely stained cells are found at the margin of developing ventricles and cells sprout from there dispersed towards the outer edge. However, with development, this band shrunk and the dispersion trend decreased. The deeply stained macrophage like cell population migration from outer cortex to ventricle observed highest in late embryonic days, continued with decreased amount in neonates and settled down in adult. In adult, a few blood borne macrophage like cells were observed through the vascular margins. TEM study depicted less distinguishable features of cells in brain in early embryo, whereas from late embryo to adult different neuroglial populations and microglia/macrophages showed distinctive features and organization in brain. CD11b expression showed some similarity, though not fully, with the distribution pattern depending on the differentiation/activation status of these macrophage lineage cells. This study provides some generalized spatial and temporal pattern of macrophage/microglia distribution in rat brain, and further indicates some intrigue areas that need to be addressed.