This study aimed to evaluate the feasibility and performance of Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway (LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in morbidly obese patients in one-lung ventilation (OLV). In a prospective, randomized double-blind controlled clinical trial, 80 morbidly obese patients (ASA I-III, aged 20–70) undergoing general anesthesia for elective thoracic surgeries were randomly allocated into groups Arndt (n=40) and L-DLT (n=40). In group Arndt, a LMA™ Proseal was placed followed by an Arndt-endobronchial blocker. In group L-DLT, patients were intubated with a left-sided double-lumen endotracheal tube. Primary endpoints were the airway establishment, ease of insertion, oxygenation, lung collapse and surgical field exposure. Results showed similar ease of airway establishment and tube/device insertion between the two groups. Oxygen arterial pressure (PaO2) of patients in the Arndt group was significantly higher than L-DLT (154±46 vs 105±52 mmHg; P<0.05). Quality of lung collapse and surgical field exposure in the Arndt group was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05). Duration of surgery and anesthesia were significantly shorter in the Arndt group (2.4±1.7 vs 3.1±1.8 and 2.8±1.9 vs 3.8±1.8 h, respectively; P<0.05). Incidence of hoarseness of voice and incidence and severity of throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h after surgery were significantly lower in the Arndt group (P<0.05). Findings suggested that Arndt-endobronchial blocker combined with LMA can serve as a promising alternative for morbidly obese patients in OLV in thoracic surgery.

This study investigates supply chain cooperative management problem. In this study, based on principal-agent, firstly we analyses cooperative management factors in supply chain including leading enterprise expected utilities, subsidiary enterprise expected incomes and leading enterprise agency cost, then the incentive contract model is constructed; Secondly the model is solved in the case of symmetric information and asymmetric information; At last, in order to make clear of the model, this paper does mathematical analysis of leading enterprise expected utilities, subsidiary enterprise expected incomes and leading enterprise agency cost. Some important conclusions are obtained: subsidiary enterprise ability, cost coefficient, absolute risk aversion factor and output variance has the same influence on leading enterprise expected utilities and subsidiary enterprise expected incomes; subsidiary enterprise ability, cost coefficient has the same influence on leading enterprise expected utilities, subsidiary enterprise expected incomes and leading enterprise agency cost; leading enterprise expected utilities and subsidiary enterprise expected incomes become bigger and bigger, but leading enterprise agency cost becomes smaller and smaller with absolute risk aversion factor and output variance decreased. etc. Leading enterprise can take on incentive measures (improving subsidiary enterprise ability, decreasing subsidiary enterprise cost coefficient.etc) to optimize supply chain management based on the common factors.