Is Head Rotation Preferred During Right Internal Jugular Vein Cannulation in Obese Asians?
Jae Hee Woo, Youn-jin Kim*, Dong Yeon Kim, Hee Jung Baik, Jong Hak Kim and Jong In Han
Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, 119, Mok-dong, Yangcheon-gu, Seoul 158-710, Korea
- *Corresponding Author:
- Youn-jin Kim, M.D., PhD
Department of Anesthesiology and Pain Medicine
School of Medicine, Ewha Womans University, 119, Mok-dong
Yangcheon-gu, Seoul 158-710, Korea
E-mail: [email protected]
Received date: September 12, 2012; Accepted date: October 04, 2012; Published date: October 14, 2012
Citation: Woo JH, Kim Yj, Kim DY, Baik HJ, Kim JH, et al. (2012) Is Head Rotation Preferred During Right Internal Jugular Vein Cannulation in Obese Asians? J Anesth Clin Res 3:245. doi: 10.4172/2155-6148.1000245
Copyright: © 2012 Woo JH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Obese subjects are considered to be a difficult group for central vein cannulation. We investigated the optimal position for right internal jugular vein (IJV) cannulation in relation to BMI in Asians.
Methods: 102 subjects were divided into three groups; 34 with a BMI of less than 25 kg/㎡ (Group Ⅰ), 34 with a BMI from 25 to 30 kg/㎡ (Group II), and 34 with a BMI of 30 kg/㎡ or above (Group III). Using a 5-12 MHz linear probe of an ultrasound system, the IJV depth, the diameter of the IJV and common carotid artery (CCA) and overlap length between them were measured at six positions: 0°, 30°, and 60° of head rotation to the contralateral side combined with 0° and 10° of Trendelenburg tilt.
Results: The IJV depth was deepest in Group III and significantly shorter at 10° Trendelenburg tilt compared to 0° Trendelenburg tilt. The IJV diameter increased by 10 to 20% with 10° Trendelenburg tilt and there were not significant change by head rotation or BMI. The overlap of the IJV and CCA was significantly increased in Group III compared to Group I and in Group III, there were significant increases of the overlap according to the degree of head rotation, regardless of Trendelenburg tilt.
Conclusion: We recommend head rotation less than 30° with 10° Trendelenburg tilt for right IJV cannulation, especially in obese Asians. In obese subjects, real-time ultrasound should be considered. Further study with actual cannulation is needed for availability of clinical outcome.