M. Botero et al., Effects of Trendelenburg position and positive intrathoracic pressure on internal jugular vein cross-sectional area in anesthetized children, J CLIN ANES, 13(2), 2001, pp. 90-93
Study Objective: To compare the cross-sectional area (in cm(2)) of the left
internal jugular vein (LIJV) and right internal jugular vein (RIJV) In ane
sthetized children, and measure the response to the Trendelenburg tilt posi
tion (TBRG) and a positive inspiratory pressure hold.
Design: Prospective, nonrandomized study.
Setting: University medical center
Patients: 45 ASA physical status I and II children, ages 6 months to 8 year
s, undergoing general anesthesia and mechanical ventilation.
interventions: The cross-sectional area of both internal jugular veins was
measured with a 5-MHz, two-dimensional surface transducer at the level of t
he cricoid cartilage. Three measurements were obtained: I) with the patient
supine, 2) during a IO-second breath-hold with a positive inspiratory pres
sure (PIP) of 20 cm H2O, and 3) with the patient at 20 degrees TBRG. Data w
ere analyzed with two-way analysis of variance (ANOVA) and Student-Newman-K
euls test, with a p < 0.05 considered significant.
Measurements and Main Results: In supine patients, the cross-sectional area
of the RIJV was larger than the LIJV in 31 patients (69%), and equal or sm
aller in 14 patients (31%) (0.80 +/- 0.38 vs. 0.59 +/- 0.22; p = 0.002). A
PIP hold, but not TBRG, significantly dilated the RIJV(0.8 +/- 0.38 at base
line vs. 0.93 +/- 0.42 with TBRG; p = not significant vs. 1.1 +/- 0.46 with
PIP; p < 0.05), whereas neither maneuver was effective with the LIJV.
Conclusions: The cross-sectional area of the RIJV is often greater than the
LIJV; the TBRG was not effective to increase the cross-sectional area of t
he internal jugular veins, and only a PIP hold increased significantly the
cross-sectional area of the RIJV. In this study, the LIJV appeared of small
er size and less compliant compared with the RIJV. (C) 2001 by Elsevier Sci
ence Inc.