Abstract
Background/Purpose: The right internal jugular vein (RIJV) is the most commonly accessed central venous site in the cardiac operating room. The Trendelenburg position is frequently used to increase the cross-sectional area (CSA) of the RIJV to facilitate its cannulation. However, the extent of change of RIJV CSA in response to Trendelenburg positioning in anesthetized patients and its predictive factors remain unknown. Methods: Thirty-seven patients presented for the cardiac surgery, and 20 ASA I and II surgical patients without a history of cardiac disease (control) were studied. After induction of anesthesia, RIJV CSA was measured both at supine level position and in 10-degree Trendelenburg using vascular ultrasonography. Central venous pressure was measured in cardiac surgery patients only, since the patients in control group did not require invasive lines placement. Results and Conclusions: Body-surface area, central venous pressure, type of surgery and ejection fraction did not show any correlation with the degree of RIJV CSA change. RIJV dilation in response to Trendelenburg was significantly less pronounced, and more variable, in female patients.
Highlights
In cardiac surgical patients, the right internal jugular vein (RIJV) is the most commonly central venous access site [1]
CVD and control groups were similar with regard to gender, body surface area (BSA) and body mass index (BMI)
Central venous pressure had no independent effect on the size of the RIJV or its response to 10-degrees Trendelenburg
Summary
The right internal jugular vein (RIJV) is the most commonly central venous access site [1]. Trendelenburg position is commonly used to promote venous distention to facilitate the vascular cannulation [2,3,4,5,6,7,8]. Jugular veins are thought to be more responsive to Trendelenburg positioning than subclavian [9]. Factors predictive of the degree of venous dilation are largely unknown. A systematic search of the National Library of Medicine (PubMed) revealed no studies of factors predictive of, or associated with, the responsiveness of jugular veins to Trendelenburg maneuver. We studied the factors likely associated with the jugular venous responsiveness to Trendelenburg position in anesthetized patients
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