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Comparison of the effect of the Trendelenburg and Trendelenburg plus passive leg raising positions on the right internal jugular vein cross-section area of the right internal jugular vein in awake patients

Barış Arslan1, Aslı Idem1, Ali Arslan2

1Department of Anesthesia and Intensive Care, Adana City Training and Research Hospital, Adana, Turkey
2Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey

BACKGROUND AND AIM: The rate of successful first pass catheterization of IJC is specifically identified with venous size. A high success rate should be more likely with a larger IJV size. Many techniques in order to increase venous size have been described including the Valsalva maneuver, positive intrathoracic pressure applications and Trendelenburg position. Passive leg raising (PLR), a maneuver of straight passive elevation, effects are simply explained by reintegration of blood in the legs to the central circulation with autotransfusion. In addition to autotransfusion, baroreflex suppression and elevated thoracic pressure are effective in Trendelenburg position.Combining these two positions may provide a wider venous diameter. The primary aim of the present study was to evaluate the effectiveness of PLR combined with Trendelenburg position on the CSA(cross section area) of the right internal jugular vein assessed with ultrasound measurement in awake patients.

METHODS: 24 adult patients were enrolled for the study. Internal Jugular Vein (IJV) with their necks turned 20-30 degrees to the left were measured by using ultrasound at four different positions one day before the surgery. First was the supine position. The second was Trendelenburg position. Then, PLR + Trendelenburg position, patients legs were elevated by 40 degrees with Trendelenburg position. Lastly, all patients have replaced the supine position again. The positions used in the study are shown in figure 1. CSA, vertical and horizontal diameters of the right IJV were measured and evaluated.

RESULTS: The mean CSA of RIJV significantly increased to 111.1± 56.5 mm2 in the Trendelenburg position compared to supine position (p<0.05) (Table-1). However, there was no statistically significant difference between the Trendelenburg and Trendelenburg+PLR position in terms of CSA.

CONCLUSIONS: PLR applied together and after Trendelenburg position does not significantly increase the mean CSA of the right IJV. In fact, this position decreases the CSA.

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