Assessment of the right internal jugular vein cross-sectional area with different levels of positive end-expiratory pressure in patients with controlled ventilation during anesthesia

Corresponding author: Dae-Young Kim, M.D., Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Junhwa-dong, Dong-gu, Ulsan 682-714, Korea. Tel: 82-52-250-7248, Fax: 82-52-250-7249, E-mail: [email protected] This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. CC For drug administration, IV fluid administration, and if securing a peripheral vein is difficult, the internal jugular vein is used for the central venous catheter to secure an IV route and for central venous pressure monitoring. Theoretically, the bigger the cross-sectional area (CSA) of the internal jugular vein, the higher the success rate when cannulation is carried out, and the smaller the area, the higher the possibility of failure, increasing the risk of complications such as hemothorax, pneumothorax, and arterial puncture [1]. Most existing cannulation methods are attempted in the trendelenburg position with leg elevation, but positive end expiratory pressure (PEEP) is being introduced as an useful method for patients under control of this study is to find an effective PEEP level for the internal jugular vein cannulation for patients under controlled ventilation and who have difficulties with the trendelenburg position. This study includes 20 American Society of Anesthesiology (ASA) Physical Status I or II patients between 24-83 year of age undergoing elective surgery that required central venous access. All patients received standardized induction of general anesthesia with penthotal sodium 5 mg/kg IV, lidocaine 60 mg IV, rocuronium 0.8-1 mg/kg IV. The patients were tracheally intubated and their lungs mechanically ventilated using volume-control mode with tidal volume 6-8 ml/kg, respiratory rate 10 breaths/min, inspiratory to expiratory ratio 1 : 2, PEEP 0 cmH2O, and were maintained with O2-Air-Desflurane. After anesthetic induction, the bed was placed in a level position and the patient was laid in the supine position, A 13 MHz linear transducer of Ultrasound (Esoate, Wing international, Italy) was placed vertically on the skin at the angular point where the medial sternocleidomastoid muscle and lateral sternocleidomastoid muscle meet, and the images of right internal jugular vein were acquired applying as little pressure as possible. (P0) The size of right internal jugular vein differs with each breath, and the largest size was recorded. Following the above method, PEEP 5 (P5), 10 (P10), 15 (P15) cmH2O and 10 o