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Optimal Head Rotation and External Landmark for Internal Jugular Vein Cannulation After Placement of Proseal Laryngeal Mask Airway

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01407302
First Posted: August 2, 2011
Last Update Posted: December 25, 2013
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Information provided by (Responsible Party):
Gwak Mi Sook, Samsung Medical Center
  Purpose

Recently, laryngeal mask airway (LMA) placements are frequently performed for general anesthesia. The investigators occasionally encounter a clinical situation to perform internal jugular vein (IJV) cannulation after LMA insertion, especially for difficult airway in subjects undergoing major surgery. However, anatomic relations of IJV and common carotid artery (CCA) in patient with LMA placement have been reported to be different from those in patients with endotracheal tube. The degree of overlapping of the right IJV and CCA after LMA placement was greater than before LMA placement. Furthermore, there are many cases of complete overlapping right IJV and CCA after LMA placement. Therefore, the risk of puncturing CCA increases when the investigators try to cannulate IJV after LMA placement. Furthermore, the central landmark commonly used for IJV cannulation was proved to show low success rate after LMA placement in previous report.

The investigators carefully examined the anatomic relations of IJV and CCA after LMA insertion with ultrasonography, and found that the degree of overlapping is different according to the degree of head rotation. The investigators postulated that if the degree of overlapping is different according to the degree of head rotation after LMA insertion, the investigators can find the angle of head rotation for least overlapping and reduce the risk of CCA puncture. Therefore, the investigators tried (1) to find the optimal head rotation angle appropriate for puncturing IJV after LMA placement, and (2) to find suitable landmark adequate for IJV cannulation after LMA placement.


Condition Intervention
General Anesthesia With Laryngeal Mask Airway (LMA) Other: Head rotation

Study Type: Observational
Study Design: Observational Model: Case Control
Time Perspective: Prospective
Official Title: Optimal Head Rotation and External Landmark for Internal Jugular Vein Cannulation After Placement of Proseal Laryngeal Mask Airway

Resource links provided by NLM:


Further study details as provided by Gwak Mi Sook, Samsung Medical Center:

Primary Outcome Measures:
  • overlap index [ Time Frame: at 5 min after anesthesia induction ]
    The overlap index was derived from the ratio of the overlapping length of the IJV to the horizontal diameter of the CCA measured on the ultrasonographic image. The formula of calculation is as follows: overlap index = [overlap length (mm)/ CCA diameter (mm)] X 100(%), the measurements were repeated according to the degree of head rotation (neutral, 15 degree, 30 degree, 45 degree)


Secondary Outcome Measures:
  • The success of simulated internal jugular vein puncture (central landmark) [ Time Frame: at 5 min after anesthesia induction ]
    The success of internal jugular vein puncture guided by the central landmark simulated on the ultrasonographic images, the measurements were repeated according to the degree of head rotation (neutral, 15 degree, 30 degree, 45 degree)

  • The success of simulated internal jugular vein puncture (external jugular vein landmark) [ Time Frame: at 5 min after anesthesia induction ]
    The success of internal jugular vein puncture as guided by 1.5 cm or 2.5 cm medial to the external jugular vein simulated on the ultrasonographic images, the measurements were repeated according to the degree of head rotation (neutral, 15 degrees, 30 degrees, 45 degrees)


Enrollment: 100
Study Start Date: July 2011
Study Completion Date: December 2012
Primary Completion Date: December 2012 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
LMA group
patients undergoing general anesthesia with LMA insertion
Other: Head rotation
Repeated ultrasonographic examination according to the degree of head rotation (examination of overlap index of internal jugular vein and common carotid artery, and accuracy of external landmark of jugular cannulation)
E-tube group
patients undergoing general anesthesia with e-tube
Other: Head rotation
Repeated ultrasonographic examination according to the degree of head rotation (examination of overlap index of internal jugular vein and common carotid artery, and accuracy of external landmark of jugular cannulation)

Detailed Description:
Recently, laryngeal mask airway (LMA) placements are frequently performed for general anesthesia. The investigators occasionally encounter a clinical situation to perform internal jugular vein (IJV) cannulation after LMA insertion, especially for difficult airway in subjects undergoing major surgery. However, anatomic relations of IJV and common carotid artery (CCA) in patient with LMA placement have been reported to be different from those in patients with endotracheal tube. The degree of overlapping of the right IJV and CCA after LMA placement was greater than before LMA placement. Furthermore, there are many cases of complete overlapping right IJV and CCA after LMA placement. Therefore, the risk of puncturing CCA increases when the investigators try to cannulate IJV after LMA placement. Furthermore, the central landmark commonly used for IJV cannulation was proved to show low success rate after LMA placement in previous report. Previous study recommended the lower puncture point near that area where the clavicular head of the sternocleidomastoid muscle attaches to the clavicle, because CCA was not observed in the vicinity of the IJV after LMA insertion. Even though they performed test puncture at the lower puncture point in 20 patients and found no complications, the lower puncture point is not the usual site for IJV cannulation for most anesthesiologists. It is known that increased head rotation is associated with high probability of CCA contact. The investigators carefully examined the anatomic relations of IJV and CCA after LMA insertion with ultrasonography, and found that the degree of overlapping is different according to the degree of head rotation. The investigators postulated that if the degree of overlapping is different according to the degree of head rotation after LMA insertion, the investigators can find the angle of head rotation for least overlapping and reduce the risk of CCA puncture. Therefore, the investigators tried (1) to find the optimal head rotation angle appropriate for puncturing IJV after LMA placement, and (2) to find suitable landmark adequate for IJV cannulation after LMA placement.
  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   20 Years to 70 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
patients undergoing general anesthesia with laryngeal mask airway insertion
Criteria

Inclusion Criteria:

  • patients undergoing general anesthesia with laryngeal mask airway insertion

Exclusion Criteria:

  • patients undergoing emergency surgery
  • patients with anatomical problem of airway
  • anticipated difficult airway
  • patients with hemodynamic unstability
  • patients with severe cardiopulmonary disease
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01407302


Locations
Korea, Republic of
Samsung Medical Center
Seoul, Korea, Republic of, 135-710
Sponsors and Collaborators
Samsung Medical Center
Investigators
Principal Investigator: Mi Sook Gwak, M.D.,Ph.D. Samsung Medical Center
  More Information

Responsible Party: Gwak Mi Sook, Professor, Samsung Medical Center
ClinicalTrials.gov Identifier: NCT01407302     History of Changes
Other Study ID Numbers: 2011-04-024
First Submitted: July 21, 2011
First Posted: August 2, 2011
Last Update Posted: December 25, 2013
Last Verified: December 2013

Keywords provided by Gwak Mi Sook, Samsung Medical Center:
Laryngeal mask airway
internal jugular vein cannulation