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Anesth Analg 2007;105:365-368
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000267259.13585.ba

PEDIATRIC ANESTHESIOLOGY

Trendelenburg Position, Simulated Valsalva Maneuver, and Liver Compression Do Not Alter the Size of the Right Internal Jugular Vein in Patients with a Bidirectional Glenn Shunt

Koichi Yuki, MD*, Kelly Chilson, MD{dagger}, Kirsten C. Odegard, MD*, and James A. DiNardo, MD*

From the *Cardiac Anesthesia Service, Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts; {dagger}Department of Anesthesiology, Washington University, Saint Louis, Missouri; and {ddagger}Department of Anaesthesia, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts.

Address correspondence and reprint requests to James A. DiNardo, MD, Department of Anesthesiology, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115. Address e-mail to james.dinardo{at}childrens.harvard.edu.

Abstract

BACKGROUND: Ultrasound is increasingly used to facilitate right internal jugular vein (RIJV) cannulation in children. In children without cardiac disease, position changes and enhancement maneuvers increase RIJV cross-sectional area (CSA) and further facilitate cannulation. We investigated the effect of these maneuvers on RIJV CSA in children with a bidirectional Glenn (BDG) shunt presenting for a Fontan procedure.

METHODS: The CSA (cm2) of the RIJV in 21 children with a BDG shunt presenting for a Fontan procedure was assessed by ultrasonic planimetry (SonoSite). Two positions, supine (S) and 15° Trendelenburg (T); and two enhancements maneuvers, manual liver compression (L) and a simulated Valsalva maneuver (V) were utilized in combination. Eight separate measurements (S, S + L, S + V, S + L + V, T, T + L, T + V, T + L + V) were made in each patient. Data were analyzed using one-way analysis of variance with repeated measures and with Tukey post hoc pairwise comparison analysis.

RESULTS: No significant change in the RIJV CSA or % change in CSA from baseline (S) was observed.

CONCLUSIONS: Position changes and enhancement maneuvers are unlikely to facilitate RIJV cannulation in BDG shunt patients presenting for Fontan procedure because these interventions do not increase RIJV CSA.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.