The Effect of Full Expiration on the Position and Size of the Subclavian Vein in Spontaneously Breathing Adults

Lim, Kyung Jee; Lee, Jung Man; Byon, Hyo-Jin; Kim, Hee Soo; Kim, Chong Sung; Lee, Soo Kyung; Kim, Jin Tae

doi:10.1213/ane.0b013e31826257f4

Cited by 18 publications

(19 citation statements)

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“…It has been reported that positive end-expiratory pressure (PEEP) application [ 1 , 3 ], intrathoracic pressure application [ 4 ], Trendelenburg position [ 1 , 4 ], hepatic compression [ 4 ], and valsalva maneuver [ 5 ] increase the CSA of IJV. The CSA of SCV, on the other hand, is reportedly increased by the combined use of inspiratory hold and Trendelenburg position [ 6 ], complete expiration in spontaneously breathing subjects [ 7 ], Trendelenburg position alone [ 8 ], and leg elevation [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation

et al. 2015

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BackgroundIncreased central venous pressure secondary to an increase in intraabdominal pressure has been reported during laparoscopic surgery. However, no study has yet determined the effect of pneumoperitoneum on cross-sectional area (CSA) of central veins by ultrasonography during laparoscopic cholecystectomy. Herein, we aimed to quantify changes in CSAs of internal jugular (IJV) and subclavian veins (SCV) by ultrasonography during this surgery.MethodsThis study included 60 ASA I-II patients scheduled for laparoscopic cholecystectomy surgery under general anesthesia. Pneumoperitoneum was performed with CO2 at 12 mmHg. The CSAs of right IJV and right SCV were measured using a 6 Mhz ultrasonography transducer in supine and neutral positions before anesthesia induction (T1), 5 min after connecting to mechanical ventilator (T2), 5 min after creation of pneumoperitoneum (T3), at the end of pneumoperitoneum (T4), and 5 min after desufflation and before extubation (T5) both at end-expiration and end-inspiration.ResultsThe comparison of IJV CSA at inspiration showed significant increase in T3 value compared to T2 value (p < 0.001). Similarly the expiratory measurements of IJV CSA demonstrated significant increase in T3 value compared to T2 value (p < 0.001). The comparison of inspiratory CSA measurements of SCV showed significantly increased in T3 (p = 0.009) than T2 value. In expiratory measurements there was a significant increase in T3 (p = 0.032) value compared to T2. All measurements of IJV and SCV SCAs both end-inspiration and end-expiration T5 values significantly decreased compared to T4 values (p < 0.001).ConclusionsPneumoperitoneum with an intraabdominal pressure of 12 mmHg produces significant increases in IJV and SCV CSAs during laparoscopic cholecystectomy procedure. We believe that this finding may enhance our understanding of pneumoperitoneum-induced hemodynamic changes and facilitate catheterization attempts.Trial registrationDate of registration 21/07/2016, ISRCTN Registry ( No:ISRCTN15164056, registered retrospectively).

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Section: Introductionmentioning

confidence: 99%

The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation

et al. 2015

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Section: Discussionmentioning

confidence: 99%

“…However, recent ultrasonographic studies have shown that lung deflation does not reduce the distance between the pleura and subclavian vein in paediatric patients receiving mechanical ventilation and in spontaneously breathing adults [5,6]. Previous studies have investi-gated only the infraclavicular area, using cross-sectional short-axis images of the subclavian vein but did not image the entire needle pathway including the site at which the subclavian vein is commonly punctured.…”

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confidence: 99%

“…During subclavian vein cannulation, lung deflation, by decreasing lung volume, may reduce the risk of pneumothorax by allowing the apex of the lung to move caudally, therefore, increasing the distance between the pleura and the subclavian vein. However, recent ultrasonographic studies have shown that lung deflation does not reduce the distance between the pleura and subclavian vein in paediatric patients receiving mechanical ventilation and in spontaneously breathing adults . Previous studies have investigated only the infraclavicular area, using cross‐sectional short‐axis images of the subclavian vein but did not image the entire needle pathway including the site at which the subclavian vein is commonly punctured.…”

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The effect of lung deflation on the position of the pleura during subclavian vein cannulation in infants receiving mechanical ventilation: an ultrasound study

et al. 2013

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SummaryWe evaluated the effect of lung deflation on the relative position of the pleura compared with a reference line during supra-and infraclavicular approaches to the right subclavian vein. The reference line was drawn relative to the predicted pathway of the needle. The distances between the pleura and the reference line for supra-and infraclavicular approaches were measured during inspiration and expiration in 41 infants. Central venous access is often required in the management of critically ill patients or those undergoing major surgery. The right subclavian vein is popular for placement of a central venous catheter due to relative patient comfort with long-term use, a low infection rate and less collapsibility during hypovolaemic conditions [1,2]. However, pneumothorax is a major concern during subclavian vein cannulation, with reported incidences ranging from 0% to 4% in paediatric patients [3,4].During subclavian vein cannulation, lung deflation, by decreasing lung volume, may reduce the risk of pneumothorax by allowing the apex of the lung to move caudally, therefore, increasing the distance between the pleura and the subclavian vein. However, recent ultrasonographic studies have shown that lung deflation does not reduce the distance between the pleura and subclavian vein in paediatric patients receiving mechanical ventilation and in spontaneously breathing adults [5,6]. Previous studies have investi- 1066

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“…Based on existing exploratory studies using ultrasonography,22 23 20 people were randomly selected for each age group. Categorical data were collated as numbers and percentages and compared using χ² test or Fisher’s exact test.…”

Section: Methodsmentioning

confidence: 99%

Influence of age, laterality, patient position, and spinal level on the interlamina space for spinal puncture

Bae

Park

Yoo

et al. 2019

Reg Anesth Pain Med

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Background and objectivesThe lumbar interlamina space height is an important determinant of successful spinal puncture. We aimed to evaluate the influence of age, laterality, patient position, and spinal level on the height of the interlamina window using ultrasonography.MethodsUltrasonographic examination was performed in 20 adult patients aged under 40 years (group Y) and 20 patients aged over 60 years (group O). We set three primary outcomes: difference in the interlamina height of the ligamentum flavum-dura mater complex (LFD) according to (1) age, (2) laterality, and (3) position. For secondary outcomes, the degree of ultrasonography visualization (poor, intermediate, or good) and the depths from the skin to LFD and to anterior complex were also measured on right and left paramedian sagittal oblique view in both lateral and sitting positions at L3/4, L4/5, and L5/S1 levels. All variables were analyzed in association with age, laterality, patient position, and spinal level.ResultsThe interlamina height of LFD was higher, and the degree of visualization was better in group Y than in group O. It differed depending on laterality in paramedian sagittal oblique view images in the same patients at all spinal levels. The interlamina height of LFD was the largest at L5/S1 level in both groups. Position had little influence on the interlamina height of LFD.ConclusionsScanning both sides and all spinal levels before selecting a puncture site for ultrasound-guided spinal anesthesia is recommended. The L5/S1 spinal level is a good option for spinal puncture in the elderly.Trial registration numberNCT03929874.

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The Effect of Full Expiration on the Position and Size of the Subclavian Vein in Spontaneously Breathing Adults

Abstract: The distance from the SCV to the pleura did not change after full expiration. However, this simple technique can still be considered during placement of subclavian catheters in spontaneously breathing patients, because it significantly enlarges the CSA of the SCV.

Cited by 18 publications

References 19 publications

The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation

The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation

The effect of lung deflation on the position of the pleura during subclavian vein cannulation in infants receiving mechanical ventilation: an ultrasound study

Influence of age, laterality, patient position, and spinal level on the interlamina space for spinal puncture

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