Department of Neurology, University Hospital Charité, Schumannstrasse 20/21, D-10098 Berlin, Germany*Corresponding author
Accepted for publication: June 24, 2002
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Abstract |
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Methods. Fifteen healthy volunteers were studied by B-mode duplex sonography to assess changes in cross-sectional area (CSA) of the right IJV during 10° head-down tilt.
Results. Median CSA in the supine position was 102 mm2 [range 16266, mean (SD) 113 (69)]. CSA increased to 139 mm2 [23388, 158 (93)] immediately after tilting (P<0.0001, repeated measures ANOVA). No significant further change was noted in the next 20 min. CSA returned to baseline level after return to the supine position.
Conclusion. The 10° head-down tilt manoeuvre in healthy volunteers causes an immediate, significant increase in CSA in the right IJV. A longer tilt did not cause further increase in jugular CSA.
Br J Anaesth 2002; 89: 76971
Keywords: measurement techniques, B-mode ultrasound; position, head-down tilt manoeuvre; veins, jugular, cannulation
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Introduction |
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Methods and results |
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The median jugular CSA in the supine position before head-down tilt was 102 mm2 [range 16266, mean 113 (69)]. One minute after tilting the median area had increased to 139 mm2 [range 23388, mean 158 (93)] and did not change significantly in the next 20 min. On return to the supine position, CSA values immediately returned to baseline levels (Fig. 2).
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Comment |
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A recent study, providing information about the duration of tilt, reported a baseline CSA of 95 (26) mm2 and follow-up values of 118 (39) and 116 (43) mm2 after 1 and 10 min of tilt respectively.1 We found that the venous CSA changes occurred within 1 min after head-down positioning. During the following 19 min, however, no further change in mean jugular CSA was found.
To assess if the individual change differed from the median results, each case was analysed for the time at which the maximal CSA was detected. Interestingly, we found a nearly even time distribution, with a median duration of 8 min (range 120). However, the absolute differences between the 1 min and maximal CSAs compared with the differences during the 3 min supine measurements (i.e. the systematic error of the applied ultrasound method) gave median values of 10 mm2 [range 037, mean 12 (10)] and 8 mm2 [range 016, mean 8 (5)] respectively. The remaining real increase in mean area of 2 mm2 during 20 min of head-down tilt compared with a 37 mm2 increase after 1 min of tilt is small and clinically irrelevant.
Prolongation of a position that can be uncomfortable for conscious patients is unnecessary.
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Acknowledgement |
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References |
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