Yuki Koichi, Chilson Kelly, Odegard Kirsten C, DiNardo James A
Cardiac Anesthesia Service, Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
Anesth Analg. 2007 Aug;105(2):365-8. doi: 10.1213/01.ane.0000267259.13585.ba.
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.
The CSA (cm(2)) 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 degrees 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.
No significant change in the RIJV CSA or % change in CSA from baseline (S) was observed.
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.
超声越来越多地用于辅助儿童右颈内静脉（RIJV）置管。在无心脏病的儿童中，体位改变和增强手法可增加RIJV横截面积（CSA），并进一步便于置管。我们研究了这些手法对接受Fontan手术的双向Glenn（BDG）分流患儿RIJV CSA的影响。
通过超声平面测量法（SonoSite）评估21例接受Fontan手术的BDG分流患儿的RIJV CSA（cm²）。采用仰卧位（S）和头低脚高位15度（T）两种体位，以及手法肝脏压迫（L）和模拟Valsalva动作（V）两种增强手法，并将其组合使用。对每位患者进行8次单独测量（S、S + L、S + V、S + L + V、T、T + L、T + V、T + L + V）。使用重复测量的单向方差分析和Tukey事后两两比较分析对数据进行分析。
未观察到RIJV CSA有显著变化，也未观察到与基线（S）相比CSA的百分比变化。
对于接受Fontan手术的BDG分流患者，体位改变和增强手法不太可能便于RIJV置管，因为这些干预措施不会增加RIJV CSA。
