Department of Neuroanesthesia, Neurological Institute Besta, Via Celoria, 11 20136 Milan, Italy.
Anesth Analg. 2012 Apr;114(4):777-84. doi: 10.1213/ANE.0b013e3182459917. Epub 2012 Jan 17.
The optimal degree of neck rotation during internal jugular vein (IJV) cannulation remains undetermined because previous studies suggested using sonography, but without puncturing the vein. We assessed whether a neutral position (NP) of the head (0 degrees) during ultrasound-guided cannulation of the IJV was safer than rotating the neck to 45 degrees head turned. The effect of these 2 positions during ultrasound-guided cannulation on major complications was the primary outcome. Overall complications, venous access time, and perception of difficulty during the procedure were also evaluated.
A prospective, randomized, controlled, nonblinded study was conducted in a tertiary neurosurgical hospital. Patients undergoing major elective neurosurgical procedures requiring a central venous line were randomly allocated to 2 groups; ultrasound-guided cannulation of the IJV was then performed using an out-of-plane orientation.
One thousand four hundred twenty-four patients were evaluated, but 92 were excluded; 670 were allocated to the head turned group and 662 to the NP group. Cannulation was 100% successful. Demographic data were similar in the 2 groups except for IJV positions. There were only 10 major complications: 6 in the 0-degree NP group and 4 in the 45-degree head turned group. The frequency of these complications was not different between the 2 groups. The overall complication rate was 13%, and was higher in women, in patients with ASA physical status ≥II, and in patients with a smaller diameter vein, or when the vein was located deeper and lateral or in the anterolateral position. An increased venous access time was associated with an increased rate of overall complications. The perception of difficulty performing the procedure with the head placed in the 2 positions was not statistically different in either group.
A head NP was as safe as a 45-degree neck rotation during ultrasound-guided IJV cannulation with regard to both major and minor complications, and venous access time was similar. Ultrasound guidance helps determine optimal head rotation for IJV cannulation.
在颈内静脉（IJV）置管过程中，颈部旋转的最佳角度仍未确定，因为之前的研究表明可以使用超声，但无需刺破静脉。我们评估了在超声引导下进行 IJV 置管时头部保持中立位（NP）（0 度）是否比将颈部旋转至 45 度头侧位更安全。这两种体位在超声引导下置管对主要并发症的影响是主要结果。总体并发症、静脉入路时间和操作过程中的难度感知也进行了评估。
一项前瞻性、随机、对照、非盲法研究在一家三级神经外科医院进行。需要中心静脉置管的择期大型神经外科手术患者被随机分配到 2 组；然后使用平面外方位进行 IJV 的超声引导置管。
评估了 1424 名患者，但有 92 名被排除；670 名患者被分配到头侧位组，662 名患者被分配到 NP 组。置管均 100%成功。除 IJV 位置外，两组的人口统计学数据相似。仅发生 10 例主要并发症：0 度 NP 组 6 例，45 度头侧位组 4 例。两组并发症发生率无差异。总体并发症发生率为 13%，女性、ASA 身体状况≥II 级、静脉直径较小、静脉位置较深且偏侧或前外侧、静脉入路时间较长的患者并发症发生率较高。静脉入路时间延长与总体并发症发生率增加相关。在这两组中，患者对头置于这两种体位的操作难度的感知没有统计学差异。
在超声引导下进行 IJV 置管时，头部 NP 与 45 度颈部旋转相比，主要和次要并发症的安全性相当，且静脉入路时间相似。超声引导有助于确定 IJV 置管时最佳的头部旋转角度。
