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A420
October 15, 2006 9:00 AM - 11:00 AM Room Hall E, Area A |
| Internal Jugular Vein Diameter on Ultrasound Predicts Jugular Bulb Dominance |
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Paul K. Tenenbein, M.D., F.R.C.P.C., Arthur M. Lam, M.D., F.R.C.P.C., Basavaraj Ghodke, M.D., Gavin W. Britz, M.P.H., Laligam N. Sekhar, M.D. Department of Anesthesiology, University of Washington, Seattle, Washington |
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Background: Monitoring jugular venous oxygenation may add valuable information to the management of patients in the operating room during neurological surgery and head injured patients in the intensive care unit. Monitoring the dominant cerebral venous drainage is desirable. However, the optimal method to determine jugular bulb dominance is controversial. The aim of this study is to compare a novel, simple and non-invasive method using ultrasound to the gold standard, cerebral angiography. Methods: After IRB approval we studied 25 consecutive patients who underwent cerebral angiography and a neurosurgical procedure for which we routinely insert a jugular bulb catheter. Following induction of general anesthesia and endotracheal intubation the diameter of each internal jugular vein was measured at the level of the cricoid cartilage using the internal scale of a portable ultrasound machine. Measurements were performed with patients supine and the neck in the neutral position. The side with the larger vein was considered dominant. This was compared to the results of the cerebral angiogram assessment made by a radiologist unaware of the results of the ultrasound examination. Jugular bulb dominance was determined by assessing each lateral sinus using the standard AP view during the venous phase of left and right carotid artery injections. Data is presented as the mean ± standard deviation. Parametric data was compared using a 2 sample t-test. Results: We studied 14 females and 11 males with an average age of 46 ± 12.9 years and average heights and weights of 168.1 ± 10.5 cm and 81.1 ± 16.1 kg. Indications for surgery included tumor, aneurysm and arteriovenous malformation. The right internal jugular vein was larger than the left in 19 patients (76.0%), the 2 veins were equal in size in 2 patients (8.0%) while the left was larger in 4 patients (16.0%). Overall, the average diameter of the right internal jugular vein was larger than the left, 1.48 ± 0.39 cm vs 1.12 ± 0.36 cm (p = .001). On angiography, the right jugular bulb was dominant in 11 patients (44.0%), jugular bulb drainage was deemed equal in 10 patients (40%) and the left jugular bulb was dominant in 4 patients (16%). In comparing ultrasound to angiography, the 4 patients with larger veins on the left had left dominant cerebral drainage while the 2 patients with equal veins had equal cerebral drainage. Of the 19 patients whose right internal jugular veins were larger, 11 patients had a right dominant jugular bulb while the remaining 8 patients had equal drainage (table 1). In the 15 patients who had a dominant jugular bulb, ultrasound predicted the dominant side with 100% sensitivity and specificity. Conclusions: Internal jugular vein diameter on ultrasound predicts jugular bulb dominance when there is a dominant side. Therefore, we suggest the use of ultrasound as a simple and accurate method of determining the ideal jugular bulb to cannulate.[figure1] Anesthesiology 2006; 105: A420 |
Figure 1
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