Optimal Head Rotation and External Landmark for Internal Jugular Vein Cannulation After Placement of Proseal Laryngeal Mask Airway

Recently, laryngeal mask airway (LMA) placements are frequently performed for general anesthesia. The investigators occasionally encounter a clinical situation to perform internal jugular vein (IJV) cannulation after LMA insertion, especially for difficult airway in subjects undergoing major surgery. However, anatomic relations of IJV and common carotid artery (CCA) in patient with LMA placement have been reported to be different from those in patients with endotracheal tube. The degree of overlapping of the right IJV and CCA after LMA placement was greater than before LMA placement. Furthermore, there are many cases of complete overlapping right IJV and CCA after LMA placement. Therefore, the risk of puncturing CCA increases when the investigators try to cannulate IJV after LMA placement. Furthermore, the central landmark commonly used for IJV cannulation was proved to show low success rate after LMA placement in previous report. The investigators carefully examined the anatomic relations of IJV and CCA after LMA insertion with ultrasonography, and found that the degree of overlapping is different according to the degree of head rotation. The investigators postulated that if the degree of overlapping is different according to the degree of head rotation after LMA insertion, the investigators can find the angle of head rotation for least overlapping and reduce the risk of CCA puncture. Therefore, the investigators tried (1) to find the optimal head rotation angle appropriate for puncturing IJV after LMA placement, and (2) to find suitable landmark adequate for IJV cannulation after LMA placement.