Internal Jugular Vein Flow in the Sitting Position

NCT02356887 | Completed Results

• 1 other identifier: 14-8319
• Study Type: interventional
• Target: 12
• Locations: 1 country
• Sites: 1

Brief Summary

During neurosurgical procedures, patients need to be placed in sitting position for surgical access especially in surgeries in the vertex or posterior fossa. Due gravitational effect of sitting position the flow in IJV may be reduced. Venous air embolism (VAE) is a common complication of sitting position craniotomy and carries high mortality and morbidity. Venous pressure decreases as the head of the patient is raised above the heart. Hence, negative venous pressure in the cerebral venous system promotes entrapment of air in accidental opening of the sinuses. Common methods to prevent VAE in sitting position include increasing the venous pressure by either jugular venous compression and/or increasing the venous pressure by adding positive end expiratory pressure (PEEP). Both these methods can decrease venous return and can lead to brain swelling.. In addition, improper neck position can cause the kinking of the IJV which may lead to decreased venous drainage and increased ICP. This has been shown to be the contributing factor for intraoperative brain swelling and postoperative neck and tongue swelling leading to airway obstruction. Optimal brain perfusion is best in the neutral position of the head, but surgery cannot always be performed with this.

Conditions

Jugular Venous Flow

Outcome Measures

Primary Outcomes (4)

• Internal Jugular Venous Flow

  Right Internal Jugular Vein Flow in the sitting position.

  1 day

• Left Internal Jugular Vein Flow

  left internal jugular vein cross-sectional area in the sitting position at rest and with application of the cervical collar.

  1 day

• Right Internal Jugular Vein Flow in the Sitting Position

  Right internal jugular vein peak velocity in the sitting position at rest and with application of the cervical collar

  one day

• Right Internal Jugular

  Comparisons of right internal jugular vein flow in the sitting position at rest and with application of the cervical collar

  one day

Secondary Outcomes (2)

• Left Internal Jugular Vein Flow in the Sitting Position

  One day

• Left Internal flow in the Sitting Position

  One day

Study Arms (1)

sitting position

EXPERIMENTAL

The volunteers were kept comfortable in the sitting position. The cricoid cartilage (representing the C6 level) was used as a landmark. A horizontal straight line drawn across the volunteer's neck at the cricoid level and intersecting the IJV on both sides of the neck marked the initial scanning points. The second scanning point was along the IJV at the highest accessible point on the neck. Internal jugular vein cross-sectional area and blood velocity were measured using 2D ultrasound and Doppler (Philips CX50, Andover, MA, USA), respectively, with a 12-3 MHz transducer (Philips L12-3, Andover, MA, USA)

Diagnostic Test: Jugular venous ultrasound

Interventions

Jugular venous ultrasound DIAGNOSTIC_TEST

All volunteers will be fully awake throughout the study and be kept comfortable. A cross will be marked where the left and right IJV cross the level of C6. This is where all the measurements will be taken in 3 different conditions at rest, jugular occlusion and valsalva maneuver. At each conditions, the left and right IJV will be scanned with an ultrasound measuring the cross sectional area and Doppler velocity of the IJV. The least amount of pressure will be used to press on the ultrasound probe and the measurements will be obtained at end inspiration. The IJV flow is then calculated.

sitting position

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult healthy volunteers who are above the age of 18 ASA 1
• Body mass index (BMI) less than and equal to 35

You may not qualify if:

• Lack of informed consent
• Language barrier
• Medical students and anesthesia residents going through the department as part of their rotation

Sponsors & Collaborators

• Lashmi Venkatraghavan: lead
• University Health Network, Toronto: collaborator

Study Sites (1)

Toronto Western Hospital

Toronto, Ontario, M5T2S8, Canada

Location

Results Point of Contact

• Title: Emad Al Azazi
• Organization: Toronto western Hospital/UHN

emad.alazazi@uhnresearch.ca

416-603-5800

Study Officials

• Lashmi Venkatraghavan, MD

  University Health Network, Toronto

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: DIAGNOSTIC
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Assistant Professor, Department of Anesthesia, Toronto Western Hospital, Toronto, Canada

Study Record Dates

• First Submitted: February 2, 2015
• First Posted: February 5, 2015
• Study Start: February 1, 2015
• Primary Completion: September 1, 2015
• Study Completion: September 1, 2015
• Last Updated: January 10, 2023
• Results First Posted: July 14, 2020

Record last verified: 2022-12

Locations

CA (1)