title: Rotation of the head might not be recommended for internal jugular puncture in infants and children.
abstract: BACKGROUND
  Traditionally, we have been puncturing the internal jugular vein (IJV) with the head rotated. However, in adults it has been suggested that rotation of the head increases the magnitude of an overlapping of the IJV to the carotid artery (CA). Therefore, in infants and children, we have examined anatomic relationship between the IJV and the CA under the head in midline and head in rotated position.
  
  
  METHODS
  Eleven infants and 51 children were included. Under general anesthesia, the patient was positioned in the Trendelenburg position with a shoulder roll to allow extension of the neck. At first, the head was placed in the midline position. The ultrasound probe was placed perpendicular to the skin, and images of the right IJV and CA were collected at the level of the cricoid cartilage. Then, the head was rotated to the left at 45 degrees. The images were collected in the same way. The position of the right IJV relative to the CA was defined as anterior (A), anterolateral (AL), or lateral (L).
  
  
  RESULTS
  Rotation of the head increased the magnitude of an overlapping because of more changes from L --> AL, L --> A, or AL --> A (P < 0.05, Wilcoxon t-test).
  
  
  CONCLUSIONS
  We conclude that the rotation of the head increases the magnitude of an overlapping of the IJV to the CA in infants and children.
authors.affiliation: Department of Anesthesiology, Gunma Children's Medical Center, Shibukawa, Gunma, Japan. tarai@gcmc.pref.gunma.jp
authors.forename: Toshimi
authors.initials: T
authors.lastname: Arai
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Kyoko
authors.initials: K
authors.lastname: Koizuka
authors.forename: Asako
authors.initials: A
authors.lastname: Yasuoka
mesh_terms: D002339:Carotid Arteries / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D005260:Female; D006257:Head / Q000000981:diagnostic imaging; D018475:Head-Down Tilt; D006801:Humans; D007223:Infant; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000502:physiology*; D008297:Male; D011677:Punctures / Q000379:methods*; D012399:Rotation; D014463:Ultrasonography