Accuracy of the central landmark for catheterization of the right internal jugular vein after placement of the ProSeal laryngeal mask airway.
OBJECTIVE
Catheterization of the internal jugular vein (IJV) after placement of a laryngeal mask airway (LMA) has been reported to be difficult. The purpose of this study was to evaluate the accuracy of the central landmark for catheterization of the right IJV after placement of a ProSeal LMA.


METHODS
We enrolled 80 patients (30 men and 50 women) who were scheduled to undergo surgery under general anesthesia conveyed by a size 3 ProSeal LMA. A needle pathway based on the central landmark for right IJV catheterization was simulated. Ultrasound images were obtained, which we contrasted with the simulated pathway to evaluate whether the landmark accuracy remained unchanged after placement of the ProSeal LMA. Both frequency of simulated right carotid artery (CA) puncture and overlap between the right IJV and right CA were also investigated.


RESULTS
The simulated needle pathway ran along the course of the right IJV in 60% (48/80) of subjects, and transected the CA in 31.3% (25/80) of subjects. Both events together occurred in 20% (16/80) of subjects. The central landmark had a medial bias of 6.8 mm (95% confidence interval, 5.3-8.4). In 83.8% (67/80) of subjects, the center of the right IJV was lateral to the central landmark. The possibility of overlap of the right IJV and CA was high after ProSeal LMA placement.


CONCLUSIONS
After placement of the ProSeal LMA, the central landmark could not offer a good success rate at the first puncture attempt. When using the central landmark to catheterize the IJV after a ProSeal LMA placement, medial deviation of the central landmark should be considered. Ultrasound guidance may be helpful in difficult cases.
Tseng
Kuang-Yi
KY
Department of Anesthesiology, Kaohsiung Medical University Hospital, and Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan, R.O.C.
Tsai
Cheng-Jing
CJ
Wu
Sheng-Hua
SH
Lu
David V
DV
Hsu
Hung-Te
HT
Lu
I-Chen
IC
Chu
Koung-Shing
KS
D000328:Adult; D000368:Aged; D002339:Carotid Arteries; D002405:Catheterization, Central Venous / Q000379:methods*; D005260:Female; D006801:Humans; D007601:Jugular Veins; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged