title: The effect of passive leg elevation and/or trendelenburg position on the cross-sectional area of the internal jugular vein in infants and young children undergoing surgery for congenital heart disease.
abstract: BACKGROUND
  In this study we evaluated the effect of passive leg elevation (LE) and Trendelenburg (T) position on the cross-sectional area (CSA) of the internal jugular vein (IJV) in infants and young children undergoing surgery for congenital heart disease. A secondary aim was to compare the CSA of the IJV between subjects with right-to-left (RL) shunt and left-to-right (LR) shunt.
  
  
  METHODS
  Ninety infants and small children from 10 days to 31 months old weighing from 1.5 to 9.7 kg were assigned to group RL (n = 48) or LR (n = 42). In both groups, the CSA, transverse, and vertical diameters of the IJV on both sides of the neck were measured using a 2-dimensional ultrasound transducer in the following positions: supine position, 15° of T position, supine position with 50° of LE, and 15° of Trendelenburg position with 50° of LE (TLE). A more than 25% increase in mean CSA of the IJV was considered clinically significant.
  
  
  RESULTS
  In group LR, T, LE, and TLE significantly increased CSA of both right (at least 12.3%, 10.3%, and 18.3%, respectively, "at least" refers to the lower 95% confidence limits) and left (at least 15.8%, 15.0%, and 18.9%, respectively) IJVs, whereas only TLE increased the CSA of both IJVs significantly in group RL (at least 8.2% and 7.7% in the right and left, respectively). The increase in the CSA of the right IJV related to T and TLE was larger in group LR than in group RL (at least 12.3% vs 1.2% for T and at least 18.3% vs 8.2% for TLE, respectively). A clinically significant increase in CSA was achieved in both right and left IJVs with TLE in group LR (mean 28.6% and 26.3%, respectively). The CSA of the right IJV was larger than that of the left IJV in most (at least 69.2%) patients.
  
  
  CONCLUSIONS
  Passive LE was as effective as T position to increase the CSA of the IJV, but there was no clinically significant increase in the CSA with any single maneuver. Only T position with passive LE achieved a clinically significant increase in the CSA of both IJVs in infants and young children with LR shunt, but not in the same age group with RL shunt.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Jong Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Sangmin M
authors.initials: SM
authors.lastname: Lee
authors.forename: Chung Su
authors.initials: CS
authors.lastname: Kim
authors.forename: Ryunga
authors.initials: R
authors.lastname: Kang
authors.forename: Chan Seon
authors.initials: CS
authors.lastname: Yoo
authors.forename: Hyun Sung
authors.initials: HS
authors.lastname: Cho
mesh_terms: D019412:Anatomy, Cross-Sectional; D000768:Anesthesia, General; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D018475:Head-Down Tilt / Q000502:physiology*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007601:Jugular Veins / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D007866:Leg / Q000502:physiology*; D008297:Male; D018401:Sample Size; D016683:Supine Position; D014463:Ultrasonography