title: The effectiveness of trendelenburg positioning on the cross-sectional area of the right internal jugular vein in obese patients.
abstract: OBJECTIVE
  Trendelenburg positioning is a common approach used during internal jugular vein (IJV) cannulation. No evidence indicates that Trendelenburg positioning significantly increases the cross-sectional area (CSA) of the IJV in obese patients. The primary aim of this study was to determine the effectiveness of Trendelenburg positioning on the CSA of the right internal jugular vein assessed with ultrasound measurement in obese patients.
  
  
  METHODS
  Forty American Society of Anesthesiologists II patients with body mass index ≥30 kg/m(2) undergoing various elective surgeries under general endotracheal anesthesia were enrolled. Ultrasound images of the right IJV were obtained in a transverse orientation at the cricoid level. We measured the CSA of the right IJV two different conditions in a sealed envelope were applied in random order: State 0, table flat (no tilt), with the patients in the supine position, and State T, in which the operating table was tilted 20° to the Trendelenburg position.
  
  
  RESULTS
  The change in the CSA of the IJV from the supine to the Trendelenburg position (1.80 cm(2) vs 2.08cm(2)) was not significantly different. The CSA was paradoxically decreased in 10 of 36 patients when the position changed from State 0 to State T.
  
  
  CONCLUSIONS
  Trendelenburg positioning does not significantly increase the mean CSA of the right IJV in obese patients. In fact, in some patients, this position decreases the CSA. The use of the Trendelenburg position for IJV cannulation in obese patients can no longer be supported.
authors.affiliation: Ozkan Onal, Department of Anesthesia and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey.
authors.forename: Ozkan
authors.initials: O
authors.lastname: Onal
authors.affiliation: Seza Apiliogullari, Department of Anesthesia and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey.
authors.forename: Seza
authors.initials: S
authors.lastname: Apiliogullari
authors.affiliation: Alaaddin Nayman, Department of Interventional Radiology, Selcuk University Medical Faculty, Konya, Turkey.
authors.forename: Alaaddin
authors.initials: A
authors.lastname: Nayman
authors.affiliation: Ali Saltali, Department of Anesthesia and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Saltali
authors.affiliation: Huseyin Yilmaz, Department of General Surgery, Selcuk University Medical Faculty, Konya, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Yilmaz
authors.affiliation: Jale Bengi Celik, Department of Anesthesia and Intensive Care, Selcuk University Medical Faculty, Konya, Turkey.
authors.forename: Jale Bengi
authors.initials: JB
authors.lastname: Celik
keywords: Central venous catheterization; Cross sectional area; Obese patients; Ultrasound