Effects Of Different Positive Airwaypressure On Internal Jugular Vein Catheterization In Patients Under General Anesthesia

Objective:Study showed that Valsalve action could increase cross section area of right internal jugular vein (RIJV) and make for RIJV catheterization. Effects of using positive airway pressure to simulate Valsalve action on RIJV catheterization in patients under general anesthesia was unknow. The content of this study was evaluated the effects of different positive airway pressure on RIJV catheterization in patients under general anesthesia and investigated suitable positive airway pressure.Methods:240 patients who accepted RIJV catheterization under general anesthesia were randomly divided into four groups (n=60):Group A, Group B,Group C and Group D. All patients were placed trendelenburg posture without pillow and 30°headrotation to left. At annular cartilage level, ultrasound probe was placed vertical to skin of neck and RIJV was identified from ultrasound image. In group A, RIJV catheterization was performed under mechanical ventilation suspension;In group B, RIJV catheterization was performed under 15cmH2O level airway pressure; In group C and group D, RIJV catheterization was performed under 20 cmH2O and 25cmH2O respectively. RIJV cross section area and central venous pressure were recorded before and during maintaining positive airway pressure; The change of HR and MAP were recorded before and during maintaining positive airway pressure; The time of puncturation and catheterization,the attemps of puncturation,the number of blood obtained during cannulation needle inserted or withdrawal from patients and the depth of cannulation needle inserted were recorded; The complication and failure information were also recoreded.Results:Compared with group A, the cross section area of RIJV and central venous pressure increased significantly in group B,group C and group D (P<0.01); Compared with group B, the cross section area of RIJV and central venous pressure increased significantly in group C and group D (P<0.01); Compared with group C,the cross section area of RIJV and central venous pressure increased significantly in group D (P<0.05 and P<0.01); Compared with group A, the depth of cannulation needle inserted decreased significantly in group B,group C and group D (P<0.01); Compared with group B, the depth of cannulation needle inserted decreased significantly in group C and group D (P<0.01); Compared with group A and group B, the achievement ratio of completing puncturation and catheterization in 30 seconds increased significantly in group C and group D (P<0.01);Compared with group A and group B, an attempt of puncturation achievement ratio increased significantly in group C and group D(P<0.01); Compared with group A, the blood obtained rate during needle inserted increased significantly in group B,group C and group D (P<0.01); Compared with group B, the blood obtained rate during needle inserted increased significantly in group C and group D (P<0.01);Compared with group A, the incidence rate of hypotension and bradycardia increased significantly in group C and group D (P<0.05 and P<0.01); Compared with group B and group C, the incidence rate of hypotension and bradycardia increased significantly in group D (P<0.01);A11 patients was accomplished RIJC catheterization successfully; Compared with group A,group B and group C, the incidence rate of local hematoma increased significantly in group D (P<0.01)Conclusion:Cross section area of RIJV and central venous increased gradually as the positive airway pressure increased gradually in certain range under general anesthesia;It was 20 cmH2O positive airway pressure that suitable for RIJV catheterization; The time of catheterization and the maximum depth of cannulation needle inserted was shorten,the mean attempts of puncturation was reduced,the incidence rate of complication was decrease and circulation was affected slightly.