Effects Of The Positive Endexpiratory Pressure And Trendelenburg Position On The Right Jugular Vein Cross-sectional Area In Obese Patients

Objective : The internal jugular vein puncture catheter had some difficulties and challenges for obese patients.Whether positive endexpiratory pressure and Trendelenburg position will increase the cross-sectional area of the right internal jugular vein in obese patients?Methods : Forty patiens were selected for perioperative period,male-to-female ratio,19:21;age rang 43-69 years,ASA ?-?,BMI ? =30kg/m2.After inducement of general anesethesia and tracheal intubation,the patients were placed in a supine position on a level bed with the head turning to the left 20°.The transverse diameter,anterposterior diameter and the cross-sectional area of the right internal jugular vein were measured incrementally from lowest to hightest with PEEP 0,5 and 10 cm H2O and the head-down position angle of 20 °.Ultrasound was used to calculate the transverse diameter,anterposterior diameter and the cross-sectional area of the right internal jugular vein at the level of the cricoid cartilage.Results: All PEEP levels increased the transverse diameter,anterposterior diameter and the cross-sectional area of the right internal jugular vein relative to the control(all*P < 0.05).Six patients were excluded because the blood pressure was below 90/60 mm Hg after setting PEEP 10 mm Hg.Transverse diameter,anterposterior diameter and the cross-sectional area of the right internal jugular vein was larger at the head-down position angle 20 ° than the PEEP levels.The largest cross-sectional area was1.38±0.34(cm2).Conclusion:The use of positive endexpiratory pressure and Trendelenburg position increased transverse diameter,anterposterior diameter and the cross-sectional area of the right internal jugular vein in obese patients.Transverse diameter,anterposterior diameter and the cross-sectional area of the right internal jugular vein was the largest at the head-down position angle 20°,then the PEEP 10 cm H2O.Airway pressure was the largest at the head-down position angle 20 °,when we setted the PEEP 10 cm H2O,six patients,blood pressure was below 90/60 mm Hg.AS for the airway pressure and hemodynamic instability,we recommend using PEEP 5 cm H2O to facilitate internal jugular venous cannulation in obese patients.