The anatomic relationship between the internal jugular vein and the carotid artery in children after laryngeal mask insertion. An ultrasonographic study.

Ravi Gopal Nagaraja (1) , Morven Wilson (1) , Graham Wilson (2) , Bruno Marciniak (3) , Thomas Engelhardt (4)

1 Anaesthesia and Intensive care
2 Anaesthesia
3 Pole d'Anesthesia Reanimation
4 Department of Anaesthesia and Intensive Care

Background: Central venous cannulation although challenging in children and prone to complications is frequently required for total parentral nutrition and infusion of drugs. Aim: The aim of this study was to determine the anatomic relationship between the internal jugular vein (IJV) and carotid artery (CA) before, and after, insertion of laryngeal mask airway (LMA) in children using ultrasound. Methods: Patients aged 2-16 yrs were recruited into this prospective study and divided into 3 groups of 20 patients each: group 1: LMA size 2, group 2:LMA size 2 and group 3: LMA size 3. Prior to, and following, LMA insertion, the position, depth and time to location of the vessels was recorded. All measurements were made at the level of the cricoid cartilage in a neutral head position in the spontaneously breathing patient during expiration. The IJV position in relation to the CA was noticed as anterior (A), anterolateral (AL), lateral (L) or medial (M). Results: The position of the IJV was found to be in the anterolateral (AL) or anterior (A) position to the CA in the majority of cases. The anatomic relationship changed in 10/120 (8.3%) following insertion of the LMA. The mean depth was 0.80 (±0.15) cm for the right IJV before LMA insertion and 0.84 (±0.17) cm after insertion. Similar measurements were made on the left side (0.81 (±0.14) cm and 0.83 (±0.18) cm). The diameter as well as the depth of the IJV increased with the age and weight of the patient. Conclusions: This study demonstrates that the IJV is anterior or anterolateral to the artery in the majority of cases and the anatomic relationship may change following the insertion of the LMA. It supports the need of using ultrasound-guided techniques for IJV cannulation following LMA insertion in spontaneously breathing children. Keywords: Laryngeal mask airway, Internal jugular vein, ultrasound.

Mots clés: Medicine

Ravi Gopal Nagaraja, Morven Wilson, Graham Wilson, Bruno Marciniak, Thomas Engelhardt. The anatomic relationship between the internal jugular vein and the carotid artery in children after laryngeal mask insertion. An ultrasonographic study.. Pediatric Anesthesia, 2010, 21 (1), pp.62. ⟨10.1111/j.1460-9592.2010.03459.x⟩. ⟨hal-00600133⟩