External Jugular Vein Catheterization Using 'Intra-Atrial Electrocardiogram'

PURPOSE: To investigate the reliability of intra-atrial electrocardiogram (ECG) use for external jugular vein (EJV) catheterization. MATERIALS AND METHODS: Patients undergoing open heart surgery in Suleyman Demirel University Hospital between February and June 2006 were included in the study. Using a sterile Seldinger technique, a triple lumen polyurethane central venous catheter was introduced (Certofix(R) Trio V 720, length 20 cm, 7 French) under intra-atrial ECG guidance. The presence of an increase in P-wave size was recorded. Just after the surgery, a portable chest X-ray was taken. The method was considered to be successful when a change in P-wave could be seen and the catheter was in the superior vena cava, as well as when there was no change in P-wave and the catheter was not in the superior vena cava. RESULTS: In six patients (12%), we were not able to advance the guidewire. In the remaining 44 patients, the catheter was inserted without problem. Eight of these 44 catheters were positioned in the innominate vein, with a malposition ratio of 18%. The success rate of external jugular vein cannulation with intra-atrial ECG was 95%. No complications occured related to the EJV cannulation. CONCLUSION: Considering that it is easily accessed without complication, and the malposition is successfully detected by intra-atrial ECG, EJV is a suitable access for central venous cannulation when internal jugular vein (IJV) is not usable.

Comparison of meperidine alone with meperidine plus dexmedetomidine for postoperative patient-controlled analgesia

To investigate if the addition of dexmedetomidine to meperidine in a patient-controlled analgesia [PCA] device would reduce postoperative meperidine consumption when compared with meperidine alone. Forty patients scheduled for elective abdominal surgery under general anesthesia in Suleyman Demirel University Medical School, Isparta, Turkey between February and September 2006, were randomly allocated into 2 groups. Group I: meperidine 0.25 mg kg[-1] intravenous bolus and dexmedetomidine 0.5 mcg kg[-1] in 50 ml of saline solution infusion before the end of surgery. Group II: meperidine 0.25 mg kg[-1] intravenous bolus and 50 ml of saline solution infusion. In the postanesthesia care unit [PACU] patients in both groups received intravenous meperidine 10 mg with 5 -minutes intervals until the patients verbal pain score is lower than 2. Patients in both groups received PCA during the 24 hours after surgery [meperidine 5 mg + dexmedetomidine 10 mcg bolus for group I, meperidine 5 mg for group II]. The verbal rating score of pain and meperidine requirement is recorded during PACU stay. Meperidine consumption with PCA is recorded until 24 hours postoperatively. Verbal rating score of pain in the PACU was lower in group I than group II [p<0.05]. Meperidine consumption was lower in group I than group II during the PACU stay and until 24 hours postoperatively [p<0.01]. When compared with meperidine PCA, meperidine-dexmedetomidine PCA reduces postoperative meperidine consumption