ABSTRACT
OBJECTIVE: We compared sonoanatomy of the internal jugular vein (IJV) the high (HA), conventional (CA) and the medial oblique approach (MA) to identify the best approach and head position for IJV cannulation. MATERIALS & METHODS: Total of 45 volunteers aged 18-65 years were included in this study. The degree of overlap in percentage, depth of IJV from skin, antero-posterior (AP) and transverse diameters (TD) of IJV were measured in real time with ultrasound (US). Measurements were taken in the HA, CA and MA in neutral and 30° head rotation on both the right and left side of the neck. RESULTS: The HA had lower percentage of overlap when compared to CA and MA in neutral and 30° head rotation (p= 0.002 to ≤0.001). The IJV was more shallow in the CA and MA. The AP and TD of the IJV were larger in the MA when compared to HA (p=<0.001) and CA (p =0.026 to < 0.001) and the right IJV has a larger AP and TD in all approaches. DISCUSSION: The HA had the least percentage of overlap compared to CA and MA, therefore the risk of accidental ICA puncture can be reduced. The apparent overlap seen in MA may not reflect the actual scenario because of the way the US beam cuts the vessel. The AP and TD of IJV were significantly increased in the MA, which would ease CVC. CONCLUSION: We conclude and recommend the medial oblique probe position with 30° head rotation provides optimal real time sonographic parameters for US guided IJV cannulation.
Subject(s)
Catheterization, Central Venous/methods , Jugular Veins/anatomy & histology , Jugular Veins/diagnostic imaging , Rotation , Ultrasonography/methods , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Young AdultSubject(s)
Carotid Artery Injuries/complications , Carotid Artery Injuries/surgery , Carotid Artery, Internal/surgery , Nose/surgery , Sphenoid Sinus/surgery , Aneurysm, False , Angiography , Blood Pressure , Carotid Artery Injuries/diagnostic imaging , Carotid Artery, Internal/diagnostic imaging , Cone-Beam Computed Tomography , Endoscopy , Endovascular Procedures , Extravasation of Diagnostic and Therapeutic Materials/complications , Extravasation of Diagnostic and Therapeutic Materials/surgery , Hemorrhage , Humans , Male , Middle Aged , Middle Cerebral Artery/diagnostic imaging , Middle Cerebral Artery/surgery , Sphenoid Sinus/diagnostic imaging , Stents , ThrombosisABSTRACT
OBJECTIVES: To evaluate patients' understanding on the status and role of anaesthesiologists. MATERIALS AND METHODS: This was a prospective, questionnaire-based cross-sectional study. The interview had three segments which questioned on (i) patients' knowledge of the qualification, training and role of anaesthesiologists, (ii) attitude of patients towards anaesthesia and anaesthesiologists and (iii) the demographic data of patients. RESULTS: Of 384 patients interviewed, 59.4% had prior anaesthesia experience. Most patients (95.6%) knew that anaesthesiologists were medical doctors, but only 27.1% knew the duration of training required to attain this specialist qualification. Patients' awareness of the various anaesthetic responsibilities was 12.2% in managing labour pain, 25.5% in intensive care units, 49.2% in chronic pain and 99.5% in postoperative pain management. During surgery, 73.7% of patients knew that anaesthesiologists were monitoring their vital signs, but only 42.2% thought anaesthesiologists also treated medical problems intraoperatively. Most patients (95.1%) would like to meet their anaesthesiologists prior to the operation and 97.7% want them to inform all possible anaesthesia complications. CONCLUSIONS: Our patients' understanding and awareness of the status and roles of anaesthesiologists are still limited and variable. This can be further improved with patient interaction and public education.
