Infants or Children Undergoing Open Heart Surgery
Conditions
Keywords
internal jugular vein cannulation, cross-sectional area, passive leg elevation, trendelenburg position, open heart surgery
Brief summary
The trendelenburg position is usually applied to increase the cross-sectional area of the IJV. However, trendelenburg position requires a tilt table to place the head in the down position. Trendelenburg position could also increase intracranial pressure. Passive leg elevation redistributes more blood from the lower extremity into the central veins and is proved to increase the cross-sectional area of IJV in adults. However, the effect of leg elevation on the cross-sectional area of IJV in small infants and children has not been evaluated. The investigators evaluated the effect of passive leg elevation on the cross-sectional area of IJV in subjects undergoing open heart surgery for congenital anomaly.
Detailed description
Internal jugular vein (IJV) cannulation is essential for open heart surgery of small infants and children for transfusion or inotropics infusion. The trendelenburg position is usually applied to increase the cross-sectional area of the IJV. However, trendelenburg position requires a tilt table to place the head in the down position. Trendelenburg position could also increase intracranial pressure. Passive leg elevation redistributes more blood from the lower extremity into the central veins and is proved to increase the cross-sectional area of IJV in adults. However, the effect of leg elevation on the cross-sectional area of IJV in small infants and children has not been evaluated. Furthermore, the children undergoing open heart surgery due to cardiac anomaly have an altered hemodynamics and often congested right heart. Therefore, the response of passive leg elevation may be different from that of normal heart physiology. Therefore, we evaluated the effect of passive leg elevation on the cross-sectional area of IJV in subjects undergoing open heart surgery for congenital anomaly.
Interventions
OTHERleg elevation
bilateral passive leg elevation for 30 seconds
Trendelenburg position (15 degrees) for 30 seconds
OTHERTrendelenburg position + passive leg elevation
Trendelenburg position + passive leg elevation
OTHERcontrol group
supine position without passive leg elevation or trendelenburg position
Sponsors
Samsung Medical Center
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
No minimum to 5 Years
Healthy volunteers
No
Inclusion criteria
* infants or children under 5 yrs undergoing elective open heart surgery for congenital anomaly for study period
Exclusion criteria
* previous history of internal jugular vein cannulation * concurrent pulmonary disease that can influence the hemodynamics of right heart * increased intracranial pressure * hemodynamic unstability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cross-sectional area of internal jugular vein | one time measurement 10 min before jugular vein cannulation | Cross-sectional area of internal jugular vein measured on the ultrasonographic image with planimetry method |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Transverse diameter of internal jugular vein | only one time measurements 10 min before internal jugular vein cannulation | Transverse diameter of internal jugular vein measured on the ultrasonographic image |
| horizontal diameter of internal jugular vein | only one time measurements 10 min before jugular vein cannulation | horizontal diameter of internal jugular vein measured on the ultrasonographic image |
| skin to internal jugular vein depth | one time measurement 10 min before jugular vein cannulation | skin to internal jugular vein depth measured on the ultrasonographic image |
Countries
South Korea
Outcome results
None listed