Jugular Venous Blood Flow
Conditions
Brief summary
Our hypothesis is that there will be a decrease in internal jugular venous flow in the park bench position when compared to the supine position. There will also be a change in blood flow in the between right and left internal jugular veins in park bench position, particularly there will be a greater reduction of flow on the dependent side. However, the internal jugular venous flow will be the same in both the prone and supine position.
Detailed description
The different positions used in neurosurgery (park bench, prone) for better accessibility to the operating field can impact on the cerebral venous drainage due to the effects of internal jugular venous outflow of blood and may increase intracranial pressure. The kinking of the internal jugular vein due to excessive neck flexion and rotation in park bench or flexion in the prone position may lead to kinking or twisting of the vein. This has been hypothesized as the major cause of disturbed venous drainage during surgery and in postoperative patients may lead to neck swelling, brachial plexus injury, macroglossia (swollen tongue), delayed airway obstruction and increases in intracranial pressure. Optimal brain perfusion is best in the neutral position of the head, but surgery cannot always be performed with this. Thus, we look to measure the internal jugular venous flow at different positions as there have been little studies looking at this important contributing factor.
Interventions
OTHERDifferent positions
Jugular venous blood flow in healthy volunteers in 3 different positions- supine, prone and park bench
Sponsors
University Health Network, Toronto
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Adult healthy volunteers who are above the age of 18 * American Society of Anesthesiologists classification (ASA) 1 * Body mass index (BMI) less than and equal to 35
Exclusion criteria
* ASA 2 and above * BMI above 35 * Lack of informed consent * Language barrier * Medical students and anaesthesia residents going through the department as part of their rotation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Internal Jugular Venous (IJV) Cross Sectional Area | 1 day | Comparisons of both jugular vein (IJV) of twenty-seven volunteers in supine and prone positions. |
| Right and Left IJV Cross Sectional Area | 1 day | Twenty-seven volunteers were included in this study. Comparisons of cross sectional area measurements in both IJVs between supine and right park bench |
| Internal Jugular Venous (IJV) Doppler Velocity | 1 day | 27 volunteers enrolled to measure the Internal Jugular Venous (IJV) in supine and prone positions |
| Bilateral Internal Jugular Vein (IJV) Flow | 1 day | Comparisons of bilateral internal jugular vein (IJV) flow between supine and prone position. Data presented as mean (SD) . |
| Bilateral Internal Jugular Vein (IJV) Doppler Velocity | 1 day | Comparisons of bilateral internal jugular vein (IJV) Doppler velocity between supine and right park bench position. |
| R IJV and L IJV Flow | 1 day | Bilateral internal jugular vein (IJV) flow between supine and right park bench position. |
Countries
Canada
Participant flow
Pre-assignment details
Twenty-seven volunteers were included in this study.
Participants by arm
| Arm | Count |
|---|---|
| Volunteers in Different Positions The following will be compared in the same volunteer:
* Bilateral internal jugular venous flow in supine and prone position
* Bilateral internal jugular venous flow in supine and park bench position
* Bilateral internal jugular venous flow in prone and park bench
Different positions: Jugular venous blood flow in healthy volunteers in 3 different positions- supine, prone and park bench | 27 |
| Total | 27 |
Baseline characteristics
| Characteristic | Volunteers in Different Positions |
|---|---|
| Age, Customized | 38 years STANDARD_DEVIATION 10 |
| Height | 169.5 units on a scale STANDARD_DEVIATION 12.5 |
| Sex/Gender, Customized | 27 participants |
| Weight | 71.8 units on a scale STANDARD_DEVIATION 15.4 |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 27 |
| other Total, other adverse events | 0 / 27 |
| serious Total, serious adverse events | 0 / 27 |
Outcome results
Primary
Bilateral Internal Jugular Vein (IJV) Doppler Velocity
Comparisons of bilateral internal jugular vein (IJV) Doppler velocity between supine and right park bench position.
Time frame: 1 day
Population: Comparisons of bilateral internal jugular vein (IJV) cross sectional area, Doppler velocity and flow between supine and right park bench position. Data presented as mean (SD).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| R IJV | Bilateral Internal Jugular Vein (IJV) Doppler Velocity | supine Doppler velocity | 19.9 cm.sec-1 | Standard Deviation 7 |
| R IJV | Bilateral Internal Jugular Vein (IJV) Doppler Velocity | right park bench Doppler velocity | 28.1 cm.sec-1 | Standard Deviation 12 |
| L IJV | Bilateral Internal Jugular Vein (IJV) Doppler Velocity | supine Doppler velocity | 18.1 cm.sec-1 | Standard Deviation 8.4 |
| L IJV | Bilateral Internal Jugular Vein (IJV) Doppler Velocity | right park bench Doppler velocity | 18.7 cm.sec-1 | Standard Deviation 11.6 |
Primary
Bilateral Internal Jugular Vein (IJV) Flow
Comparisons of bilateral internal jugular vein (IJV) flow between supine and prone position. Data presented as mean (SD) .
Time frame: 1 day
Population: Comparisons of bilateral internal jugular vein (IJV) flow between supine and prone position. Data presented as mean (SD) .
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| R IJV | Bilateral Internal Jugular Vein (IJV) Flow | Supine Flow | 1430.1 ml.min-1 | Standard Deviation 803 |
| R IJV | Bilateral Internal Jugular Vein (IJV) Flow | Prone Flow | 1924.2 ml.min-1 | Standard Deviation 1139.7 |
| L IJV | Bilateral Internal Jugular Vein (IJV) Flow | Supine Flow | 1112.9 ml.min-1 | Standard Deviation 578.1 |
| L IJV | Bilateral Internal Jugular Vein (IJV) Flow | Prone Flow | 1178.4 ml.min-1 | Standard Deviation 832.1 |
Primary
Internal Jugular Venous (IJV) Cross Sectional Area
Comparisons of both jugular vein (IJV) of twenty-seven volunteers in supine and prone positions.
Time frame: 1 day
Population: Twenty-seven volunteers were included in this study. Comparisons of right and left internal jugular vein (IJV) cross sectional area, Doppler velocity and flow between supine and prone position.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| R IJV | Internal Jugular Venous (IJV) Cross Sectional Area | Supine-Cross sectional area | 1.2 cm2 | Standard Deviation 0.6 |
| R IJV | Internal Jugular Venous (IJV) Cross Sectional Area | Prone-Cross sectional area | 1.8 cm2 | Standard Deviation 1 |
| L IJV | Internal Jugular Venous (IJV) Cross Sectional Area | Supine-Cross sectional area | 1.0 cm2 | Standard Deviation 0.3 |
| L IJV | Internal Jugular Venous (IJV) Cross Sectional Area | Prone-Cross sectional area | 1.4 cm2 | Standard Deviation 0.4 |
Primary
Internal Jugular Venous (IJV) Doppler Velocity
27 volunteers enrolled to measure the Internal Jugular Venous (IJV) in supine and prone positions
Time frame: 1 day
Population: Comparisons of bilateral internal jugular vein (IJV) Doppler velocity between supine and prone position. Data presented as mean (SD) .
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| R IJV | Internal Jugular Venous (IJV) Doppler Velocity | Supine Doppler velocity | 19.9 cm.sec-1 | Standard Deviation 7 |
| R IJV | Internal Jugular Venous (IJV) Doppler Velocity | Prone Doppler velocity | 19.3 cm.sec-1 | Standard Deviation 7.9 |
| L IJV | Internal Jugular Venous (IJV) Doppler Velocity | Supine Doppler velocity | 18.1 cm.sec-1 | Standard Deviation 8.4 |
| L IJV | Internal Jugular Venous (IJV) Doppler Velocity | Prone Doppler velocity | 13.6 cm.sec-1 | Standard Deviation 7.7 |
Primary
Right and Left IJV Cross Sectional Area
Twenty-seven volunteers were included in this study. Comparisons of cross sectional area measurements in both IJVs between supine and right park bench
Time frame: 1 day
Population: Comparisons of bilateral internal jugular vein (IJV) cross sectional area, Doppler velocity and flow between supine and right park bench position.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| R IJV | Right and Left IJV Cross Sectional Area | Supine-Cross sectional area (cm2) | 1.2 cm2 | Standard Deviation 0.6 |
| R IJV | Right and Left IJV Cross Sectional Area | Right park bench-Cross sectional area | 0.9 cm2 | Standard Deviation 0.5 |
| L IJV | Right and Left IJV Cross Sectional Area | Supine-Cross sectional area (cm2) | 1.0 cm2 | Standard Deviation 0.3 |
| L IJV | Right and Left IJV Cross Sectional Area | Right park bench-Cross sectional area | 1.1 cm2 | Standard Deviation 0.5 |
Primary
R IJV and L IJV Flow
Bilateral internal jugular vein (IJV) flow between supine and right park bench position.
Time frame: 1 day
Population: Comparisons of bilateral internal jugular vein (IJV) flow between supine and right park bench position. Data presented as mean (SD).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| R IJV | R IJV and L IJV Flow | supine Flow | 1430.1 ml.min-1 | Standard Deviation 803 |
| R IJV | R IJV and L IJV Flow | right park bench Flow | 1403.1 ml.min-1 | Standard Deviation 1006.1 |
| L IJV | R IJV and L IJV Flow | supine Flow | 1112.9 ml.min-1 | Standard Deviation 578.1 |
| L IJV | R IJV and L IJV Flow | right park bench Flow | 1266.9 ml.min-1 | Standard Deviation 959.6 |