JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Verghese, S. T. Articles by Patel, K. M. Search for Related Content PubMed PubMed Citation Articles by Verghese, S. T. Articles by Patel, K. M. Related Collections Monitoring (Cardiac) Pediatrics

---

PEDIATRIC ANESTHESIA

The Effects of the Simulated Valsalva Maneuver, Liver Compression, and/or Trendelenburg Position on the Cross-Sectional Area of the Internal Jugular Vein in Infants and Young Children

Department of Anesthesiology, Children’s National Medical Center and George Washington University Medical Center, Washington, DC

Address correspondence and reprint requests to Susan T. Verghese, MD, Department of Anesthesiology, Children’s National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010. Address e-mail to sverghes{at}cnmc.org

We calculated the effects of the simulated Valsalva (V), liver (L) compression, and Trendelenburg (T) position on the cross-sectional area (CSA) of the right internal jugular vein by using planimetry (Aloka^® ultrasound machine) in 84 infants and young children. Eight combinations of positions and interventions were studied for each patient, with the patient supine, in the T position, during the simulated V maneuver, with L compression and a combination of maneuvers. Data were analyzed by using Friedman’s ² test and Wilcoxon’s signed rank test. An increase of >25% in the CSA of the internal jugular vein was considered significant. In infants, the maximal mean increase achieved with the combination of all 3 maneuvers was only 17.4% ± 16.1%. As a single maneuver, the simulated V was the most effective (11.6% ± 11.5%). In children, the combination of all 3 maneuvers performed simultaneously produced a mean 65.9% (SD ± 44.7%) increase in the CSA, which was larger than the increase by all other maneuvers alone or in a single combination (Friedman’s test, P < 0.001 and Wilcoxon’s test, P < 0.002). As a single maneuver, V produced the most increase (40.4% ± 32.2%) compared with L compression (14.3% ± 18.9%) or T position (24.3% ± 27.1%).

IMPLICATIONS: The combinations of simulated Valsalva, liver compression, and Trendelenburg maneuvers produce the maximal mean increase in the size of the internal jugular vein in infants and young children, with the Valsalva maneuver being the most effective single maneuver. This increase is significant in young children, but negligible in infants.

This article has been cited by other articles:

				K. Yuki, K. Chilson, K. C. Odegard, and J. A. DiNardo Trendelenburg Position, Simulated Valsalva Maneuver, and Liver Compression Do Not Alter the Size of the Right Internal Jugular Vein in Patients with a Bidirectional Glenn Shunt Anesth. Analg., August 1, 2007; 105(2): 365 - 368. [Abstract] [Full Text] [PDF]

				S Clenaghan, R E McLaughlin, C Martyn, S McGovern, and J Bowra Relationship between Trendelenburg tilt and internal jugular vein diameter Emerg. Med. J., December 1, 2005; 22(12): 867 - 868. [Abstract] [Full Text] [PDF]

				S. J. Schreiber, U. K. W. Lambert, F. Doepp, and J. M. Valdueza Effects of prolonged head-down tilt on internal jugular vein cross-sectional area Br. J. Anaesth., November 1, 2002; 89(5): 769 - 771. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999