Randomized Controlled Trial
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4245-4253
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4245
Effect of different types of laryngeal mask airway placement on the right internal jugular vein: A prospective randomized controlled trial
Jing-Jing Zhang, Zong-Yang Qu, Zhen Hua, Ming-Zhang Zuo, Hong-Ye Zhang
Jing-Jing Zhang, Zong-Yang Qu, Zhen Hua, Ming-Zhang Zuo, Hong-Ye Zhang, Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
Author contributions: Zhang JJ, Qu ZY, Hua Z, Zuo MZ, and Zhang HY contributed to the study design, manuscript writing, and revisions.
Institutional review board statement: The study was reviewed and approved by the Beijing Hospital Medical Ethics Committee (2012bjyyec-030-02).
Informed consent statement: Informed consent was signed by the patient or legal guardian before enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The manuscript was revised according to the CONSORT 2010.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hong-Ye Zhang, MD, Doctor, Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, No. 1 Dahua Road, Dongcheng District, Beijing 100730, China. anaesthesia120@163.com
Received: September 29, 2019
Peer-review started: September 29, 2019
First decision: November 19, 2019
Revised: November 27, 2019
Accepted: November 30, 2019
Article in press: November 30, 2019
Published online: December 26, 2019
Abstract
BACKGROUND

In recent years, with the popularity of laryngeal mask airway (LMA) for the management of clinical anesthesia, the influence of the LMA on the position and blood flow of the internal jugular vein (IJV) has attracted an increasing amount of attention.

AIM

To investigate the effect of placement of different types of LMA (Supreme LMA, Guardian LMA, I-gel LMA) on the position and blood flow of the right IJV.

METHODS

This was a prospective randomized controlled trial. A total of 102 patients aged 18-75 years who were scheduled to undergo laparoscopic abdominal surgery with general anesthesia were randomly assigned to three groups: Supreme LMA (group 1), Guardian LMA (group 2), and I-gel LMA (group 3) groups. The main indicator was the overlap index (OI) of IJV and the common carotid artery (CCA) at the high, middle, and low points before and after the placement of the LMA. The second indicators were the proportion of ultrasound-simulated needle crossing the IJV and CCA, and the cross-sectional area and blood flow velocity of the IJV before and after placement of the LMA at the middle point.

RESULTS

Data from 100 patients were included in the statistical analysis. The OI increased significantly after placement of the LMA in the three groups at the three points (P < 0.01), except group 2 at the low point. In group 2 and group 3, the OI was lower than that in group 1 after LMA insertion at the high point (P < 0.0167). At the middle point, after LMA insertion, the proportion of simulated needle crossing the IJV significantly decreased in all three groups (P < 0.05), and the proportion in group 2 was higher than that in group 3 (P < 0.0167). The proportion of simulated needle crossing the CCA or both the IJV and CCA significantly increased in group 1 and group 2 (P < 0.05), which increased with no statistical significance in group 3. After LMA insertion, the cross-sectional area of ​​the IJV significantly increased, while the blood flow velocity significantly decreased (P < 0.01). There was no significant difference among the three groups.

CONCLUSION

The placement of Supreme, Guardian, and I-gel LMA can increase the OI, reduce the success rate of IJV puncture, increase the incidence of arterial puncture, and cause congestion of IJV. Type of LMA did not influence the difficulty of IJV puncture. Therefore when LMA is used, ultrasound is recommended to guide the IJV puncture.

Keywords: Laryngeal mask airway, Internal jugular vein, Common carotid artery, Blood flow

Core tip: The placement of laryngeal mask airway (LMA) may affect the position and blood flow of the internal jugular vein (IJV). The results of our study show that the placement of Supreme, Guardian, and I-gel LMA can increase the overlap index, reduce the success rate of IJV puncture, increase the incidence of arterial puncture, and cause congestion of IJV. Type of LMA did not influence the difficulty of IJV puncture. Therefore when LMA is used, ultrasound is recommended to guide the IJV puncture.