Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4245
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
Since the introduction of the laryngeal mask airway (LMA) into wide clinical practice, there has been a great expansion in its clinical applications, and IJV cannulation may be required in such cases, which rely on anatomical landmarks to indicate the likely position of the vein. In recent years, the impact of placement of LMA on the main blood vessels of the neck has attracted more and more attention.
In clinical anesthesia using LMA for airway management, central venous catheterization via the IJV might be required in some patients. However, placement of the LMA may cause a change in the anatomy of the surrounding structures, especially the position relation of the IJV and common carotid artery (CCA). These anatomical changes may lead to failure of the catheterization of IJV based on the landmark technique. In addition, placement of the LMA may also cause venous congestion. However, there are few studies on the influence of placement of LMA or type of LMA on the position of the IJV and CCA, and the changes in blood flow of IJV.
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.
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: the Supreme LMA group (group 1), the Guardian LMA group (group 2), and the I-gel LMA group (group 3). The main indicator was the OI of IJV and CCA at the high, middle and low points before and after the placement of the LMA. The second indicators were the proportion of the ultrasound-simulated needle cross the IJV and CCA, the cross-sectional area and blood flow velocity of the IJV before and after the placement of the LMA at the middle point.
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 the simulated needle cross the IJV significantly decreased in all the three groups (P < 0.05), and the proportion in group 2 was higher than that in group 3 (P < 0.0167). The proportion of the simulated needle cross 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 the 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 between the three groups.
The placement of Supreme, Guardian and I-gel LMA can increase 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.
With the popularity of LMA for the management of clinical anesthesia, we should pay more attention to the influence of the LMA on the position and blood flow of the IJV. The best type and proper pressure of the cuff of the LMA, which cause minor effects on the position and blood flow of the IJV, should be the subject of further investigations.