4 research outputs found
Day Care General Anaesthesia for a Child with Bardet-Biedl Syndrome
Bardet-Biedl syndrome is a very rare autosomal-recessive disorder with pan-systemic effects. The perioperative period may be hazardous for patients with this disorder. We describe the presenting features and management of a child who was scheduled for elective ambulatory general anesthesia and discuss the relevant points for the busy anesthesiologist
Long versus Short Axis ultrasound guided approach for internal jugular vein cannulation: a prospective randomised controlled trial
Abstract Aim: The aim of this study was to compare the short and long axis approaches to ultrasound guided right internal jugular vein cannulation with respect to indicators of success. Methods: Patients undergoing cardiac surgery requiring central venous cannulation (99 patients) were randomised to undergo either long or short axis ultrasound guided cannulation of the right internal jugular vein by a skilled anaesthetist. First pass success, number of needle passes, procedural taken and complications were documented for each procedure. Results: The right internal jugular vein was successfully cannulated in all 99 patients. The first pass success rate was significantly higher in the short axis 98% group compared to the long axis group 78% [48:1 (98%) versus 39:11 (78%) p <0.006]. Procedural time was comparable in both the groups [39.6 (18.4) versus 46.9 (42.4)]. Fewer needle redirections were required in the short axis group [1.02 (0.02) versus 1.24 (0.56) p <0.004]. Carotid artery puncture only occurred in the long axis group. Conclusions: We conclude that anaesthetists with experience in ultrasound guided internal jugular vein cannulation, have higher first pass success rate and less carotid artery puncture when a short axis, rather than a long axis, approach is employed. Keywords: internal jugular vein, ultrasound, venous cannulation, scanning axis Rezumat Scopul studiului: Compararea ratei de succes a cateterizării în ax lung şi în ax scurt a venei jugulare interne prin ghidaj ecografic. Metode: Au fost randomizaţi 99 de pacienţi supuşi unor intervenţii chirugicale cardiovasculare ce necesitau montarea unui cateter central; acestora li s-a montat un cateter la nivelul venei jugulare interne drepte de către un anestezist cu experienţă, prin ghidaj ecografic, folosind abordul vascular în axul lung sau în cel scurt. Reuşita la prima tentativă, numărul de redirecţionări ale acului, timpul necesar precum şi complicaţiile survenite au fost documentate pentru fiecare dintre cele doua proceduri. Rezultate: Vena jugulară internă dreaptă a fost cateterizată cu succes la toţi cei 99 de pacienţi. Succesul de la prima tentativa a fost semnificativ mai mare la grupul cu abord in ax scurt 98%, prin comparatie cu grupul cu abord in ax lung 78% [48:1 (98%) versus 39:11 (78%) p <0.006]. Timpul procedurii a fost similar in ambele grupuri [39.6 (18.4) versus 46.9 (42.4)]. Un numar mai mic de redirectionari ale acului au fost necesare in grupul cu abord in ax scurt [1.02 (0.02) versus 1.24 (0.56) p <0.004]. Punctionarea accidentala a arterei carotide a survenit doar la grupul cu abord in ax lung. Concluzii: Anesteziştii cu experienţă în cataterizarea venei jugulare interne prin ghidaj ecografic au o rată mai mare a succesului de la prima tentativă şi un numar mai mic de puncţionari ale arterei carotide atunci când folosesc abordul în ax scurt. Cuvinte cheie: vena jugulară internă, ecografie, canulare venoasă, plan de examinar