Der Vena jugularis interna Katheter - Erfolgsrate und Komplikationen unter Berücksichtigung des Ausbildungsstandes

The sizes of internal jugular veins in Turkish children aged between 7 and 12 years

OBJECTIVE

In this study, we aimed at searching for internal jugular vein (IJV) diameters in Turkish children in order to learn about anatomic details of IJV diameters and to supplement the diagnostic criteria in vascular pathologies such as phlebectasia.

METHODS

A total of 92 children within the age range of 7-12 years were included in this study. In order to provide a consistent anatomical landmark in all subjects, all of the children were imaged by ultrasonography (USG) at the level of the cricoid cartilage. The measurements consisted the maximal antero-posterior (AP) and transverse (T) cross-sectional internal diameters of the internal jugular veins during both regular breathing and Valsalva maneuver. For the statistical purposes, the following analyses were performed: the relationship between the IJV diameters obtained at rest and those obtained during Valsalva maneuver, with the paired t-test; the relationship between the age groups and the IJV diameters, with the unpaired test. The significance was set at P < 0.05.

RESULTS

During regular breathing, the mean transvers diameters of the right and left IJVs were 11.26 and 10.01 mm, respectively, while they were 16.28 and 13.61 mm during straining phase of the Valsalva maneuver. The mean antero-posterior diameters of the right and left IJVs before and during Valsalva maneuver were 7.64 and 6.8 mm versus 11.53 and 9.84 mm. The IJV diameters were larger on the right side than those on the left and also there were significant increases in the diameters by Valsalva maneuver.

CONCLUSION

As a result, in this study performed among Turkish children aged between 7-12 years, it was shown that there was no correlation between the IJV diameters and the age groups (P > 0.05), while there was a significant increase in the IJV diameters on Valsalva maneuver (P < 0.05). We think that the results we obtained in this study may be useful and important for comparison in the patients with phlebectasia and also for the required knowledge of the anatomic details in medical interventions performed through IJV. However, since children aged between 0 and 6 years were not included in this study and the lack of relation found in our study may not be the same among 0-6 years, a further study is needed to show any interrelationship between former age group and size.

[Claude Bernard-Horner syndrome and its opposite, Pourfour du Petit syndrome, in anesthesia and intensive care]

OBJECTIVE

To analyse cases of Horner's syndrome (HS) and its opposite, Pourfour du Petit's syndrome (PPS), occurring in anaesthesia and intensive therapy with consideration of the data of current literature.

DATA SOURCES

For this paper we have reviewed the French, English and German literature published in anaesthesia and intensive care journals using Medline search and the current textbooks.

STUDY SELECTION

All observational studies on these syndromes, whether clinical cases or letters to the editor, form the basis for this article.

DATA EXTRACTION

The articles were analysed mainly with regard to diagnosis, therapy and prognosis of syndromes due to iatrogenic causes.

DATA SYNTHESIS

HS is caused by a paralysis of the ipsilateral sympathetic cervical chain and includes a ptosis of the upper eyelid, a slight elevation of the lower lid, a sinking of the eyeball, a constriction of the pupil, a narowing of the palpebral fissure, a nasal stuffiness associated with anhidrosis, and flushing of the affected side of the face. Regional anaesthesia (intra-oral anaesthesia, brachial plexus block, epidural anaesthesia whether by thoracic, lumbar or caudal approach, as well as interpleural analgesia) is the main anaesthetic cause for HS. HS due to the effect of a local anaesthetic is transient, it can precede a high spinal block and a cardiovascular collapse. HS from puncture of the internal jugular vein is most often permanent. When transient, HS regresses within 3 months after puncture. Other causes of HS include intraoperative posture, pleural drain, neck surgery, neck trauma. A mydriatic collyrium, such as phenylephrine, resolves ptosis for less than 1 hour and results in blurred vision from pupillary dilation. Major ptosis requires surgery. PPS is the reciprocal HS and is caused by a stimulation of the ipsilateral sympathetic cervical chain. PPS can precede HS. It carries a risk for conjunctivitis, keratitis and epiphora in case of major exophthalmia. PPS is often reported as an unilateral mydriasis. PPS has the same causes as HS. Myotic collyriums are relatively inefficient. Major lid retraction requires a tarsorraphy, pomades and nocturnal lid occlusion. A part of HS and most PPS occurring in anaesthesia and intensive care remain unrecognized or are recognized with delay, especially if they remain minor and transient or when they occur in unconscious patients, in horizontal posture.

Iatrogenically-related, fatal haemorrhage occurring in end-stage renal failure: a series of three cases

Three patients with end-stage renal failure died from acute haemorrhage which, in the first two cases, was related to the use of internal jugular catheters for haemodialysis. In the third instance, severe haemorrhage was caused by the apparent self-insertion of a 16-gauge butterfly needle, connected to a siliconised cannula (also designed for haemodialysis) into the superficial median cubital vein of the left forearm. The hazards associated with the use of internal jugular catheters and the medicolegal implications of these cases are briefly discussed.