The effect of the trendelenburg position on the internal jugular vein’s cross-sectional area in overweight and obese children

Background: The Trendelenburg position is a common technique used during internal jugular vein (IJV) cannulation in pediatric patients. There has been some speculation as to the correlation between Trendelenburg positioning and increases in the cross-sectional area (CSA) of the IJV in obese child patients. In the present study, we use ultrasound (US) measurements to assess and determine the predictivity of Trendelenburg positioning on the CSA of the right IJV in obese child patients. Methods: The researchers of this studyenrolled 30 cases from the American Society of Anesthesiologists (ASA) II of patients under the age of 18 who underwent ultrasonographic examination between December 2013 and March 2015. US images of the right IJV of each patient were obtained in a transverse orientation at the cricoid level. The CSAs of the right IJVs were measured undert wo different conditions applied in a random orderin a sealed envelope: State 0, in which the table was flat (no tilt) and the patient lay in the supine position; and State T, in which the operating table wastilted 20 degrees to the Trendelenburg position. Results: The change in the CSA of the IJV from the supine to the Trendelenburg position (0.99 cm2 vs 0.96 cm2) was not significant. In contrast, the CSA of the right IJV decreased in 14 of the 30 patients (9 of the 14 were female). Conclusions: The Trendelenburg position does not cause the mean CSA of the right IJV in obese child patients to increase; in fact, the position causes the CSA in some patients to decrease. The researchers of this study do not support the use of the Trendelenburg position for IJV cannulation in obese child patients.