Effects of laryngeal mask placement on position of internal jugular puncture

Objective: The purpose of this study was to explore the best angle for tilting the head to the left to locate a puncture point during right internal jugular puncture for patients with a laryngeal mask and to provide a theoretical basis for improving the success rate in clinical practice and reduce complications associated with internal jugular puncture. Methods: Vascular overlapping rates at three points when the right side of the patient’s neck was at different angles (high: midline of the protuberance on the sternocleidomastoid and clavicle; medium: intersection point of the sternocleidomastoid chest bone and clavicle segment; low: sternocleidomastoid chest bone near the clavicle area) were measured in 366 adult patients to analyze the vascular overlapping rates of the same puncture point when the head was tilted to the left at different angles as well as the vascular overlapping rates of different puncture points when the head was tilted to the left at the same angle. Results: After placement of the laryngeal mask, overlapping degrees were clearly increased at the high and medium levels when the neck was tilted to the left at 30° (P<0.05) and at the high level when the neck was tilted to the left at 60° (P<0.05). However, no obvious increases of overlapping degree were observed at the low level when the neck was tilted to the left at 30° (P>0.05) or at the medium and low levels when the neck was tilted to the left at 60° (P>0.05). Conclusion: The best puncture locations of the right internal jugular vein are obtained at the low level with the head tilted to the left at 30° and at the medium and low levels with the head tilted to the left at 60° after placement of a laryngeal mask.