Jugular Venous Flow Neurosurgical Patients

Effect of Different Surgical Positions on the Cerebral Venous Drainage: an Ultrasound Study on Neurosurgical Patients

Our hypothesis is that there will be a decrease in internal jugular venous flow in the park bench position when compared to the supine position. There will also be a change in blood flow between the right and left internal jugular veins in the park bench position. In particular, there will be a greater reduction of flow on the dependent side. However, the internal jugular venous flow will be the same in both the prone and supine positions.

Study Overview

• Status: Withdrawn
• Conditions: Jugular Venous Flow
• Intervention / Treatment: Other: comparison of different neurosurgical position

Detailed Description

The different positions used in neurosurgery for better accessibility to the operating field (park bench, prone) can impact cerebral venous drainage due to the effects of internal jugular venous outflow of blood, and may increase intracranial pressure. Excessive neck flexion and rotation in the park bench position, or flexion in the prone position, may lead to kinking or twisting of the internal jugular vein. This has been hypothesized as the major cause of disturbed venous drainage during surgery and may lead to neck swelling, brachial plexus injury, macroglossia (swollen tongue), delayed airway obstruction, and increases in intracranial pressure in postoperative patients. Optimal brain perfusion is best in the neutral position of the head, but surgery cannot always be performed in this position. Thus, we look to measure the internal jugular venous flow at different positions, as there have been few studies looking at this important contributing factor.

• Study Type: Observational

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5T 2S8
      • University Health Network, Toronto Western Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Neurosurgical patients in either park bench or prone position for their surgery

Description

Inclusion Criteria:

• Adult neurosurgical patients who are above the age of 18
• Patients undergoing neurosurgery requiring general anesthesia and placement in either in prone or park bench position for surgical accessibility

Exclusion Criteria:

• Lack of informed consent
• Patients undergoing surgical procedures only in the supine position
• Patients needing a central venous catheter in the neck

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
park bench position; Comparing jugular venous flow in supine and park bench position in neurosurgical patients requiring their surgery in park bench position	Other: comparison of different neurosurgical position; in 2 of 3 positions (supine, plus either prone or park bench) with both left and right internal jugular vein cross-sectional area of vein, doppler velocity, internal jugular venous flow, position of internal jugular vein in relation to carotid artery (All measured with the use of ultrasound)
prone position; Comparing the jugular venous flow in the supine and prone position in patients requiring their surgery to be done in the prone position.	Other: comparison of different neurosurgical position; in 2 of 3 positions (supine, plus either prone or park bench) with both left and right internal jugular vein cross-sectional area of vein, doppler velocity, internal jugular venous flow, position of internal jugular vein in relation to carotid artery (All measured with the use of ultrasound)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Jugular venous flow	One of the following will be compared depending on the position of the patient; Bilateral internal jugular venous flow in supine and prone position; Bilateral internal jugular venous flow in supine and park bench position	1 day

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
cross- sectional area of internal jugular vein	Comparing the cross-sectional area of the internal jugular vein in different positions	1 day
doppler velocity of jugular venous flow	Comparing the doppler velocity of jugular venous flow in different surgical positions in neurosurgical patients	1 day

Collaborators and Investigators

• Sponsor: University Health Network, Toronto
• Investigators: Principal Investigator: Lashmi Venkatraghavan, University Health Network, Toronto Western Hospital; Principal Investigator: Vincent Chan, University Health Network, Toronto Western Hospital; Principal Investigator: Pirjo Manninen, University Health Network, Toronto Western Hospital; Principal Investigator: Audrey MY Tan, University Health Network, Toronto Western Hospital; Principal Investigator: Jigesh Mehta, University Health Network, Toronto Western Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2015
• Primary Completion (Anticipated): November 21, 2019
• Study Completion (Anticipated): December 31, 2019

Study Registration Dates

• First Submitted: November 29, 2013
• First Submitted That Met QC Criteria: December 4, 2013
• First Posted (Estimate): December 5, 2013

Study Record Updates

• Last Update Posted (Actual): December 22, 2022
• Last Update Submitted That Met QC Criteria: December 20, 2022
• Last Verified: December 1, 2022

More Information

Terms related to this study

• Other Study ID Numbers: 13-6432

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No