Clinical trial NCT02002507: Jugular Venous Flow Neurosurgical Patients
Official title: Effect of Different Surgical Positions on the Cerebral Venous Drainage: an Ultrasound Study on Neurosurgical Patients
Study type: OBSERVATIONAL
Overall status: WITHDRAWN
Conditions: Jugular Venous Flow
Lead sponsor: University Health Network, Toronto
Sponsor class: OTHER
First posted: 2013-12-05
Enrollment: 0
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Neurosurgical patients in either park bench or prone position for their surgery

Brief summary: 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.

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.

Eligibility criteria: 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

Primary outcomes:
measure: Jugular venous flow
timeFrame: 1 day
Secondary outcomes:
measure: cross- sectional area of internal jugular vein
timeFrame: 1 day
measure: doppler velocity of jugular venous flow
timeFrame: 1 day
Other outcomes:
Locations:
city: Toronto
country: Canada
facility: University Health Network, Toronto Western Hospital
state: Ontario
Study officials:
affiliation: University Health Network, Toronto Western Hospital
name: Lashmi Venkatraghavan
role: PRINCIPAL_INVESTIGATOR
affiliation: University Health Network, Toronto Western Hospital
name: Vincent Chan
role: PRINCIPAL_INVESTIGATOR
affiliation: University Health Network, Toronto Western Hospital
name: Pirjo Manninen
role: PRINCIPAL_INVESTIGATOR
affiliation: University Health Network, Toronto Western Hospital
name: Audrey MY Tan
role: PRINCIPAL_INVESTIGATOR
affiliation: University Health Network, Toronto Western Hospital
name: Jigesh Mehta
role: PRINCIPAL_INVESTIGATOR
References: