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Canadian Journal of Anesthesia 52:656-657 (2005)
© Canadian Anesthesiologists' Society, 2005

Correspondence

Antecubital approach for monitoring jugular bulb venous oxygen saturation during carotid endarterectomy

Satoki Inoue, MD, Masahiko Kawaguchi, MD, Hitoshi Furuya, MD and Toshisuke Sakaki, MD

Nara Medical University, Nara, Japan, E-mail: seninoue{at}naramed-u.ac.jp

To the Editor:

Monitoring of jugular bulb venous oxygen saturation (SjO2) is one method used to detect changes in cerebral oxygen saturation during carotid endarterectomy (CEA).1,2 However, it usually requires direct insertion of a catheter within the operating field to obtain either continuous or intermittent monitoring of SjO2.1–3 We have recently used a novel alternative method for insertion of the catheter which avoided disturbance of the surgical procedure.

The antecubital vein was used to cannulate the jugular bulb. We chose a 5.5 Fr fibreoptic pulmonary artery catheter (Opticath®, Abbott Laboratories, North Chicago, IL, USA). First, a 6 Fr introducer sheath was placed, and then the 5.5 Fr fibreoptic catheter was advanced through the indwelling introducer sheath. A fluoroscopic image guide was essential to advance the catheter with the arm positioned alongside the body and the head rotated 20 to 30° contralaterally. Usually, several attempts were required to introduce the catheter to the internal jugular vein. Changing the head and arm positions or rotating the catheter tip are additional maneuvers for successful advancement of the catheter based upon our initial experience. The catheter tip is advanced to the appropriate site for monitoring of SjO2 with the aid of fluoroscopy. The FigureGo shows successful placement of the fibreoptic catheter at the right jugular bulb. We attempted this method in three patients. The first trial case failed due to our limited experience, but in the next two cases, the catheter was placed successfully.



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  		FIGURE Successful placement of the fibreoptic catheter at the right jugular bulb on x-ray anteroposterior view, which shows the catheter tip situated cranial to a line extending from the atlanto-occipital joint space and caudal to the lower margin of the orbit.4 The arrow indicates the catheter tip. The catheter line can be traced distally via the clavicle on the film.

 
The method we describe will require further detailed evaluation; however it presents clear advantages for monitoring SjO2 during CEA. Further refinements may improve this technique, including use of a guide wire for introducing the catheter into the internal jugular vein. In addition, this method should be compared with the conventional technique of monitoring SjO2 during CEA in terms of 1) accuracy and continuity of measurements, 2) time necessary to obtain the measurement and 3) cost effectiveness evaluation. Further improvement and experience are essential for establishing the effectiveness and safety of this potentially promising aproach to SjO2 monitoring.

Footnotes

This work was covered only by departmental funding.

References

1 Niinai H, Nakagawa I, Shima T, Kawamoto M, Yuge O. Continuous monitoring of jugular bulb venous oxygen saturation for evaluation of cerebral perfusion during carotid endarterectomy. Hiroshima J Med Sci 1998; 47: 133–7.[Medline]

2 Williams IM, Picton A, Farrell A, Mead GE, Mortimer AJ, McCollum CN. Light-reflective cerebral oximetery and jugular bulb venous oxygen saturation during carotid endarterectomy. Br J Surg 1994; 81: 1291–5.[Medline]

3 Sahlein DH, Heyer EJ, Rampersad A, et al. Failure of intraoperative jugular bulb S-100B and neuron-specific enolase sampling to predict cognitive injury after carotid endarterectomy. Neurosurgery 2003; 53: 1243–9.

4 White H, Baker A. Continuous jugular venous oximetory in the neurointensive care unit–a brief review. Can J Anesth 2002; 49: 623–9.[Abstract/Free Full Text]





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