• Vincent DeAngelis, John Denny, Darrick Chyu, Thomas Jan, Anthony Lemaire, Antonio Chiricolo, and Al Solina.
• Departments of Anesthesia.
• J. Cardiothorac. Vasc. Anesth. 2015 Oct 1; 29 (5): 1257-60.

ObjectivesThe aim of this study was to determine the degree of head rotation that creates the maximal anatomic separation between the right internal jugular vein and the carotid artery.DesignSingle-center prospective, observational cohort study.SettingUniversity medical center.ParticipantsFifty patients aged>21 years and undergoing cardiac surgery.InterventionsAn ultrasound machine equipped with a digital caliper was used to determine the relational anatomy of the internal jugular vein and the carotid artery, with patients in the Trendelenburg position at head angles of -15°, 0°,+15°,+30°,+45°,+60°,+75°, and+90°.Measurements And Main ResultsWhen examining the percentage of the internal jugular vein vertical diameter that is not overlapped by the carotid artery (vertically unencumbered), there was a difference between the head angle groups (p<0.01). Unencumbered vertical distance was different between+75° versus 0°, and+75° versus+15°. At+75°, 60.3%±5.3% of the internal jugular vein was unencumbered vertically, whereas at 0°, it was 37.2%±3.9%, and at+15° it was 40.3%±3.8%. Only 72% of the patients were able to position their head at+75°, and 54% of the subjects were able to position their head at+90°.ConclusionThe authors found the internal jugular vein becomes more vertically separated from the carotid artery at more extreme angles of contralateral head rotation.Copyright © 2015 Elsevier Inc. All rights reserved.

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