The Second Try During Landmark Approach of the Internal Jugular Vein: an Ultrasonographic Prelocation Study

Immediately after induction of general anesthesia, the patient's head is turned slightly, and the table is tilted at 10 degrees, and the puncture point estimated by the anatomical landmarks are marked on the patient's skin. The investigators obtain a sonographic view at the estimated puncture point. It is recorded "success" when the internal jugular vein is visualized on the ultrasonography, and the estimated needle path passes the internal jugular vein. It is recorded "failure" if the internal jugular vein is not visualized on the ultrasonography, and the estimated needle path does not pass the internal jugular vein. After "failure" of the first attempt, the probe is either turned laterally or moved medially until the internal jugular vein is visualized on the ultrasonography, and the estimated needle path passes the internal jugular vein. The angle and distance is recorded. The location of the carotid artery is always marked on the ultrasonography for evaluation of complications.

Inclusion criteria

• Patients scheduled for general anesthesia

Exclusion criteria

• Refusal of consent
• Patients with C-spine injuries
• Patients with atlanto-axial instability
• Patients at risk of increased intracranial pressure