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| Name | Class |
|---|---|
| University Health Network, Toronto | OTHER |
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During neurosurgical procedures, patients need to be placed in sitting position for surgical access especially in surgeries in the vertex or posterior fossa. Due gravitational effect of sitting position the flow in IJV may be reduced. Venous air embolism (VAE) is a common complication of sitting position craniotomy and carries high mortality and morbidity. Venous pressure decreases as the head of the patient is raised above the heart. Hence, negative venous pressure in the cerebral venous system promotes entrapment of air in accidental opening of the sinuses.
Common methods to prevent VAE in sitting position include increasing the venous pressure by either jugular venous compression and/or increasing the venous pressure by adding positive end expiratory pressure (PEEP). Both these methods can decrease venous return and can lead to brain swelling.. In addition, improper neck position can cause the kinking of the IJV which may lead to decreased venous drainage and increased ICP. This has been shown to be the contributing factor for intraoperative brain swelling and postoperative neck and tongue swelling leading to airway obstruction. Optimal brain perfusion is best in the neutral position of the head, but surgery cannot always be performed with this.
Currently, there are no studies that looked into the IJV flow in sitting position and effect of venous outflow obstruction on the IJV flow. Valsalva maneuver (forced inspiration with closed glottis) and /or compression of internal jugular veins (IJV) are the two commonly used physiological methods that can cause venous outflow obstruction. A custom made neck collar can be used for compression of internal jugular vein and previous investigations have used a similar device in a rat model to demonstrate the protective effects on slosh-mediated brain injury by increasing intracranial blood volume . While the collars have not yet been studied on people for their effectiveness at preventing concussions, many studies have looked at the effect of neck collars on both jugular compression and ICP..
The purpose of this study is to measure the venous blood flow of healthy volunteers by the use of an ultrasound and Doppler velocimetry in sitting position. the investigators will measure the IJV flow on both sides in sitting position at rest and at two conditions of venous outflow obstruction- 1. Neck compression using a custom made collar and 2. During 30 seconds Valsalva maneuver. This study will provide information on the cerebral venous drainage. This information will be very useful in planning and positioning of patients undergoing neurosurgical procedures and to prevent complications from the improper patient position.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| sitting position | Experimental | The volunteers were kept comfortable in the sitting position. The cricoid cartilage (representing the C6 level) was used as a landmark. A horizontal straight line drawn across the volunteer's neck at the cricoid level and intersecting the IJV on both sides of the neck marked the initial scanning points. The second scanning point was along the IJV at the highest accessible point on the neck. Internal jugular vein cross-sectional area and blood velocity were measured using 2D ultrasound and Doppler (Philips CX50, Andover, MA, USA), respectively, with a 12-3 MHz transducer (Philips L12-3, Andover, MA, USA) |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Jugular venous ultrasound | Diagnostic Test | All volunteers will be fully awake throughout the study and be kept comfortable. A cross will be marked where the left and right IJV cross the level of C6. This is where all the measurements will be taken in 3 different conditions at rest, jugular occlusion and valsalva maneuver. At each conditions, the left and right IJV will be scanned with an ultrasound measuring the cross sectional area and Doppler velocity of the IJV. The least amount of pressure will be used to press on the ultrasound probe and the measurements will be obtained at end inspiration. The IJV flow is then calculated. |
| Measure | Description | Time Frame |
|---|---|---|
| Internal Jugular Venous Flow | Right Internal Jugular Vein Flow in the sitting position. | 1 day |
| Left Internal Jugular Vein Flow | left internal jugular vein cross-sectional area in the sitting position at rest and with application of the cervical collar. | 1 day |
| Right Internal Jugular Vein Flow in the Sitting Position | Right internal jugular vein peak velocity in the sitting position at rest and with application of the cervical collar | one day |
| Right Internal Jugular | Comparisons of right internal jugular vein flow in the sitting position at rest and with application of the cervical collar | one day |
| Measure | Description | Time Frame |
|---|---|---|
| Left Internal Jugular Vein Flow in the Sitting Position | Comparisons of left internal jugular vein peak velocity in the sitting position at rest and with application of the cervical collar | One day |
| Left Internal flow in the Sitting Position |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Lashmi Venkatraghavan, MD | University Health Network, Toronto | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Toronto Western Hospital | Toronto | Ontario | M5T2S8 | Canada |
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| ID | Title | Description |
|---|---|---|
| FG000 | Internal Jugular Vein Flow in the Sitting Position | The volunteers were kept comfortable in the sitting position. The cricoid cartilage (representing the C6 level) was used as a landmark. A horizontal straight line drawn across the volunteer's neck at the cricoid level and intersecting the IJV on both sides of the neck marked the initial scanning points |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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Data analyzed for only 10 participants who completed the study, two participants were excluded from the study due to poor compliance.
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| ID | Title | Description |
|---|---|---|
| BG000 | Sitting Position | The volunteers were kept comfortable in the sitting position. The cricoid cartilage (representing the C6 level) was used as a landmark. A horizontal straight line drawn across the volunteer's neck at the cricoid level and intersecting the IJV on both sides of the neck marked the initial scanning points |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Out of 12 participants, 10 participants completed the study, two participants were excluded from the study due to poor compliance. |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Internal Jugular Venous Flow | Right Internal Jugular Vein Flow in the sitting position. | Data analyzed for only 10 participants who completed the study, two participants were excluded from the study due to poor compliance. | Posted | Median | Inter-Quartile Range | cm2 | 1 day |
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1 day
Any adverse events detected during the procedure
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Internal Jugular Venous Flow in Sitting Position | The volunteers were kept comfortable in the sitting position. The cricoid cartilage (representing the C6 level) was used as a landmark. A horizontal straight line drawn across the volunteer's neck at the cricoid level and intersecting the IJV on both sides of the neck marked the initial scanning points |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Emad Al Azazi | Toronto western Hospital/UHN | 416-603-5800 | 6237 | emad.alazazi@uhnresearch.ca |
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left internal jugular vein flow in the sitting position at rest and with application of the cervical collar
| One day |
| Count of Participants |
| Participants |
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| Sex: Female, Male | Out of 12 participants, 10 participants completed the study, two participants were excluded from the study due to poor compliance. | Count of Participants | Participants |
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| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
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| Units | Counts |
|---|---|
| Participants |
|
|
| Primary | Left Internal Jugular Vein Flow | left internal jugular vein cross-sectional area in the sitting position at rest and with application of the cervical collar. | Data analyzed for only 10 participants who completed the study, two participants were excluded from the study due to poor compliance. | Posted | Median | Inter-Quartile Range | cm2 | 1 day |
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| Primary | Right Internal Jugular Vein Flow in the Sitting Position | Right internal jugular vein peak velocity in the sitting position at rest and with application of the cervical collar | Data analyzed for only 10 participants who completed the study, two participants were excluded from the study due to poor compliance. | Posted | Median | Inter-Quartile Range | cm.sec-1 | one day |
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| Primary | Right Internal Jugular | Comparisons of right internal jugular vein flow in the sitting position at rest and with application of the cervical collar | Data analyzed for only 10 participants who completed the study, two participants were excluded from the study due to poor compliance. | Posted | Median | Inter-Quartile Range | mL.min-1 | one day |
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| Secondary | Left Internal Jugular Vein Flow in the Sitting Position | Comparisons of left internal jugular vein peak velocity in the sitting position at rest and with application of the cervical collar | Data analyzed for only 10 participants who completed the study, two participants were excluded from the study due to poor compliance. | Posted | Median | Inter-Quartile Range | cm.sec-1 | One day |
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| Secondary | Left Internal flow in the Sitting Position | left internal jugular vein flow in the sitting position at rest and with application of the cervical collar | Data analyzed for only 10 participants who completed the study, two participants were excluded from the study due to poor compliance. | Posted | Median | Inter-Quartile Range | mL.min-1 | One day |
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| 0 |
| 10 |
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| 10 |
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| 10 |
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