Christian Berger, Philipp Brandhorst, Elena Asen, Sven Grallert, Sascha Treskatsch, Moritz Weigeldt
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Measurements were taken awake and during general anesthesia, each with and without the application of a tourniquet, and in three different arm positions (0°, 30°, and max° retroflexion) each. Data are presented as median and interquartile range [IQR].</p><p><strong>Results: </strong>Tourniquet application (AT) had the greatest single effect on Cubital vein outer diameter compared to the baseline value of all measures (3.9 mm [3.4-5.1]; 4.8 mm [4.1-5.7], P = 0.001, r = 0.515). This effect was surpassed by the combination of AT and GA (5.1 mm [4.6-6.6], P = 0.001, r = 0.889). In contrast, retroflexion alone did not result in an increase at either 30° (4.2 mm [3.7-5.1], p = 1.0, r = 0.12) or max° (4.2 mm [3.6-4.9], p = 0.72, r = 0.23). With GA and AT, no further enlargement was measurable by 30° (5.4 mm [4.6-6.6], p = 1.0, r = 0.15) or max° (5.4 mm [4.6-6.6], p = 1.0, r = 0.07) retroflexion compared to GA-AT-0° (5.1 mm [4.6-6.6], p = 1.0, r = 0.15).</p><p><strong>Conclusions: </strong>This study provides evidence that retroflexion of the arm in supine patients, whether alone or in addition to a tourniquet or general anesthesia, does not have any additional effect on vein width as a surrogate parameter for successful IV success. It shows for the first time that general anesthesia effectively increases vein diameter.</p><p><strong>Trial registration: </strong>DRKS00029603 (date of registration 07.07.2022).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"24 1","pages":"379"},"PeriodicalIF":2.3000,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494795/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of arm position compared to tourniquet and general anesthesia on peripheral vein width in supine adult patients: a prospective, monocentric, cross-sectional study.\",\"authors\":\"Christian Berger, Philipp Brandhorst, Elena Asen, Sven Grallert, Sascha Treskatsch, Moritz Weigeldt\",\"doi\":\"10.1186/s12871-024-02765-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>IV access is a commonly performed procedure that is often taught based on tradition rather than evidence. The effect of arm retroflexion on vein width, either alone or in combination with a tourniquet or general anesthesia (GA), remains unclear. In this case, the sonographically measured vein width is a surrogate parameter for the success of the puncture.</p><p><strong>Methods: </strong>Prospective, cross-sectional study involving 57 patients scheduled for surgery in general anesthesia. We analyzed the impact of arm retroflexion, tourniquet, general anesthesia, and their combinations on the antebrachial veins in supine patients by ultrasound. Measurements were taken awake and during general anesthesia, each with and without the application of a tourniquet, and in three different arm positions (0°, 30°, and max° retroflexion) each. Data are presented as median and interquartile range [IQR].</p><p><strong>Results: </strong>Tourniquet application (AT) had the greatest single effect on Cubital vein outer diameter compared to the baseline value of all measures (3.9 mm [3.4-5.1]; 4.8 mm [4.1-5.7], P = 0.001, r = 0.515). This effect was surpassed by the combination of AT and GA (5.1 mm [4.6-6.6], P = 0.001, r = 0.889). In contrast, retroflexion alone did not result in an increase at either 30° (4.2 mm [3.7-5.1], p = 1.0, r = 0.12) or max° (4.2 mm [3.6-4.9], p = 0.72, r = 0.23). With GA and AT, no further enlargement was measurable by 30° (5.4 mm [4.6-6.6], p = 1.0, r = 0.15) or max° (5.4 mm [4.6-6.6], p = 1.0, r = 0.07) retroflexion compared to GA-AT-0° (5.1 mm [4.6-6.6], p = 1.0, r = 0.15).</p><p><strong>Conclusions: </strong>This study provides evidence that retroflexion of the arm in supine patients, whether alone or in addition to a tourniquet or general anesthesia, does not have any additional effect on vein width as a surrogate parameter for successful IV success. 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引用次数: 0
摘要
背景:静脉通路是一种常用的操作方法,其教学往往基于传统而非证据。无论是单独还是与止血带或全身麻醉(GA)结合使用,手臂后屈对静脉宽度的影响仍不明确。在这种情况下,声像图测量的静脉宽度是穿刺成功与否的替代参数:方法:前瞻性横断面研究,涉及 57 名计划在全身麻醉下进行手术的患者。我们通过超声波分析了手臂后屈、止血带、全身麻醉及其组合对仰卧患者腋前静脉的影响。分别在清醒状态和全身麻醉状态下、使用止血带和不使用止血带的情况下、在三种不同的手臂位置(0°、30°和最大°后屈)进行测量。数据以中位数和四分位距[IQR]表示:结果:与所有测量指标的基线值相比,使用止血带(AT)对眶静脉外径的影响最大(3.9 mm [3.4-5.1]; 4.8 mm [4.1-5.7], P = 0.001, r = 0.515)。AT和GA组合的效果更佳(5.1 mm [4.6-6.6],P = 0.001,r = 0.889)。与此相反,单独的后屈在 30°(4.2 mm [3.7-5.1],P = 1.0,r = 0.12)或最大°(4.2 mm [3.6-4.9],P = 0.72,r = 0.23)时都没有增加。与GA-AT-0°(5.1 mm [4.6-6.6],p = 1.0,r = 0.15)相比,使用GA和AT后,30°(5.4 mm [4.6-6.6],p = 1.0,r = 0.15)或最大°(5.4 mm [4.6-6.6],p = 1.0,r = 0.07)后屈不能测量到进一步扩大:本研究提供的证据表明,无论是单独使用止血带或全身麻醉,还是附加使用止血带或全身麻醉,仰卧位患者的手臂后屈都不会对静脉宽度(静脉输液成功的替代参数)产生额外影响。该研究首次表明,全身麻醉可有效增加静脉直径:试验注册:DRKS00029603(注册日期:2022 年 7 月 7 日)。
Impact of arm position compared to tourniquet and general anesthesia on peripheral vein width in supine adult patients: a prospective, monocentric, cross-sectional study.
Background: IV access is a commonly performed procedure that is often taught based on tradition rather than evidence. The effect of arm retroflexion on vein width, either alone or in combination with a tourniquet or general anesthesia (GA), remains unclear. In this case, the sonographically measured vein width is a surrogate parameter for the success of the puncture.
Methods: Prospective, cross-sectional study involving 57 patients scheduled for surgery in general anesthesia. We analyzed the impact of arm retroflexion, tourniquet, general anesthesia, and their combinations on the antebrachial veins in supine patients by ultrasound. Measurements were taken awake and during general anesthesia, each with and without the application of a tourniquet, and in three different arm positions (0°, 30°, and max° retroflexion) each. Data are presented as median and interquartile range [IQR].
Results: Tourniquet application (AT) had the greatest single effect on Cubital vein outer diameter compared to the baseline value of all measures (3.9 mm [3.4-5.1]; 4.8 mm [4.1-5.7], P = 0.001, r = 0.515). This effect was surpassed by the combination of AT and GA (5.1 mm [4.6-6.6], P = 0.001, r = 0.889). In contrast, retroflexion alone did not result in an increase at either 30° (4.2 mm [3.7-5.1], p = 1.0, r = 0.12) or max° (4.2 mm [3.6-4.9], p = 0.72, r = 0.23). With GA and AT, no further enlargement was measurable by 30° (5.4 mm [4.6-6.6], p = 1.0, r = 0.15) or max° (5.4 mm [4.6-6.6], p = 1.0, r = 0.07) retroflexion compared to GA-AT-0° (5.1 mm [4.6-6.6], p = 1.0, r = 0.15).
Conclusions: This study provides evidence that retroflexion of the arm in supine patients, whether alone or in addition to a tourniquet or general anesthesia, does not have any additional effect on vein width as a surrogate parameter for successful IV success. It shows for the first time that general anesthesia effectively increases vein diameter.
Trial registration: DRKS00029603 (date of registration 07.07.2022).
期刊介绍:
BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.