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  1. Kurien M, Teo R, Zainuddin K, Azidin AM, Izaham A, Budiman M, et al.
    Clin Ter, 2021 Jul 05;172(4):278-283.
    PMID: 34247211 DOI: 10.7417/CT.2021.2332
    Objective: We compared sonoanatomy of the internal jugular vein (IJV) the high (HA), conventional (CA) and the medial oblique approach (MA) to identify the best approach and head position for IJV cannulation.

    Materials & Methods: Total of 45 volunteers aged 18-65 years were included in this study. The degree of overlap in percentage, depth of IJV from skin, antero-posterior (AP) and transverse diameters (TD) of IJV were measured in real time with ultrasound (US). Measurements were taken in the HA, CA and MA in neutral and 30° head rotation on both the right and left side of the neck.

    Results: The HA had lower percentage of overlap when compared to CA and MA in neutral and 30° head rotation (p= 0.002 to ≤0.001). The IJV was more shallow in the CA and MA. The AP and TD of the IJV were larger in the MA when compared to HA (p=<0.001) and CA (p =0.026 to < 0.001) and the right IJV has a larger AP and TD in all approaches.

    Discussion: The HA had the least percentage of overlap compared to CA and MA, therefore the risk of accidental ICA puncture can be reduced. The apparent overlap seen in MA may not reflect the actual scenario because of the way the US beam cuts the vessel. The AP and TD of IJV were significantly increased in the MA, which would ease CVC.

    Conclusion: We conclude and recommend the medial oblique probe position with 30° head rotation provides optimal real time sonographic parameters for US guided IJV cannulation.

  2. Lim YP, Yahya N, Izaham A, Kamaruzaman E, Zainuddin MZ, Wan Mat WR, et al.
    Turk J Med Sci, 2018 Dec 12;48(6):1219-1227.
    PMID: 30541250 DOI: 10.3906/sag-1802-126
    Background/aim: Regional anesthesia for surgery is associated with increased anxiety for patients. This study aimed to compare the
    effect of propofol and dexmedetomidine infusion on perioperative anxiety during regional anesthesia.

    Materials and methods: Eighty-four patients were randomly divided into two groups receiving either study drug infusion. Anxiety
    score, level of sedation using the Bispectral Index and Observer’s Assessment of Alertness and Sedation, hemodynamic stability, and
    overall patient’s feedback on anxiolysis were assessed.

    Results: Both groups showed a significant drop in mean anxiety score at 10 and 30 min after starting surgery. Difference in median
    anxiety scores showed a significant reduction in anxiety score at the end of the surgery in the dexmedetomidine group compared to the
    propofol group. Dexmedetomidine and propofol showed a significant drop in mean arterial pressure in the first 30 min and first 10 min
    respectively. Both drugs demonstrated a significant drop in heart rate in the first 20 min from baseline after starting the drug infusion.
    Patients in the dexmedetomidine group (76.20%) expressed statistically excellent feedback on anxiolysis compared to patients in the
    propofol group (45.20%).

    Conclusion: Dexmedetomidine infusion was found to significantly reduce anxiety levels at the end of surgery compared to propofol
    during regional anesthesia.

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