[Landmark method and ultrasound-guided method of internal jugular vein puncture: comparison of residents with staffs].

BACKGROUND: We compared landmark with ultrasound-guided methods of internal jugular vein puncture in residents and staffs. METHODS: Seven residents and five staffs practiced internal jugular vein puncture with landmark and ultrasound-guided methods on a manikin for internal jugular vein cannulation. Thereafter, they performed internal jugular vein cannulation on 42 patients. RESULTS: Number of attempts of internal jugular vein cannulation by the residents was significantly lower with ultrasound-guided method than with landmark method. Three internal jugular veins could not be cannulated by residents with landmark method. The common carotid artery was punctured in one case with either method by residents. CONCLUSIONS: Residents need more practice of internal jugular vein puncture on a manikin before clinical practice.

[Training of internal jugular vein cannulation: comparison of landmark method with ultrasound-guided method].

We compared training of internal jugular vein cannulation with ultrasound-guided method and that with landmark method in a group of 10 residents and that of 10 staffs. Cannulation was increasingly successful with both methods as the training proceeded, and with increasingly less time and fewer number of punctures. There was no statistically significant difference in time or in number of punctures with ultrasound-guided method between the groups. Ultrasound-guided method needed fewer number of punctures than those with landmark method in both groups.

[Pulmonary edema due to upper airway obstruction after extubation].

We report a patient who developed pulmonary edema due to airway obstruction after extubation. A 22-year-old man underwent removal of the nails for thoracoplasty under general anesthesia combined with epidural anesthesia. Upper airway obstruction occurred after extubation. SpO2 decreased to 70%. Insertion of an oral airway relieved the airway obstruction. However, inspiratory wheezing was heard over both lung fields. Chest X-ray taken 90 minutes after the event revealed pulmonary edema. Pulmonary edema gradually resolved after intravenous furosemide and oxygen inhalation by mask.