Context: Internal jugular vein (IJV) is cannulated in a variety of patients. Left IJV cannulation sometimes becomes necessary. Aim: This study was done to evaluate the usefulness of ultrasonography (USG) in performing left and right IJV cannulation compared with use of surface anatomy landmarks. Setting and Design: Prospective randomized study in a tertiary care teaching hospital. Methods: Ninety one American Society of Anesthesiologists (ASA) class I, II or III adult patients scheduled for elective cardiothoracic, vascular, neurosurgical or major abdominal surgeries requiring IJV cannulation were randomized to undergo either right IJV cannulation using surface landmarks (Group 1) or USG (Group 2) or left IJV cannulation using surface landmarks (Group 3) or USG (Group 4). The number of attempts, time taken, the success rate, any change in technique or side of cannulation and any complications were recorded. Results: There was a significant difference in the success rate and number of complication between group 3 and group 4 (p<0.05). There was a statistically significant difference in the time taken for cannulation between Group 3 and Group 4 (273.9±127.6 Vs 135.2±105.1 sec, p<0.001). There was a significant difference in the number of attempts between Group 1 and Group 2 (2.05±1.2 Vs 1.46±0.64, p<0.05) and between Groups 3 and Group 4 (2.78±1.41 Vs 1.69±0.18, p<0.01). Complications (carotid puncture) were significantly more common on left side using surface landmarks (p<0.05). Conclusion: Ultrasound significantly improves the success rate of left and right IJV cannulation when compared to use of surface landmarks. It also reduces the number of attempts, the time required for cannulation and incidence of complications.