Ventriculoperitoneal shunt

Ventriculoperitoneal shunt

Anesthesia type	GA
Airway	ETT
Lines and access	PIV x1, 20G is acceptable
Monitors	Standard, EKG leads on back/side as chest is prepped
Primary anesthetic considerations
Preoperative
Intraoperative	Mild hyperventilation if elevated ICP involved,
Postoperative
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VP shunting is commonly utilized to tread hydrocephalus. A thin catheter is inserted into the brain to shunt CSF from the lateral ventricles of the brain into the peritoneum. The surgeon usually makes incision in the right parietal area (behind the right ear) as well as in the abdominal wall via the rectus sheath to access the peritoneum. The distal catheter is then tunneled from under the skin and subcutaneous tissue behind the ear, neck, down to the peritoneal cavity. A fluid pump with valve is placed under the skin behind the ear, and the valve is connected to both catheters. When extra intracranial pressure builds, the valve opens and excess fluid can drain out into the peritoneal space.

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic	Check for antiepileptics, as they alter metabolism of other anesthetic drugs Assess for kyphoscoliosis
Cardiovascular	Assess for congenital cardiac disease
Pulmonary	Assess for congenital bronchopulmonary dysplasia or recurrent respiratory infections secondary to neurologic dysfunction
Gastrointestinal
Hematologic
Renal
Endocrine
Other	Patients are most commonly children

Intraoperative management

Monitoring and access

• Usually 20G PIV is sufficient
• EKG leads should be placed on the back and side as the chest is prepped for tunneling

Positioning

• Supine, arms to the side, head turned to the left (contralateral side of shunt insertion)
• Shoulder roll occasionally utilized

Maintenance and surgical considerations

• Duration 1-2h
• Tunneling is the most stimulating portion of the surgery
• Mild hyperventilation can be employed if elevated ICP is involved, but avoid overventilation as ventricles can be more challenging to cannulate if empty due to hyperventilation

Postoperative management

Potential complications

• Head bleed
• Brain swelling
• Bowel perforation
• CSF fluid leakage under the skin
• Infection of the shunt or brain
• Seizure
• Damage to brain tissue
• Shunt malfunction requiring surgical repair

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications