Ventriculoperitoneal shunt

Ventriculoperitoneal shunt

Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
Article quality
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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

Maintenance and surgical considerations

• Tunneling is the most stimulating portion of the surgery

Procedure variants

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