Ventriculoperitoneal shunt
Anesthesia type

General

Airway

ETT

Lines and access

PIV

Monitors

Standard ECG leads on back/side

Primary anesthetic considerations
Preoperative
Intraoperative

ICP management High stimulation during tunneling

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

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

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

Induction and airway management

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

Emergence

Postoperative management

Disposition

Pain 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

References