Difference between revisions of "Ventriculoperitoneal shunt"

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
	Article quality
Editor rating	In development
User likes	0

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Latest revision as of 00:25, 5 April 2022

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

Top contributors: Olivia Sutton and Chris Rishel

@@ Line 1: / Line 1: @@
+{{Infobox surgical procedure
+| anesthesia_type = General
+| airway = ETT
+| lines_access = PIV
+| monitors = Standard
+ECG leads on back/side
+| considerations_preoperative =
+| considerations_intraoperative = ICP management
+High stimulation during tunneling
+| considerations_postoperative =
+}}
+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<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
+{| class="wikitable"
+|+
+!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<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
+=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
+=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
+=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
+== Intraoperative management ==
+=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or 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<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
+=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
+* Supine, arms to the side, head turned to the left (contralateral side of shunt insertion)
+* Shoulder roll occasionally utilized
+=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
+* 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<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
+== Postoperative management ==
+=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
+=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
+=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
+* 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<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
+{| class="wikitable wikitable-horizontal-scroll"
+|+
+!
+!Variant 1
+!Variant 2
+|-
+|Unique considerations
+|
+|
+|-
+|Position
+|
+|
+|-
+|Surgical time
+|
+|
+|-
+|EBL
+|
+|
+|-
+|Postoperative disposition
+|
+|
+|-
+|Pain management
+|
+|
+|-
+|Potential complications
+|
+|
+|}
+== References ==
+[[Category:Surgical procedures]]