Difference between revisions of "Ventriculoperitoneal shunt"
From WikiAnesthesia
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = GA | ||
| airway = | | airway = ETT | ||
| lines_access = | | lines_access = PIV x1, 20G is acceptable | ||
| monitors = | | monitors = Standard, EKG leads on back/side as chest is prepped | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = Mild hyperventilation if elevated ICP involved, | ||
| considerations_postoperative = | | considerations_postoperative = | ||
}} | }} | ||
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=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === 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. --> === | === 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. --> === | === 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. --> === | === 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. --> === | ||
* Tunneling is the most stimulating portion of the surgery | * 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. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
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=== Potential complications<!-- List and/or describe any potential postoperative complications 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). --> == | == 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). --> == | ||
Revision as of 12:38, 14 March 2022
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 | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
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