Ventriculoperitoneal shunt - Revision history

Dominicmangino at 18:46, 14 September 2025

2025-09-14T18:46:58Z

← Older revision		Revision as of 11:46, 14 September 2025
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	=== 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. --> ===
			Emergence should be timely and avoid medications that alter neuro exam.

	== Postoperative management ==		== Postoperative management ==

Chris.Rishel at 07:25, 5 April 2022

2022-04-05T07:25:36Z

← Older revision		Revision as of 00:25, 5 April 2022
Line 1:		Line 1:
	{{Infobox surgical procedure		{{Infobox surgical procedure
	\| anesthesia_type = GA		\| anesthesia_type = General
	\| airway = ETT		\| airway = ETT
	\| lines_access = PIV ~~x1, 20G is acceptable~~		\| lines_access = PIV
	\| monitors = Standard~~, EKG~~ leads on back/side ~~as chest is prepped~~		\| monitors = Standard
			ECG leads on back/side
	\| considerations_preoperative =		\| considerations_preoperative =
	\| considerations_intraoperative = ~~Mild hyperventilation if elevated~~ ICP ~~involved,~~		\| considerations_intraoperative = ICP management
			High stimulation during tunneling
	\| considerations_postoperative =		\| considerations_postoperative =
	}}		}}

Oliviamsutton at 19:38, 14 March 2022

2022-03-14T19:38:55Z

← Older revision		Revision as of 12:38, 14 March 2022
Line 1:		Line 1:
	{{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 =
	}}		}}
Line 59:		Line 59:

	=== 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. --> ===
Line 77:		Line 85:

	=== 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). --> ==

Oliviamsutton at 19:02, 14 March 2022

2022-03-14T19:02:32Z

← Older revision	Revision as of 12:02, 14 March 2022
Line 1:	Line 1:
		{{Infobox surgical procedure
		\| anesthesia_type =
		\| airway =
		\| lines_access =
		\| monitors =
		\| considerations_preoperative =
		\| considerations_intraoperative =
		\| 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. --> ===

		=== 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. --> ===

		=== 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

		=== 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. --> ===

		== 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]]

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