Laparoscopic surgery in patients with ventriculoperitoneal shunts: Safety and monitoring

Purpose: It was suggested that patients with a ventriculoperitoneal shunt a re at risk for increased intracranial pressure during pneumoperitoneum. Shu nt pressure monitoring and ventricular drainage to maintain normal pressure were recommended. We evaluated a series of patients with a ventriculoperit oneal shunt who underwent laparoscopic surgery to determine the clinical in dications of increased intracranial pressure. Materials and Methods: We reviewed the anesthesia records of 12 females and 6 males with a mean age of 13.2 years who had a ventriculoperitoneal shunt and underwent a total of 19 consecutive laparoscopic operations. Data on o perative time, carbon dioxide level, pulse, blood pressure and any untoward anesthetic events were obtained. Postoperative records were assessed for e vidence of neurological change. Results: Mean operative time was 7 hours 13 minutes and estimated mean lapa roscopic time was 2 hours 52 minutes. Average insufflation pressure was 16 mm. Hg (range 12 to 20). There was no evidence of a trend to combined brady cardia and hypertension or surgically related neurological deterioration an d no untoward anesthetic events. Ventriculoperitoneal shunt revision was do ne in 3 cases, a rate consistent with that in the literature. Mean followup was 23.4 months (range 1 to 58). Conclusions: There was no evidence of clinically significant increased intr acranial pressure in our series or in the literature in patients with a ven triculoperitoneal shunt who undergo laparoscopy. Invasive methods for shunt monitoring are not without risk. Routine anesthetic monitoring should rema in the standard of care in the absence of clear evidence to the contrary.