title: Laparoscopic surgery in patients with ventriculoperitoneal shunts: safety and monitoring.
abstract: OBJECTIVE
  It was suggested that patients with a ventriculoperitoneal shunt are at risk for increased intracranial pressure during pneumoperitoneum. Shunt pressure monitoring and ventricular drainage to maintain normal pressure were recommended. We evaluated a series of patients with a ventriculoperitoneal shunt who underwent laparoscopic surgery to determine the clinical indications of increased intracranial pressure.
  
  
  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 operative time, carbon dioxide level, pulse, blood pressure and any untoward anesthetic events were obtained. Postoperative records were assessed for evidence of neurological change.
  
  
  RESULTS
  Mean operative time was 7 hours 13 minutes and estimated mean laparoscopic 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 bradycardia and hypertension or surgically related neurological deterioration and no untoward anesthetic events. Ventriculoperitoneal shunt revision was done 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 intracranial pressure in our series or in the literature in patients with a ventriculoperitoneal shunt who undergo laparoscopy. Invasive methods for shunt monitoring are not without risk. Routine anesthetic monitoring should remain the standard of care in the absence of clear evidence to the contrary.
authors.affiliation: James Buchanan Brady Urological Institute, and Departments of Neurosurgery and Neurology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Jackman
authors.forename: J D
authors.initials: JD
authors.lastname: Weingart
authors.forename: S L
authors.initials: SL
authors.lastname: Kinsman
authors.forename: S G
authors.initials: SG
authors.lastname: Docimo
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007427:Intracranial Pressure; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt