[Haemorrhagic shock during cerebrospinal fluid shunt procedure. Reassessment of the anaesthetic or surgical practice?].
We report two cases of perioperative haemorrhagic shock after accidental puncture of trunc vessels, during emergency shunt procedures in children who suffer of severe intracranial hypertension. In both cases it's the peritoneal internalization of the shunt with Portnoy trocar which is responsible of these deep vascular wounds. Evolution was favourable in both cases with cardiovascular resuscitation, transfusion and surgical haemostatic correction. Few days later, an internal shunt was performed in the second patient, while the first patient did not need shunt anymore. These two accidents lead to the discussion of the surgical procedure with surgeons, in order to have a better prevention against this complication. We also discuss our anaesthesiological practice from preoperative to perioperative period of this usually non-haemorrhagic surgical procedure.
Combettes
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E
Département d'Anesthésie-Réanimation Chirurgicale, Hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
Blanot
S
S
Cuttaree
H
H
Zérah
M
M
Orliaguet
G
G
D000758:Anesthesia; D016080:Arachnoid Cysts / Q000601:surgery; D002536:Cerebral Arteries / Q000293:injuries; D002543:Cerebral Hemorrhage / Q000209:etiology; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D006801:Humans; D019586:Intracranial Hypertension / Q000601:surgery; D007431:Intraoperative Complications / Q000209:etiology* / Q000628:therapy; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012771:Shock, Hemorrhagic / Q000209:etiology* / Q000628:therapy