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Intracranial pressure and haemodynamic changes during the tunnelling phase of ventriculoperitoneal shunt insertion

Published online by Cambridge University Press:  25 November 2005

H. Prabhakar ,
G. P. Rath ,
P. K. Bithal  and
R. S. Chouhan
H. Prabhakar
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesiology, New Delhi, India
G. P. Rath
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesiology, New Delhi, India
P. K. Bithal
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesiology, New Delhi, India
R. S. Chouhan
Affiliation:
All India Institute of Medical Sciences, Department of Neuroanaesthesiology, New Delhi, India
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Extract

Summary

Background and objective: The tunnelling phase of ventriculoperitoneal shunt insertion is the most painful part but patients are often given inadequate opioid analgesic for fear of post operative delayed recovery and/or respiratory depression. This may result in an increase in intracranial pressure. Methods: Twenty adults scheduled to undergo ventriculoperitoneal shunt insertion were administered standard anaesthesia. Monitoring included heart rate, electrocardiogram, end-tidal carbon dioxide, invasive blood pressure, and oxygen saturation. Intracranial pressure was monitored by placing the ventricular end of shunt catheter in the dilated lateral ventricle. Five minutes before tunnelling, fentanyl 1 μg kg−1 was administered. Mean arterial pressure, heart rate and intracranial pressure were recorded during tunnelling and subsequently at 1-min interval for 5 min. Data were analysed using t-test and repeated measured test. Results: Tunnelling caused significant increase in mean arterial pressure (from 81.4 ± 11.0 to 110.9 ± 15.3 mmHg, P < 0.05), intracranial pressure (from 21.4 ± 8.1 to 29.2 ± 12.5 mmHg, P < 0.05) and heart rate (from 74.4 ± 13.8 to 94.1 ± 17.8 beats min−1, P < 0.05). Whereas, the increase in haemodynamic parameters persisted for 3 min post-tunnelling, elevated intracranial pressure lasted for 2 min. Conclusion: Tunnelling significantly increases intracranial pressure and blood pressure despite prior fentanyl administration. This may be deleterious in the presence of intracranial pathology.

Keywords

VENTRICULOPERITONEAL SHUNTINTRACRANIAL PRESSUREPHYSIOLOGICAL MEASUREMENT TECHNIQUES, blood pressure, heart rateSURGICAL PROCEDURES, intracranialANAESTHESIA GENERALNARCOTICS, fentanyl
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 12 , December 2005 , pp. 947 - 950
Copyright
© 2005 European Society of Anaesthesiology

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