Perioperative Management of Hydrocephalus
- Author: H. Krovvidi
- Full Title: Perioperative Management of Hydrocephalus
- Category: #books
Highlights
- The total adult CSF volume is around 150 ml, distributed between the cranial and spinal subarachnoid channels (125 ml) with a smaller, albeit variable volume in the ventricles (average 25 ml). Most CSF is produced in the ependymal cells of the choroid plexus, whilst a small proportion is formed around the cerebral vessels from brain interstitial fluid. The formation of CSF is independent of the cerebral perfusion pressure and intracranial pressure (ICP), up to the point where ICP is increased to such a degree that CSF production is compromised. (Page 1)
- The rate of absorption is largely driven by the ICP, with resistance to CSF outflow provided by the arachnoid granulations and the intracranial venous sinus pressure. (Page 2)
- The height of the burette and scale are adjusted so that the ‘zero’ on the scale corresponds with the foramen of Monro. When the patient is supine, the external auditory meatus approximates to this point. When the patient is being nursed in the lateral position, the reference point lies between the eyebrows, above the nasion. (Page 4)
- Antibiotic prophylaxis is usually used to reduce the incidence of wound infection. Antibiotics are less likely to be effective in preventing the establishment of infection in the CSF pathways, in part because of the limited CSF penetration of many antibiotics. (Page 6)
- Ventriculo-peritoneal (VP) shunt insertion can be performed as an emergency or an elective procedure. The duration of surgery varies, typically between 45 min and up to 2 h. (Page 6)
- When the distal catheter is being passed, this can be a particularly stimulating part of the procedure for the anaesthetised patient. Postoperative pain after shunting procedures is usually mild-to-moderate. Usually, paracetamol and COX-2 inhibitors are sufficient, with oral opioids for breakthrough pain, usually required for no more than the first 72 h. (Page 6)
- Questions are often raised when a patient with a peritoneal shunt is to undergo laparoscopic surgery.17 One concern is regarding whether or not the shunt system might fail under the pressure of the pneumoperitoneum. Good practice is observation by the surgeon of continuous CSF flow from the distal end of the catheter at the start, during, and at the end of the procedure. Minimising the duration and the pressure of pneumoperitoneum are also suggested. (Page 6)
Perioperative Management of Hydrocephalus
- Author: H. Krovvidi
- Full Title: Perioperative Management of Hydrocephalus
- Category: #books
Highlights
- The total adult CSF volume is around 150 ml, distributed between the cranial and spinal subarachnoid channels (125 ml) with a smaller, albeit variable volume in the ventricles (average 25 ml). Most CSF is produced in the ependymal cells of the choroid plexus, whilst a small proportion is formed around the cerebral vessels from brain interstitial fluid. The formation of CSF is independent of the cerebral perfusion pressure and intracranial pressure (ICP), up to the point where ICP is increased to such a degree that CSF production is compromised. (Page 1)
- The rate of absorption is largely driven by the ICP, with resistance to CSF outflow provided by the arachnoid granulations and the intracranial venous sinus pressure. (Page 2)
- The height of the burette and scale are adjusted so that the ‘zero’ on the scale corresponds with the foramen of Monro. When the patient is supine, the external auditory meatus approximates to this point. When the patient is being nursed in the lateral position, the reference point lies between the eyebrows, above the nasion. (Page 4)
- Antibiotic prophylaxis is usually used to reduce the incidence of wound infection. Antibiotics are less likely to be effective in preventing the establishment of infection in the CSF pathways, in part because of the limited CSF penetration of many antibiotics. (Page 6)
- Ventriculo-peritoneal (VP) shunt insertion can be performed as an emergency or an elective procedure. The duration of surgery varies, typically between 45 min and up to 2 h. (Page 6)
- When the distal catheter is being passed, this can be a particularly stimulating part of the procedure for the anaesthetised patient. Postoperative pain after shunting procedures is usually mild-to-moderate. Usually, paracetamol and COX-2 inhibitors are sufficient, with oral opioids for breakthrough pain, usually required for no more than the first 72 h. (Page 6)
- Questions are often raised when a patient with a peritoneal shunt is to undergo laparoscopic surgery.17 One concern is regarding whether or not the shunt system might fail under the pressure of the pneumoperitoneum. Good practice is observation by the surgeon of continuous CSF flow from the distal end of the catheter at the start, during, and at the end of the procedure. Minimising the duration and the pressure of pneumoperitoneum are also suggested. (Page 6)