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  • Print publication year: 2011
  • Online publication date: May 2011

Case 72 - Neurologiccomplications following cardiothoracic surgery

from Section I - Neuroanesthesia


A ventriculoperitoneal (VP) shunt, a series of catheters with a unidirectional valve to divert cerebrospinal fluid (CSF) from the brain by draining it into the peritoneum, may be implanted from birth onwards as a definitive surgical correction for hydrocephalus. This chapter presents a case study of a 15-month-old female with a history significant for stenosis of the aqueduct of Sylvius, epilepsy, and VP shunt placement as an infant, presented to the emergency department for evaluation. Endotracheal intubation via direct laryngoscopy was confirmed and general anesthesia was maintained with intravenous anesthesia and intermittent opioids. Communicating hydrocephalus means that CSF can still flow between ventricles but flow is blocked as it exits the ventricles. The obtunded child with acute hydrocephalus requires careful preoperative assessment and monitoring in order to formulate an appropriate anesthetic plan to avoid further rises in intracranial pressure (ICP).


1. G. W. Roach, M. Kanchuger, C. M. Mangano et al. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med 1996; 335: 1857–63.
2. G. Djaiani, M. Ali, M. A. Borger et al. Epiaortic scanning modifies planned intraoperative surgical management but not cerebral embolic load during coronary artery bypass surgery. Anesth Analg 2008; 106: 1611–18.
3. T. M. Fleck, M. Czerny, D. Hutschala et al. The incidence of transient neurologic dysfunction after ascending aortic replacement with circulatory arrest. Ann Thorac Surg 2003; 76: 1198–202.
4. E. Apostolakis, E. N. Koletsis, F. Dedeilias et al. Antegrade versus retrograde cerebral perfusion in relation to postoperative complications following aortic arch surgery for acute aortic dissection type A. J Card Surg 2008; 23: 480–7.
5. A. Zierer, M. R. Moon, S. J. Melby et al. Impact of perfusion strategy on neurologic recovery in acute type A aortic dissection. Ann Thorac Surg 2007; 83: 2122–8.
6. A. M. Grigore, C. F. Murray, F. Ramakrishna et al. A core review of temperature regimens and neuroprotection during cardiopulmonary bypass: does rewarming rate matter? Anesth Analg 2009; 109: 1741–51.
7. A. K. Lipshutz, M. A. Gropper. Perioperative glycemic control: an evidence-based review. Anesthesiology 2009; 110: 408–21.
8. M. C. Taillefer, A. Y. Denault. Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy. Can J Anaesth 2005; 52: 79–87.