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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).