An audit of the perioperative anaesthetic management of ventriculoperitoneal shunt insertion in the paediatric population at Inkosi Albert Luthuli Central Hospital

Abstract

Objective: Our study included an assessment of current anaesthetic practice in paediatric ventriculoperitoneal shunt insertion (VPSI), a review of shunt revision and complication rates, an evaluation of the incidence of congenital syndromes, retroviral disease and tuberculosis meningitis, and differentiation with regard to the age groups in which shunt surgery most commonly occurs.
Method: This is was a retrospective audit study. We reviewed information obtained from the computerised database on children from birth to 18 years of age undergoing VPSI at Inkosi Albert Luthuli Central Hospital from 1 September 2012 to 1 September 2013.
Results: One hundred and ten children were included in the study. Arnold-Chiari II and Dandy-Walker syndrome were associated with 8 (7.3%) and 9 (8.2%) of the children, respectively. Tuberculosis meningitis was documented in 21 (19.1%) of the cases. The majority of the anaesthetic techniques included a volatile induction and maintenance of anaesthesia (VIMA) approach, with opioid-sparing practice. Laryngoscopy was not difficult and most of the children were extubated. Half of the shunt insertions were performed in infancy. One fourth of the children required shunt revisions within three months, and these were mostly blocked shunts.
Conclusion: The anaesthetist needs to be cognisant of differences in the anatomy and physiology in these patients, and to have an awareness of associated syndromes and co- morbidities. A VIMA approach seems to be appropriate and the anaesthetist must be prepared to manage the infant age group, together with complications that result in revision surgery.

Keywords: hydrocephalus, paediatric, anaesthesia, ventriculoperitoneal shunt, congenital syndromes, shunt revision