Transcranial Doppler monitoring of middle cerebral flow velocity in a patient with a ventriculoperitoneal shunt undergoing laparoscopy

• Published in: Journal of clinical monitoring and computing Vol. 26; no. 6; pp. 487 - 489
• Main Authors: Staikou, C., Tsaroucha, A., Mani, A., Fassoulaki, A.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.12.2012; Springer Nature B.V
• Subjects: Adult; Anesthesiology; Blood Flow Velocity; Brief Report; Cerebrovascular Circulation; Critical Care Medicine; Female; Health Sciences; Humans; Intensive; Intracranial Pressure; Laparoscopy; Medicine; Medicine & Public Health; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - physiopathology; Monitoring, Intraoperative; Statistics for Life Sciences; Ultrasonography, Doppler, Transcranial; Ventriculoperitoneal Shunt; Laparoscopic surgery; Ventriculoperitoneal shunts; Intracranial pressure; Pneumoperitoneum; Transcranial Doppler
• ISSN: 1387-1307; 1573-2614
• DOI: 10.1007/s10877-012-9380-y

Laparoscopic surgery is possibly associated with a risk of intracranial pressure (ICP) increase due to pneumoperitoneum in patients with ventriculoperitoneal shunts (VPS). Invasive techniques for shunt pressure monitoring are not routinely used because of the possible complications. Transcranial Doppler (TCD) is a non-invasive, safe method which gives accurate information about blood-flow velocities in basal cerebral arteries and indirectly about the ICP. Moreover it is inexpensive and simple in use. We report the use of TCD for middle cerebral flow velocity monitoring in a patient with a VPS who underwent laparoscopic surgery. In the case we present, during 60 min of pneumoperitoneum, TCD showed a sustained, but not clinically significant increase of the Pulsatility Index, with a recorded maximum change of 31 %. We consider that the use of TCD may increase the safety of laparoscopic procedures in patients with preexisting VPS.