Intraoperative monitoring during VP shunt surgery goes significantly beyond what is standard for routine procedures. Because the brain is already under elevated pressure and the surgical environment can produce rapid changes in physiological parameters, continuous real-time monitoring is essential throughout the case. At Sparsh Hospital, Hennur, Bengaluru, the neuroanaesthesia team uses a comprehensive monitoring approach for every VP shunt procedure.
Invasive arterial line: A catheter placed in a peripheral artery provides continuous beat-to-beat blood pressure monitoring, which is essential because even brief drops in arterial pressure can reduce cerebral perfusion pressure to dangerous levels in a brain with elevated intracranial pressure. The arterial line also allows immediate blood sampling for gases and electrolytes
End-tidal carbon dioxide (EtCO2): Carbon dioxide is the most potent physiological regulator of cerebral blood flow. Monitoring EtCO2 continuously allows controlled ventilation to be precisely targeted maintaining the CO2 level that optimises cerebral perfusion without causing vasodilation-related pressure rise or ischaemia
Oxygen saturation (SpO2): Continuous pulse oximetry monitors systemic oxygenation throughout the procedure
Cerebral near-infrared spectroscopy (NIRS): In selected cases, cerebral oximetry sensors placed on the forehead provide a non-invasive estimate of regional cerebral oxygen saturation, adding an additional layer of protection against undetected cerebral hypoperfusion
Temperature monitoring: Particularly important in neonates and infants, where heat loss is rapid and hypothermia impairs coagulation
The anaesthetic record generated during every VP shunt case at Sparsh Hospital is a continuous log of all these parameters, allowing the team to identify and respond to any concerning trend immediately rather than retrospectively. This is what neuroanaesthesia monitoring means in practice.
Written by Dr Deepa Chandran, MBBS (M S Ramaiah Medical College, Bengaluru), DA (Bangalore Medical College), DNB Anaesthesia (Bangalore Baptist Hospital), Fellowship in Ultrasound Guided Regional Anaesthesia (Jubilee Mission Hospital), Fellowship in Pain and Palliative Care, Consultant Neuroanaesthesiologist and Critical Care Specialist, Sparsh Hospital, HBR Layout, Hennur Road, Bengaluru 560043. Phone: 9686911560.
