Department of Anesthesiology, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis. Sophias Ave., 11528 Athens, Greece.
J Clin Monit Comput. 2012 Dec;26(6):487-9. doi: 10.1007/s10877-012-9380-y. Epub 2012 Jul 11.
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.
腹腔镜手术可能会导致气腹引起颅内压（ICP）升高，对于脑室腹腔分流术（VPS）患者尤其如此。由于可能出现并发症，因此通常不使用侵入性的分流压监测技术。经颅多普勒（TCD）是一种非侵入性、安全的方法，可提供关于大脑基底动脉血流速度的准确信息，并间接提供 ICP 的信息。此外，它价格低廉且使用简便。我们报告了在接受腹腔镜手术的 VPS 患者中使用 TCD 监测大脑中动脉血流速度的情况。在我们报告的病例中，在 60 分钟的气腹过程中，TCD 显示脉动指数持续但无临床意义的升高，记录到的最大变化为 31%。我们认为，在存在 VPS 的患者中使用 TCD 可能会提高腹腔镜手术的安全性。
