VP Shunt and Pneumoperitoneum — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNeuroanaesthesiaVP Shunt and PneumoperitoneumFRCA Final

A 30-year-old woman (ASA I, 65 kg) with idiopathic intracranial hypertension (IIH) and a VP shunt is listed for laparoscopic cholecystectomy. Which specific concern relates to the pneumoperitoneum?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Increased ICP from pneumoperitoneum-mediated reduction in CSF drainage through the shunt

Pneumoperitoneum increases intra-abdominal pressure, which can impair CSF drainage through a VP shunt (the distal catheter terminates in the peritoneal cavity). This may cause raised ICP with headache, nausea, visual disturbance, and in severe cases brainstem herniation. Intra-abdominal pressures should be kept as low as feasible (<12 mmHg if possible). The shunt should be checked pre-operatively. Post-operative monitoring for signs of raised ICP is essential. Some neurosurgeons recommend converting to a programmable shunt or ventriculoatrial shunt for patients requiring frequent abdominal procedures.

Reference: RCOA – 2023 – Neuroanaesthesia module; Association of Anaesthetists – 2020 – VP shunts and surgery