The anaesthetic and perioperative management of the patient undergoing insertion of a peritoneo-venous shunt.

The infusion of ascitic fluid from the peritoneal cavity into the central venous circulation may relieve massive intractible ascites, and improve renal function when hepatorenal syndrome is present. preoperative preparation of these patients includes investigation of hepatic, renal, pulmonary, cardiac and neurological function, correction of electrolyte and coagulation abnormalities, restoration of normal fluid balance and the provision of supplemental vitamins and calories. Premedication is achieved with an oral benzodiazepine or an intramuscular injection of a narcotic agent. General anaesthesia is provided by thiopentone, suxamethonium, nitrous oxide, oxygen, pancuronium and a narcotic, with intermittent positive pressure ventilation. Close monitoring of cardiac, respiratory and renal function is imperative perioperatively. Postoperatively, supervision in an Intensive Care Unit is advised as complications such as cardiac failure, septicaemia and disseminated intravascular coagulation may occur.