Case 70 - Permissivehypertension in a patient with von Willebrand's disease and a preexisting ventriculoperitoneal shunt

Summary

Hypertension is not usually considered acceptable in patients with abnormal coagulation, including von Willebrand's disease. This chapter presents a case study of a 56-year-old male reporting a remote history of stroke with residual left-sided weakness, prior radiation therapy of a pontine brain tumor, ventriculoperitoneal (VP) shunt. Transfusion of platelets became necessary to control excessive and persistent bleeding from the prostate bed. After completion of surgery the patient was permitted to awaken from anesthesia and to be tracheally extubated after exhibiting the ability to sustain head lift and follow commands. It is most important to consider this entire range of possible complications and management options in VP shunt patients undergoing laparoscopic procedures, which require coordination, advanced planning, and continued close cooperation between the surgical and anesthesia teams if potentially serious adverse sequelae are to be averted.