REGIONAL ANESTHESIA IN CHILDREN

Christya Lorena G*; Arie Utariani**

* Resident, Department of Anesthesiology and Reanimation, Faculty of Medicine Airlangga University,

Dr. Soetomo Hospital Surabaya, Indonesia
** Intensivist Consultant, Department of Anesthesiology and Reanimation, Faculty of Medicine
Airlangga University, Dr. Soetomo Hospital Surabaya, Indonesia

BACKGROUND

Tracheostomy is a surgical procedure opening the anterior wall of the trachea allowing
mechanical ventilation through a tracheostomy tube. Early tracheostomy needs to be
considered if the use of a ventilator is expected to be used for a long time. Early
Tracheostomy is recommended because it can improve respiratory function, reduce the risk
of nosocomial infections (Ventilator Associated Pneumonia/VAP), improve patient comfort,
cleanse secretions in the throat, reduce laryngeal ulceration, improve mobilization and speech
efforts, and allow treatment outside the Intensive Care Unit (ICU).

CASE REPORT

We report a case of regional anesthesia in children

An. Guruh, 16 y.o man with lupus nefritis, Chronic Kidney Disease stage 5, and infected
CAPD with comorbid cardiomyophaty dilatation.

In these four cases, an early tracheostomy was performed ( 4 days) with consideration of the
initial critical GCS, the location of the lesion, and mechanical ventilation is expected to be
used for a long period of time. During treatment there is no VAP which is evidenced by a
culture examination.

DISCUSSION

Based on a meta-analysis study early tracheostomy ( 4 days) can reduce mortality due to
VAP by up to 50% and reduce the length of stay in ICU compared to delayed/late
tracheostomy (> 10 days) or prolonged intubation (> 14 days). Early tracheostomy is
performed on Critically Ill patients who are expected to use long-term mechanical ventilation
or Prolonged mechanical ventilation. VAP prevention efforts are carried out by applying
VAP Bundle.

CONCLUSION

Early tracheostomy provides more benefits than prolonged intubation or delayed/late

tracheostomy. VAP Bundle is performed on every patient who uses a ventilator, and it can be
proven scientifically that the application of VAP Bundle can reduce the incidence of VAP by
up to 25%.

References
1. Maclntyre NR, Epstein SK, Carson S, et al. Management of patients requiring prolonged mechanical ventilation: report of A
NAMDRC consensus conference. Chest 2015; 128:3937.
2. Ahmed N, Kuo YH, et al. Early versus late tracheostomy in patients with severe head injury. Available at pubmed.gov.com
3. Boyer AF, Schoenberg N, Babcock H, et al. A prospective evaluation of ventilator-associated conditions and infection-related
ventilator-associated conditions. Chest 2015; 147:68.
4. Institute for health care improvement. Implement the Ventilator bundle. Available at http//www.ihi.org/IHI/Topics/crit
care/intensive care/changes/implement the ventilator bundle.htm
5. Rello J, Diaz E. Pneumonia in the intensive care unit. Crit Care 2. Med 2013; 31:2544